The risk of multiple sclerosis developing in patients with isolated idiopathic optic neuritis in Brazil

Lana-Peixoto, Marco Aurélio; Lana-Peixoto, Maria Inês Vilhena

doi:10.1590/S0004-282X1991000400002

Abstracts

We studied 88 patients with isolated idiopathic optic neuritis (IION) in order to evaluate the rate of progression to multiple sclerosis (MS) in Brazil. The patients were reassessed from one month to nine years after the development of the HON (mean follow-up was 4.6 years). There were 52 men and 36 women with ages ranging from three to 59 years (mean 24.3 years). Bilateral optic neuritis occurred in 19 patients whereas sequential involvement of the fellow eye after an interval longer than four weeks occurred in other 19 patients. Recurrences in the same eye occurred in seven cases. Nine patients (10.8%) developed clinically definitive MS - 13.9% of the women and 7.7% of the men with IION. The median age at the time of diagnosis of MS was 25 years. The mean interval between HON and the emergence of other MS signs varied from one month to five years - median one year. Sixty-seven percent of these, patients developed signs of spinal cord involvement. Our findings when compared to published series in different countries are closer to figures reported in Japan than those in the West.

O risco de progressão da neurite óptica idiopática isolada (NOH) para esclerose múltipla (EM) ainda não está bem definido, com taxas variáveis dependendo de critérios de diagnóstico, tempo de follow-up, fatores genéticos, raciais e, possivelmente geográficos. Com o propósito de estudar a taxa de desenvolvimento de EM em pacientes com NOIÍ, um grupo de 88 pacientes (52 homens e 36 mulheres) com NOII foi seguido por período de 1 mês a 9 anos (média 4,6 anos). Em 19 pacientes a neurite óptica foi bilateral, ou seja, ocorreu simultaneamente ou em intervalo até 4 semanas nos dois olhos; enquanto em outros 19 pacientes ela foi seqüencial, afetando o olho contralateral após intervalo maior que um mês. Recorrências afetando o mesmo olho foram observadas em 7 pacientes. Nove pacientes (10,8%) com NOII desenvolveram sinais de EM entre 1 mês e 5 anos após o primeiro episódio de neurite óptica, o intervalo mediano sendo 1 ano. Estes pacientes representavam 13,9% das mulheres e 7,7% dos homens com NOII e a mediana das idades foi 25 anos. Dois terços dos pacientes que desenvolveram EM apresentaram envolvimento predominantemente medular. Nossos achados, em relação à taxa de progressão da NOII para EM assim como à predileção por envolvimento espinal, se assemelham mais aos dados publicados no Japão que em países ocidentais.

CONTENTS CONTEÚDO

Marco Aurélio Lana-Peixoto; Maria Inês Vilhena Lana-Peixoto

Associate Professor of Neurology, Department of Neurology, Federal University of Minas Gerais

SUMMARY

We studied 88 patients with isolated idiopathic optic neuritis (IION) in order to evaluate the rate of progression to multiple sclerosis (MS) in Brazil. The patients were reassessed from one month to nine years after the development of the HON (mean follow-up was 4.6 years). There were 52 men and 36 women with ages ranging from three to 59 years (mean 24.3 years). Bilateral optic neuritis occurred in 19 patients whereas sequential involvement of the fellow eye after an interval longer than four weeks occurred in other 19 patients. Recurrences in the same eye occurred in seven cases. Nine patients (10.8%) developed clinically definitive MS - 13.9% of the women and 7.7% of the men with IION. The median age at the time of diagnosis of MS was 25 years. The mean interval between HON and the emergence of other MS signs varied from one month to five years - median one year. Sixty-seven percent of these, patients developed signs of spinal cord involvement. Our findings when compared to published series in different countries are closer to figures reported in Japan than those in the West.

