Gå direkt till huvudinnehållet

Optikusneurit, ON

Senast reviderad:
Sakkunnig:
Definition:
Inflammatorisk demyelinisering av synnerven. Orsaken är okänd, men mer än hälften utvecklar MS efter 30–40 år.
Förekomst:
Cirka 1–3 fall per 100 000 per år, vanligtvis mellan 20–49 års ålder. Vanligare bland kvinnor.
Symtom:
En subakut oftast ensidig synnedsättning som utvecklas inom timmar till dagar, smärta eller obehag vid ögonrörelser, oförmåga att känna igen färger (sidoskillnad) är typiska. Synen kommer nästan alltid tillbaka inom en viss tid.
Kliniska fynd:
Nedsatt synskärpa och synfält. Nedsatt pupillreaktion vid direkt belysning.
Diagnostik:
Ögonbottenundersökning, neurologisk undersökning och MRT.
Behandling:
Högados kortikosteroider peroralt eller intravenöst. Plasmaferes, intravenöst immunoglobulin (IVIG) eller sjukdomsmodifierande behandling (DMD) kan övervägas.
  1. Toosy AT, Mason DF, Miller DH. Optic neuritis. Lancet Neurol 2014; 13: 83-99. pmid:24331795 PubMed  
  2. Rodriguez M, Siva A, Cross SA, O'Brien PC, Kurland LT. Optic neuritis: a population-based study in Olmsted County, Minnesota. Neurology. 1995 Feb;45(2):244-50. doi: 10.1212/wnl.45.2.244. PMID: 7854520 PubMed  
  3. Morales DS, Siatkowski RM, Howard CW, Warman R. Optic neuritis in children. J Pediatr Ophthalmol Strabismus 2000; 37: 254 - 9. PubMed  
  4. Yaqub S, von Hanno T, Stokke A, Skjeflo T, Neset KA. Akutt synstap hos åtte år gammel jente. Tidsskr Nor Lægeforen 2004; 124: 189-91. Tidsskrift for Den norske legeforening  
  5. Arnold AC. Evolving management of optic neuritis and multiple sclerosis. Am J Ophthalmol 2005; 139: 1101-8. PubMed  
  6. Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, de Seze J, Fujihara K, Greenberg B, Jacob A, Jarius S, Lana-Peixoto M, Levy M, Simon JH, Tenembaum S, Traboulsee AL, Waters P, Wellik KE, Weinshenker BG; International Panel for NMO Diagnosis. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015 Jul 14;85(2):177-89. doi: 10.1212/WNL.0000000000001729. Epub 2015 Jun 19. PMID: 26092914 PubMed  
  7. Dalbro SEJ, Kerty E. Atypisk optikusnevritt. Tidsskr Nor Laegeforen. 2019 Sep 23;139(13). PMID: 31556528 PubMed  
  8. Weerasinghe D, Lueck C. Mimics and chameleons of optic neuritis. Pract Neurol 2016; 16: 96-110. pmid:26764409 PubMed  
  9. Hassan MB, Stern C, Flanagan EP, Pittock SJ, Kunchok A, Foster RC, Jitprapaikulsan J, Hodge DO, Bhatti MT, Chen JJ. Population-Based Incidence of Optic Neuritis in the Era of Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibodies. Am J Ophthalmol. 2020 Dec;220:110-114. doi: 10.1016/j.ajo.2020.07.014. Epub 2020 Jul 21. PMID: 32707199 PubMed  
  10. Chen JJ, Pittock SJ, Flanagan EP, Lennon VA, Bhatti MT. Optic neuritis in the era of biomarkers. Surv Ophthalmol. 2020 Jan-Feb;65(1):12-17. Epub 2019 Aug 16. PMID: 31425702. PubMed  
  11. De Lott LB, Bennett JL, Costello F. The changing landscape of optic neuritis: a narrative review. J Neurol. 2021 Jan 3:10.1007/s00415-020-10352-1. Epub ahead of print. PMID: 33389032 PubMed  
  12. Filippi M, Rocca MA, Ciccarelli O, et al . MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. Lancet Neurol 2016; 15: 292-303. doi:26822746. PMID: 26822746 PubMed  
  13. Kerty E, Midelfart A. Opticus neuritt. Nasjonal kvalitetshåndbok for oftalmologi. Vedtatt november 2017. www.helsebiblioteket.no  
  14. Hickman SJ, Dalton CM, Miller DH et al. Management of acute optic neuritis. Lancet 2002; 360: 1953-62. PubMed  
  15. Cornblath WT, Quint DJ. MRI of optic nerve enlargement in optic neuritis. Neurology. 1997 Apr;48(4):821-5. doi: 10.1212/wnl.48.4.821. PMID: 9109862 PubMed  
  16. Brex PA, Ciccarelli O, O'Riordan JI, Sailer M, Thompson AJ, Miller DH. A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. N Engl J Med. 2002 Jan 17;346(3):158-64. doi: 10.1056/NEJMoa011341. PMID: 11796849 PubMed  
  17. Holder GE. Pattern electroretinography (PERG) and an integrated approach to visual pathway diagnosis. Prog Ret Eye Res 2001; 20: 531-61. PubMed  
  18. Gronseth GS, Ashman EJ. Practice parameter: The usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 54: 1720-5. PMID: 10802774 PubMed  
  19. Lamirel C, Newman NJ, Biousse V. Optical Coherence Tomography (OCT) in Optic Neuritis and Multiple Sclerosis. Rev Neurol (Paris) 2010; 166: 978-86. pmid:20605617 PubMed  
  20. Gal RL, Vedula SS, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD001430. DOI: 10.1002/14651858.CD001430.pub4. DOI  
  21. De Lott LB, Burke JF, Andrews CA, et al. Association of Individual-Level Factors With Visual Outcomes in Optic Neuritis: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3: e204339. pmid:32379333 PubMed  
  22. Deschamps R, et al. Plasma exchange response in 34 patients with severe optic neuritis. J Neurol. 2016 May;263(5):883-7. pmid:26964539 PubMed  
  23. Roesner S, Appel R, Gbadamosi J, Martin R, Heesen C. Treatment of steroid-unresponsive optic neuritis with plasma exchange. Acta Neurol Scand. 2011;126:103-108. PubMed  
  24. Optic neuritis: Prognosis and treatment.Osborne B, Balcer L. UpToDate. Last updated: Sep 30, 2021. www.uptodate.com  
  25. Phuljhele S, Kedar S, Saxena R. Approach to optic neuritis: An update. Indian J Ophthalmol. 2021 Sep;69(9):2266-2276. doi: 10.4103/ijo.IJO_3415_20. PMID: 34427197 PubMed  
  26. Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up. Arch Neurol 2008; 65: 727-32. PubMed  
  27. Brex PA, O'Riordan JI, Miszkiel KA et al. Multisequence MRI in clinically isolated syndromes and the early development of MS. Neurology 1999; 53: 1184-90. PMID: 10522870 PubMed  
  28. McDonald WI, Compston A, Edan G et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 2001; 50: 121-7. PubMed  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet
  • Rune Midgard, dr. med., overlege, førsteamanuensis II emeritus, NTNU