Abstract General Information

Title

Real-world application of 2022 diagnosis criteria and proposed classification of optic neuritis

Abstract

Introduction: Optic neuritis (ON) is an inflammatory disorder of the optic nerve that may present with diverse clinical features and be associated with a wide range of differential diagnoses. To mitigate misdiagnosis, Petzold proposed new diagnostic criteria in 2022, based on clinical features and paraclinical tests. However, there is limited data on the real-world application of these criteria.
Objectives: We aimed to investigate the distribution of causes of ON based on the certainty of diagnosis and the clinical presentation, according to the Petzold criteria of 2022.
Methods: We conducted a retrospective review of medical records of patients diagnosed with ON at the emergency department of our service, from 2015 to 2020. We collected data on clinical, radiological and laboratory characteristics. We classified patients into definite or possible ON based on the certainty of diagnosis, and into clinical presentation A (typical neuritis), B (painless with all other features of A), or C (binocular with all other features of A or B). We estimated the frequency of AQP4-ON, MOG-ON, MS-ON, SION, RION, CRION, and NMOSD-AQP4 negative-ON for each group.
Results: A total of 77 patients were included in the study, with 48 (62%) classified as definite ON and 29 (38%) as possible ON. CRION (definite 2/8 (25%); possible 6/8 (75%)) and NMOSD-AQP4 negative-ON (definite 1/6 (16%); possible 5/6 (84%)) were less commonly seen in definite ON. The most common etiology in clinical presentation A was MS-ON (16/39, 41%), while AQP4-ON was predominant in clinical presentations B (3/5, 60%) and C (2/4, 50%).
Conclusions: The real-world application of the 2022 criteria revealed a lower-than-expected frequency of definite ON, particularly for seronegative non-MS causes, which can still pose a diagnostic challenge. Furthermore, the broader clinical presentation, including the B and C phenotypes, proved to be particularly useful in diagnosing non-MS-ON such as AQP4-ON.