RESUMO

O risco de progressão da neurite óptica idiopática isolada (NOH) para esclerose múltipla (EM) ainda não está bem definido, com taxas variáveis dependendo de critérios de diagnóstico, tempo de follow-up, fatores genéticos, raciais e, possivelmente geográficos. Com o propósito de estudar a taxa de desenvolvimento de EM em pacientes com NOIÍ, um grupo de 88 pacientes (52 homens e 36 mulheres) com NOII foi seguido por período de 1 mês a 9 anos (média 4,6 anos). Em 19 pacientes a neurite óptica foi bilateral, ou seja, ocorreu simultaneamente ou em intervalo até 4 semanas nos dois olhos; enquanto em outros 19 pacientes ela foi seqüencial, afetando o olho contralateral após intervalo maior que um mês. Recorrências afetando o mesmo olho foram observadas em 7 pacientes. Nove pacientes (10,8%) com NOII desenvolveram sinais de EM entre 1 mês e 5 anos após o primeiro episódio de neurite óptica, o intervalo mediano sendo 1 ano. Estes pacientes representavam 13,9% das mulheres e 7,7% dos homens com NOII e a mediana das idades foi 25 anos. Dois terços dos pacientes que desenvolveram EM apresentaram envolvimento predominantemente medular. Nossos achados, em relação à taxa de progressão da NOII para EM assim como à predileção por envolvimento espinal, se assemelham mais aos dados publicados no Japão que em países ocidentais.

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Dr. M. A. Lana Peixoto - Institute Hilton Rocha - Av Anel da Serra 1335 - 30210 Belo Horizonte MG - Brasil.

