Optic Neuritis and Multiple Sclerosis

Question:
I was diagnosed with RRMS 10 years ago. My first flare was 12 years ago. All previous flares and symptoms (except fatigue) seemed myelopathic. I have been on Avonex (18 mos), Tysabri (6yrs), and Tecfidera (2yrs). A year ago I stopped taking DMTs mostly due to apathy but my neuro OK'd this because MRI has been stable except for evolution of small lesions into small black holes.

Recently I developed right eye pain which was increased with eye movement. Pain is not severe but dull ache "behind" the eye. Right upper quadrant is a little blurry but no noticeable vision change otherwise. My ophthalmologist says it is mild optic neuritis and that no treatment is needed. This is fine with me since steroids do NOT agree with me. My questions are first, is it not unusual to develop my first episode of optic neuritis at this point? And second, should I go back on Tecfidera? 

Answer:
Since you are not currently on treatment, it is not unusual to have a relapse 12 years into your course of MS.  While optic neuritis is a common first attack in multiple sclerosis, it can occur at any time during the relapse remitting phase of the disease.

Over time, about 75% of patients with MS will have some type of visual problem (optic neuritis, double vision, nystagmus, etc.).

As to whether you should go back on Tecfidera, that is something you need to discuss with your neurologist.  I would recommend you start treatment with some immunomodulatry therapy as you are still having relapses; whether it should be Tecfidera or another medication is something you and your neurologist can discuss.

Benjamin Osborne, MD
Associate Professor
Departments of Neurology and Ophthalmology
Georgetown University Hospital