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Research Article| Volume 312, ISSUE 1-2, P21-25, January 15, 2012

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Optic neuritis in an ethnically diverse population: Higher risk of atypical cases in patients of African or African-Caribbean heritage

Published:September 19, 2011DOI:https://doi.org/10.1016/j.jns.2011.08.030

      Abstract

      Purpose

      To investigate the presence of an ethnicity bias within patients presenting with optic neuritis in London.

      Design

      Observational cross-sectional study.

      Methods

      The ethnicity profile of all patients attending a neuro-ophthalmology clinic in central London with acute optic neuritis over a 16 month period (n=86) was studied. A comparison was made with the ethnicity profile of the population of London as well as patients with Multiple Sclerosis-associated optic neuritis (n=41), Neuromyelitis Optica spectrum disorder-associated optic neuritis (n=27) and patients with an atypical corticosteroid-dependent optic neuropathy (21).

      Results

      The ethnicity profile of the patient cohort presenting to our clinic with acute optic neuritis over a 16 month period closely matched the ethnicity profile of London (P=0.08). Within this cohort, patients of African or African-Caribbean heritage were found to be more likely to manifest either a pattern or aetiology of optic neuritis requiring immunosuppressive treatment in comparison with patients of a white Caucasian background (relative risk 3.47; 95% CI=1.092 to 11.007). There was a disproportionately high representation of patients from an African or African-Caribbean background within the Neuromyelitis Optica spectrum-related optic neuritis diagnostic group (P<0.00).

      Conclusions

      Patients with acute isolated optic neuritis from African or African Caribbean backgrounds are over 3 times more likely than patients of white Caucasian backgrounds to have an ‘atypical’ pattern of optic neuritis where corticosteroid therapy may be required. Our results suggest that a patient's ethnic background is an important factor to be taken into consideration when deciding on the diagnosis and management of acute isolated optic neuritis.

      Keywords

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      References

        • Bhigjee A.I.
        • Moodley K.
        • Ramkissoon K.
        Multiple sclerosis in KwaZulu Natal, South Africa: an epidemiological and clinical study.
        Mult Scler. Nov 2007; 13: 1095-1099
        • Zelnik N.
        • Gale A.D.
        • Shelburne Jr., S.A.
        Multiple sclerosis in black children.
        J Child Neurol. Jan 1991; 6: 53-57
        • Kira J.
        Neuromyelitis optica and opticospinal multiple sclerosis: mechanisms and pathogenesis.
        Pathophysiology. Feb 2011; 18: 69-79
        • Asgari N.
        • Lillevang S.T.
        • Skejoe H.P.
        • Falah M.
        • Stenager E.
        • Kyvik K.O.
        A population-based study of neuromyelitis optica in Caucasians.
        Neurology. May 3 2011; 76: 1589-1595
        • Cabre P.
        • Gonzalez-Quevedo A.
        • Lannuzel A.
        • Bonnan M.
        • Merle H.
        • Olindo S.
        • et al.
        Descriptive epidemiology of neuromyelitis optica in the Caribbean basin.
        Rev Neurol (Paris). Aug-Sep 2009; 165: 676-683
        • Cabrera-Gómez J.A.
        • Kurtzke J.F.
        • González-Quevedo A.
        • Lara-Rodríguez R.
        An epidemiological study of neuromyelitis optica in Cuba.
        J Neurol. Jan 2009; 256: 35-44
        • Wingerchuk D.M.
        • Lennon V.A.
        • Lucchinetti C.F.
        • Pittock S.J.
        • Weinshenker B.G.
        The spectrum of neuromyelitis optica.
        Lancet Neurol. 2007; 6: 805-815
      1. The 5-year risk of MS after optic neuritis. Experience of the optic neuritis treatment trial. Optic Neuritis Study Group.
        Neurology. Nov 1997; 49: 1404-1413
        • Lennon V.A.
        • Wingerchuk D.M.
        • Kryzer T.J.
        • Pittock S.J.
        • Lucchinetti C.F.
        • Fujihara K.
        • et al.
        A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis.
        Lancet. Dec 11–17 2004; 364: 2106-2112
        • Wingerchuk D.M.
        • Lennon V.A.
        • Pittock S.J.
        • Lucchinetti C.F.
        • Weinshenker B.G.
        Revised diagnostic criteria for neuromyelitis optica.
        Neurology. 2006; 66: 1485-1489
        • Nakamura M.
        • Nakazawa T.
        • Doi H.
        • Hariya T.
        • Omodaka K.
        • Misu T.
        • et al.
        Early high-dose intravenous methylprednisolone is effective in preserving retinal nerve fiber layer thickness in patients with neuromyelitis optica.
        Graefes Arch Clin Exp Ophthalmol. Dec 2010; 248: 1777-1785
      2. London: Resident population estimates by ethnic group. Office for National Statistics Neighbourhood Statistics. http://neighbourhood.statistics.gov.uk. Retrieved Aug 2009.