1. Alter M, Good J, Okihiro M. Optic neuritis in Orientals and Caucasians. Neurology 1973, 23:631.
2. Alvarez G, Cárdenas M. Multiple sclerosis following optic neuritis in Chile. J Neurol Neurosurg Psichiat 1989, 52:115.
3. Anmarkrud N, Slettnes ON. Uncomplicated retrobulbar neuritis and the development of multiple sclerosis. Acta Ophthalmol 1989, 67:306.
4. Appen RE, Allen JC. Optic neuritis under 60 years of age. Ann Ophthalmol 1974, 6:143.
5. Baoxun Z, Xiuqin L, Yupu G, Yinchang Y, Huifen H. Multiple sclerosis: a clinical study of 70 cases. Chin Med J 1980, 93 : 260.
6. Bradley WR, Whitty CWM. Acute optic neuritis: its clinical features and their relation to prognosis for recovery of vision. J Neurol Neurosurg Psychiat 1968, 31:18.
7. Chopra JS, Radhakrishnan K, Sawhney BB, Pal SR, Banerjee AL. Multiple sclerosis in North West India. Acta Neurol Scand 1980, 62:312.
8. Cohen MM, Lessel S, Wolf PA. A prospective study of the risk of developing multiple sclerosis in uncomplicated optic neuritis. Neurology 1979, 29:208.
9. Compston DAS, Batchelar JR, Earl CJ, McDonald WI. Factors influencing the risk of multiple sclerosis developing in patients with optic neuritis. Brain 1978, 101:495.
10. DeLeersnyder H, Bursztyn J, Ponsot G, Dulac O, Arthuis M. Nevrites optiques de l'enfant: aspects cliniques et évolutifs à propos de 14 observations. Arch Fr Pediatr 1981, 38:563.
11. Feasby TE, Ebers GE. Risk of multiple sclerosis in isolated optic neuritis. Can J Neurol Sci 1982, 9:269.
12. Feinsod M, Hoyt WF. Subclinical optic neuropathy in multiple sclerosis: how early VER components reflect axon loss land conduction defects in optic pathways. J Neurol Neurosurg Psichiat 1975, 38:1109.
13. Francis DA, Composton DAS, Batchelor JR, McDonald WI. A ressessment of the risk of multiple sclerosis developing in patients with optic neuritis after extend follow-up. J Neurol Neurosurg Psichiat 1987, 50:758.
14. Halliday AM, McDonald WI, Mushin J. Visual evoked response in diagnosis of multiple sclerosis. Br J Med 1973, 4:661.
15. Hely MA, McManis PG, Doran TJ, Walsh JC, Mcleod JG. Acute optic neuritis: a prospective study of risk factors for multiple sclerosis. J Neurol Neurosurg Psichiat 1986, 49:1125.
16. Hutchinson WM. Acute optic neuritis and the prognosis for multiple sclerosis. J Neurol Neurosurg Psychiat 1976, 39:283.
17. Isayama Y, Takahashi T, Shimoyoma T, Yamadori A. Acute optic neuritis and multiple sclerosis. Neurology 1982, 32:73.
18. Kahana E, Alter M, Feldman S. Optic neuritis in relation to multiple sclerosis. J Neurol 1976, 213:87.
19. Kinnunen E. The incidence of optic neuritis and its prognosis for multiple sclerosis. Acta Neuroi Scand 1986, 68:371.
20. Kurland LT, Auth TL, Beebe GW, Kurtzke JF, Lessell S, Nagler B, Nefzger MD. Studies on the natural history of multiple sclerosis: II. Progression from optic neuropathy to multiple sclerosis. Trans Am Neurol Assoc 1963, 88:233.
21. Kurland LT, Beebe GW, Kurtzke JF, Nagler B, Auth TL, Lessell S, Nefzger MD. Studies on the natural history of multiple sclerosis: II. The progression of optic neuritis to multiple sclerosis. Acta Neurol Scand 1966, 42(suppl 19):157.
22. Kuroiwa Y, Hung TP, Landsborough D, Park CS, Singlall BS, Soemargo S, Vejajyiva A, Shibasaki H. Multiple sclerosis in Asia. Neurology 1977, 27:188.
23. Kuroiwa Y, Igata A, Itahara A, Koshijima S, Tsubaki T, Toyokura Y, Shibasaki H. Nationwide survey of multiple sclerosis in Japan: clinical analysis of 1084 cases. Neurology 1975, 25:845.
24. Kuroiwa Y, Shibasaki H. Multiple sclerosis: general view. Adv Neurol Sci (Tokyo) 1975, 19:5.
25. Kuroiwa Y, Shibasaki H, Inone N. Epidemiologic study of multiple sclerosis group in Japan. Adv Neurol Sci (Tokyo) 1970, 14:607.
26. Kurtzke JF. Optic neuritis or multiple sclerosis. Arch Neurol 1985, 42:704.
27. Kurtzke JF, Park CS, Oh SJ. Multiple sclerosis in Korea: clinical features and prevalence. J Neurol Sci 1968, 6:463.
28. Lana-Peixoto MA. Is multiple sclerosis in Brazil and Asia alike? In preparation.
29. Landy PJ. A prospective study of the risk of developing multiple sclerosis in optic neuritis in a tropical and subtropical area. J Neurol Neurosurg Psychiat 1983, 46:659.
30. Lumsden CE. The neuropathology of multiple sclerosis. In Vinken PJ, Bruyn GW (eds) : Handbook of Clinical Neurology. Amsterdam: North Holland, 1970, Vol 9, p 217-309.
31. Lyn BH. Retrobulbar neuritis: a survey of the present condition of cases occuring over the last fifty-six years. Trans Ophthalmol Soc UK 1959, 79:701.
32. Mapelli G, De Palma P, Fini M, Piavoni M, Franco P, Pirazzoli G. Retrobulbar optic neuritis as an initial sympton of multiple sclerosis: results of a prospective study. Riv Neurol 1985, 55:53.
33. McAlpine D, Lumsden CE, Acheson ED. Multiple sclerosis. A Reappraisal. Edinburgh: Livingstone, 1965.
34. McDonald WI - Doyne Lecture: The significance of optic neuritis. Trans Ophthalmol Soc UK 1983, 103:230.
35. Nair KR, Sahasranam KV. Multiple sclerosis in Malabar. J Ass Physicians India 1978, 26:893.
36. Nikoskelainen E, Frey H, Salmi A. Prognosis of optic neuritis with special reference to cerebrospinal fluid immunoglobulins and measles virus antibodies. Ann Neurol 1980, 9:545.
37. Nikoskelainen E, Riekkinen P. Optic neuritis: a sign of multiple sclerosis or other diseases of the nervous system. Acta Neurol Scand 1974, 50:590.
38. Nordmann JP, Saraux H, Roullet E. Contrast sensitivity: a study in 35 patients with and without optic neuritis. Ophthalmologica 1987, 195:199.
39. Parkin JP, Hierons R, McDonald WI. Bilateral optic neuritis: a logn-term follow-up. Brain 1984, 107:951.
40. Percy AK, Nobrega FT, Kurland LT. Optic neuritis and multiple sclerosis. Arch Ophthalmol 1972, 87:135.
41. Perkin GD, Rose FC. Optic Neuritis and its Differential Diagnosis. Oxford: Oxford Univ Press, 1979.
42. Poser CM, Patty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983, 13:227.
43. Regan D, Silver R, Murray TJ. Visual acuity and contrast sensitivity in multiple sclerosis: hidden visual loss, an auxiliary diagnostic test. Brain 1977, 100:563.
44. Rikonen R, Ketonen L, Sipponen J. Magnetic resonance imaging, evoked responses and cerebrospinal fluid findings in a follow-up study of children with optic neuritis. Acta Neurol Scand 1988, 77:44.
45. Rischbieth RHC. Retrobulbar neuritis in the state of South Australia. Proc Aust Assoc Neurol 1968, 5:573.
46. Rizzo JF, Lessel S. Risk of developing multiple sclerosis after uncomplicated optic neuritis. Neurology 1988, 38:185.
47. Rose FC. The aetiology of optic neuritis. Clin Sci 1970, 39:17P.
48. Sandberg-Wolheim M. Optic neuritis: studies on the cerebrospinal fluid in relation to clinical course in 61 patients. Acta Neurol Scand 1975, 52:167.
49. Sanders EACM, Van Lith GHM. Optic neuritis confirmed by visual evoked response and the risk for multiple sclerosis: a prospective survey. J Neurol Neurosurg Psichiat 1989, 52:799.
50. Shibasaki H. Kuroda Y, Iwashita H. Clinical studies of multiple sclerosis in Japan: multiple sclerosis starting with retrobulbar neuritis. J Neurol 1974, 208:17.
51. Shibasaki H, Kuroda Y, Kuroiwa Y. Clinical studies of multiple sclerosis in Japan: classical multiple sclerosis and Devic's disease. J Neurol Sci 1974, 23:215.
52. Stendahl-Brodin L, Link H. Optic neuritis: oligoclonal bands increase the risk of multiple sclerosis. Acta Neurol Scand 1983, 67:301.
53. Stendahl-Brodin L, Link H, Möller E, Noorby E. Optic neuritis and the distribution of genetic markers of the HLA system. Acta Neurol Scand 1978, 57:418.
54. Taub RG, Rucker CW. The relationship of retrobulbar neuritis to multiple sclerosis. Am J Ophthalmol 1954, 32:488.

