Optic Neuritis, MS Differentials, and Modern Treatment Pathways

In this episode of MD Newsline, Dr. Nilüfer Kale, Head of the Department of Neurology at Başakşehir Çam and Sakura City Hospital in Istanbul, Turkey, provides an in-depth look into optic neuritis, multiple sclerosis (MS), and related demyelinating disorders. She discusses the pathophysiology, diagnostic challenges, and treatment evolution of these conditions—offering valuable insights for clinicians managing autoimmune neuroinflammatory diseases.

Dr. Kale also highlights the importance of accurate differential diagnosis, the role of neuroimaging and biomarkers, and how advancements in remyelination research are shaping the future of MS treatment.

Episode Highlights

Epidemiology and Patient Demographics
Dr. Kale explains that autoimmune neurological disorders such as MS and optic neuritis predominantly affect young women in their childbearing years. She attributes this trend to the interplay of hormonal, genetic, and environmental factors, including vitamin D deficiency, Epstein–Barr virus exposure, and obesity.

Pathophysiology of MS and Optic Neuritis
She provides a detailed overview of how immune system activation, particularly involving T cells, B cells, and cytokines, leads to demyelination and subsequent neurodegeneration. While early disease stages may allow remyelination, progressive degeneration contributes to long-term disability.

Diagnosis and Differential Considerations
Dr. Kale emphasizes that early and accurate diagnosis is critical to preventing irreversible damage.
Conditions such as neuromyelitis optica (NMO) and MOG antibody disease (MOGAD) can mimic MS, underscoring the need for MRI imaging, CSF analysis, and antibody testing to guide correct classification and treatment.

Clinical Presentation and Early Detection
Optic neuritis often presents with eye pain, color desaturation, and central vision loss. Dr. Kale notes that orbital and cranial MRI scans with contrast are essential for confirming inflammation and ruling out other causes such as ischemic optic neuropathy or ophthalmologic conditions.

Treatment Strategies and Advances
Standard management involves high-dose intravenous corticosteroids to accelerate visual recovery and delay MS onset, as shown in the Optic Neuritis Treatment Trial (ONTT).
For severe or atypical cases, Dr. Kale recommends plasmapheresis or IV immunoglobulin (IVIG) therapy. She stresses tailoring therapy to the individual patient, noting that treatment protocols for MS, NMO, and MOGAD differ significantly.

Evolving Therapies and Global Access
Dr. Kale reflects on the progress from early interferon-based therapies to modern monoclonal antibody treatments, highlighting how health policy and access continue to affect patient outcomes worldwide.

Emerging Research and Biomarkers
Advances in PET imaging and astrocyte-targeted ligands show promise for identifying chronic lesions and smoldering plaques, which could pave the way for future remyelination-focused treatments.

Patient-Centered Care and Gender Considerations
Beyond science, Dr. Kale underscores the emotional and social burden faced by women living with MS—balancing family responsibilities, work, and health. She advocates for stronger patient networks and social support systems to improve quality of life.

Key Takeaway
Dr. Kale emphasizes that timely diagnosis, personalized therapy, and advances in neuroimaging and immunology are transforming MS and optic neuritis care. She calls for continued collaboration between clinicians, researchers, and policymakers to ensure equitable access to modern treatments and better long-term outcomes for patients.

Resources

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