        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • Clanet M.
        • Cohen J.A.
        • Filippi M.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Ann Neurol. Feb 2011; 69: 292-302
        • Kupersmith M.J.
        • Burde R.M.
        • Warren F.A.
        • Klingele T.G.
        • Frohman L.P.
        • Mitnick H.
        Autoimmune optic neuropathy: evaluation and treatment.
        J Neurol Neurosurg Psychiatry. Nov 1988; 51: 1381-1386
      3. Erratum.
        in: J Neurol Neurosurg Psychiatry. 52(5). May 1989: 692
        • Kidd D.
        • Burton B.
        • Plant G.T.
        • Graham E.M.
        Chronic relapsing inflammatory optic neuropathy (CRION).
        Brain. Feb 2003; 126: 276-284
        • Waters P.
        • Jarius S.
        • Littleton E.
        • Leite M.I.
        • Jacob S.
        • Gray B.
        • et al.
        Aquaporin-4 antibodies in neuromyelitis optica and longitudinally extensive transverse myelitis.
        Arch Neurol. Jul 2008; 65: 913-919
        • Deschamps R.
        • Paturel L.
        • Jeannin S.
        • Chausson N.
        • Olindo S.
        • Béra O.
        • et al.
        Different HLA class II (DRB1 and DQB1) alleles determine either susceptibility or resistance to NMO and multiple sclerosis among the French Afro-Caribbean population.
        Mult Scler. Jan 2011; 17: 24-31
        • Petzold A.
        • Pittock S.
        • Lennon V.
        • Maggiore C.
        • Weinshenker B.G.
        • Plant G.T.
        Neuromyelitis optica-IgG (aquaporin-4) autoantibodies in immune mediated optic neuritis.
        J Neurol Neurosurg Psychiatry. Jan 2010; 81: 109-111
        • Rees P.
        • Butt F.
        Ethnic change and diversity in England, 1981–2001.
        Area. 2004; 36.2: 174-186
        • Phillips P.H.
        • Newman N.J.
        • Lynn M.J.
        Optic neuritis in African Americans.
        Arch Neurol. Feb 1998; 55: 186-192
        • Beck R.W.
        • Cleary P.A.
        Optic neuritis treatment trial. One-year follow-up results.
        Arch Ophthalmol. Jun 1993; 111: 773-775
        • Ghosh A.
        • Kelly S.P.
        • Mathews J.
        • Cooper P.N.
        • Macdermott N.
        Evaluation of the management of optic neuritis: audit on the neurological and ophthalmological practice in the north west of England.
        J Neurol Neurosurg Psychiatry. Jan 2002; 72: 119-121
        • Shimizu J.
        • Hatanaka Y.
        • Hasegawa M.
        • Iwata A.
        • Sugimoto I.
        • Date H.
        • et al.
        IFNβ-1b may severely exacerbate Japanese optic-spinal MS in neuromyelitis optica spectrum.
        Neurology. Oct 19 2010; 75: 1423-1427