The risk of multiple sclerosis developing in patients with isolated idiopathic optic neuritis in Brazil

Risco de desenvolvimento de esclerose múltipla em pacientes com neurite óptica idiopática isolada no Brasil.

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
Dec 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alter M, Good J, Okihiro M. Optic neuritis in Orientals and Caucasians. Neurology 1973, 23:631.

[2] 2. Alvarez G, Cárdenas M. Multiple sclerosis following optic neuritis in Chile. J Neurol Neurosurg Psichiat 1989, 52:115.

[3] 3. Anmarkrud N, Slettnes ON. Uncomplicated retrobulbar neuritis and the development of multiple sclerosis. Acta Ophthalmol 1989, 67:306.

[4] 4. Appen RE, Allen JC. Optic neuritis under 60 years of age. Ann Ophthalmol 1974, 6:143.

[5] 5. Baoxun Z, Xiuqin L, Yupu G, Yinchang Y, Huifen H. Multiple sclerosis: a clinical study of 70 cases. Chin Med J 1980, 93 : 260.

[6] 6. Bradley WR, Whitty CWM. Acute optic neuritis: its clinical features and their relation to prognosis for recovery of vision. J Neurol Neurosurg Psychiat 1968, 31:18.

[7] 7. Chopra JS, Radhakrishnan K, Sawhney BB, Pal SR, Banerjee AL. Multiple sclerosis in North West India. Acta Neurol Scand 1980, 62:312.

[8] 8. Cohen MM, Lessel S, Wolf PA. A prospective study of the risk of developing multiple sclerosis in uncomplicated optic neuritis. Neurology 1979, 29:208.

[9] 9. Compston DAS, Batchelar JR, Earl CJ, McDonald WI. Factors influencing the risk of multiple sclerosis developing in patients with optic neuritis. Brain 1978, 101:495.

[10] 10. DeLeersnyder H, Bursztyn J, Ponsot G, Dulac O, Arthuis M. Nevrites optiques de l'enfant: aspects cliniques et évolutifs à propos de 14 observations. Arch Fr Pediatr 1981, 38:563.

[11] 11. Feasby TE, Ebers GE. Risk of multiple sclerosis in isolated optic neuritis. Can J Neurol Sci 1982, 9:269.

[12] 12. Feinsod M, Hoyt WF. Subclinical optic neuropathy in multiple sclerosis: how early VER components reflect axon loss land conduction defects in optic pathways. J Neurol Neurosurg Psichiat 1975, 38:1109.

[13] 13. Francis DA, Composton DAS, Batchelor JR, McDonald WI. A ressessment of the risk of multiple sclerosis developing in patients with optic neuritis after extend follow-up. J Neurol Neurosurg Psichiat 1987, 50:758.

[14] 14. Halliday AM, McDonald WI, Mushin J. Visual evoked response in diagnosis of multiple sclerosis. Br J Med 1973, 4:661.

[15] 15. Hely MA, McManis PG, Doran TJ, Walsh JC, Mcleod JG. Acute optic neuritis: a prospective study of risk factors for multiple sclerosis. J Neurol Neurosurg Psichiat 1986, 49:1125.

[16] 16. Hutchinson WM. Acute optic neuritis and the prognosis for multiple sclerosis. J Neurol Neurosurg Psychiat 1976, 39:283.

[17] 17. Isayama Y, Takahashi T, Shimoyoma T, Yamadori A. Acute optic neuritis and multiple sclerosis. Neurology 1982, 32:73.

[18] 18. Kahana E, Alter M, Feldman S. Optic neuritis in relation to multiple sclerosis. J Neurol 1976, 213:87.

[19] 19. Kinnunen E. The incidence of optic neuritis and its prognosis for multiple sclerosis. Acta Neuroi Scand 1986, 68:371.

[20] 20. Kurland LT, Auth TL, Beebe GW, Kurtzke JF, Lessell S, Nagler B, Nefzger MD. Studies on the natural history of multiple sclerosis: II. Progression from optic neuropathy to multiple sclerosis. Trans Am Neurol Assoc 1963, 88:233.

[21] 21. Kurland LT, Beebe GW, Kurtzke JF, Nagler B, Auth TL, Lessell S, Nefzger MD. Studies on the natural history of multiple sclerosis: II. The progression of optic neuritis to multiple sclerosis. Acta Neurol Scand 1966, 42(suppl 19):157.

[22] 22. Kuroiwa Y, Hung TP, Landsborough D, Park CS, Singlall BS, Soemargo S, Vejajyiva A, Shibasaki H. Multiple sclerosis in Asia. Neurology 1977, 27:188.

[23] 23. Kuroiwa Y, Igata A, Itahara A, Koshijima S, Tsubaki T, Toyokura Y, Shibasaki H. Nationwide survey of multiple sclerosis in Japan: clinical analysis of 1084 cases. Neurology 1975, 25:845.

[24] 24. Kuroiwa Y, Shibasaki H. Multiple sclerosis: general view. Adv Neurol Sci (Tokyo) 1975, 19:5.

[25] 25. Kuroiwa Y, Shibasaki H, Inone N. Epidemiologic study of multiple sclerosis group in Japan. Adv Neurol Sci (Tokyo) 1970, 14:607.

[26] 26. Kurtzke JF. Optic neuritis or multiple sclerosis. Arch Neurol 1985, 42:704.

[27] 27. Kurtzke JF, Park CS, Oh SJ. Multiple sclerosis in Korea: clinical features and prevalence. J Neurol Sci 1968, 6:463.

[28] 28. Lana-Peixoto MA. Is multiple sclerosis in Brazil and Asia alike? In preparation.

[29] 29. Landy PJ. A prospective study of the risk of developing multiple sclerosis in optic neuritis in a tropical and subtropical area. J Neurol Neurosurg Psychiat 1983, 46:659.

[30] 30. Lumsden CE. The neuropathology of multiple sclerosis. In Vinken PJ, Bruyn GW (eds) : Handbook of Clinical Neurology. Amsterdam: North Holland, 1970, Vol 9, p 217-309.

[31] 31. Lyn BH. Retrobulbar neuritis: a survey of the present condition of cases occuring over the last fifty-six years. Trans Ophthalmol Soc UK 1959, 79:701.

[32] 32. Mapelli G, De Palma P, Fini M, Piavoni M, Franco P, Pirazzoli G. Retrobulbar optic neuritis as an initial sympton of multiple sclerosis: results of a prospective study. Riv Neurol 1985, 55:53.

[33] 33. McAlpine D, Lumsden CE, Acheson ED. Multiple sclerosis. A Reappraisal. Edinburgh: Livingstone, 1965.

[34] 34. McDonald WI - Doyne Lecture: The significance of optic neuritis. Trans Ophthalmol Soc UK 1983, 103:230.

[35] 35. Nair KR, Sahasranam KV. Multiple sclerosis in Malabar. J Ass Physicians India 1978, 26:893.

[36] 36. Nikoskelainen E, Frey H, Salmi A. Prognosis of optic neuritis with special reference to cerebrospinal fluid immunoglobulins and measles virus antibodies. Ann Neurol 1980, 9:545.

[37] 37. Nikoskelainen E, Riekkinen P. Optic neuritis: a sign of multiple sclerosis or other diseases of the nervous system. Acta Neurol Scand 1974, 50:590.

[38] 38. Nordmann JP, Saraux H, Roullet E. Contrast sensitivity: a study in 35 patients with and without optic neuritis. Ophthalmologica 1987, 195:199.

[39] 39. Parkin JP, Hierons R, McDonald WI. Bilateral optic neuritis: a logn-term follow-up. Brain 1984, 107:951.

[40] 40. Percy AK, Nobrega FT, Kurland LT. Optic neuritis and multiple sclerosis. Arch Ophthalmol 1972, 87:135.

[41] 41. Perkin GD, Rose FC. Optic Neuritis and its Differential Diagnosis. Oxford: Oxford Univ Press, 1979.

[42] 42. Poser CM, Patty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983, 13:227.

[43] 43. Regan D, Silver R, Murray TJ. Visual acuity and contrast sensitivity in multiple sclerosis: hidden visual loss, an auxiliary diagnostic test. Brain 1977, 100:563.

[44] 44. Rikonen R, Ketonen L, Sipponen J. Magnetic resonance imaging, evoked responses and cerebrospinal fluid findings in a follow-up study of children with optic neuritis. Acta Neurol Scand 1988, 77:44.

[45] 45. Rischbieth RHC. Retrobulbar neuritis in the state of South Australia. Proc Aust Assoc Neurol 1968, 5:573.

[46] 46. Rizzo JF, Lessel S. Risk of developing multiple sclerosis after uncomplicated optic neuritis. Neurology 1988, 38:185.

[47] 47. Rose FC. The aetiology of optic neuritis. Clin Sci 1970, 39:17P.

[48] 48. Sandberg-Wolheim M. Optic neuritis: studies on the cerebrospinal fluid in relation to clinical course in 61 patients. Acta Neurol Scand 1975, 52:167.

[49] 49. Sanders EACM, Van Lith GHM. Optic neuritis confirmed by visual evoked response and the risk for multiple sclerosis: a prospective survey. J Neurol Neurosurg Psichiat 1989, 52:799.

[50] 50. Shibasaki H. Kuroda Y, Iwashita H. Clinical studies of multiple sclerosis in Japan: multiple sclerosis starting with retrobulbar neuritis. J Neurol 1974, 208:17.

[51] 51. Shibasaki H, Kuroda Y, Kuroiwa Y. Clinical studies of multiple sclerosis in Japan: classical multiple sclerosis and Devic's disease. J Neurol Sci 1974, 23:215.

[52] 52. Stendahl-Brodin L, Link H. Optic neuritis: oligoclonal bands increase the risk of multiple sclerosis. Acta Neurol Scand 1983, 67:301.

[53] 53. Stendahl-Brodin L, Link H, Möller E, Noorby E. Optic neuritis and the distribution of genetic markers of the HLA system. Acta Neurol Scand 1978, 57:418.

[54] 54. Taub RG, Rucker CW. The relationship of retrobulbar neuritis to multiple sclerosis. Am J Ophthalmol 1954, 32:488.