I would be grateful if you could give me some information on optic neuritis. Nearly two years ago I had an attack of optic neuritis, with a left side weakness and mobility problems. An MRI scan of the brain was clear, so the neurologist ruled out multiple sclerosis.

I have problems with my neck and upper back, and my walking is much slower. The neurologist wouldn’t do a lumbar puncture, as he’s adamant it’s not MS.

I’ve had to leave work as a manager of a post office, as the continual stamping made my back, neck and arms hurt.

My left eye has improved, but I’m left with a weakness, my vision changes daily, sometimes from hour to hour, and I get a dark shadow sometimes.

My dad developed optic neuritis. What can cause it, apart from MS? Is this condition genetic? JB, County Durham……

In optic neuritis (ON), the optic nerve, the central cable carrying electrical impulses from our eye to our brain, is inflamed. The degree that this affects your vision depends upon how many nerve fibres are involved. In mild cases of optic neuritis, vision can be nearly normal. More typically, though, vision is blurred, colour vision is diminished the world appears in shades of grey there may even be blind spots. In the very worse cases, a patient may not even be able to see light. You can experience pain with each movement of the eye. Usually, only a single eye is affected, and it most commonly strikes people in their early 30s.

ON develops after many illnesses, typically after viral infections such as mumps, measles, or the common cold, or even as a side effect of immunisation. But often times it is a symptom of a larger problem usually a disease affecting the nerves of the entire body or an autoimmune disease like systemic lupus erythematosus (SLE).

In rare cases, a particular form of this condition, called Leber’s optic neuropathy, affecting both eyes, does run in families.

However the most common scenario, as your doctor seems to realise, is that ON prefigures MS. It’s estimated that some 40 per cent of people with ON go on to develop MS, and the risk of developing MS is greatest in the first two years after a bout of ON.

Both conditions are “demyelinating diseases”, causing destruction of the myelin, or insulation coating around a nerve, which affects its ability to send messages.

If the problem is simple ON, the best treatment is to leave well alone. Studies have shown that taking oral steroids can result in poorer vision than if the patient isn’t treated at all. Three quarters of patients improve on their own within a few weeks and get completely better in a few months. In some cases, vision, particularly your colour field, isn’t quite as acute after the illness.

In our view, your consultant is missing the forest for the trees. Like many other doctors, he has ruled out MS simply on the basis of a MRI scan of the brain.

As Dr Patrick Kingsley has pointed out, many clinicians now ignore clear clinical signs because they’ve got the space age gadgetry to do their diagnostics for them.

All your problems with mobility strongly suggest that your nerve problems extend further than your eyes. It may be wise to return to a doctor with an excellent track record for diagnosing MS. Even your GP can perform a simple test, called the Babinski’s sign, a little motor reflex test performed on the sole of the foot which will alert your doctor for the need for more tests.

In the view of our Alternatives columnist Harald Gaier, you should also have a thorough eye test to rule out the possibility of macular degeneration.

If it turns out that you do have MS, remember that in our view and that of many of the best and the brightest working in this field, MS is less a disease than a type of environmental poisoning in slow motion. MS often develops in patients with many mercury amalgam fillings, an allergy to cow’s milk, high pesticide intake, or low levels of B12. See WDDTY vol 7 no 11 for more information about how to treat this illness.

Simple optic neuritis responds to supplements of vitamin C. You may also consider supplementing with other nutrients (E, B6 and zinc), which are also found to be low in patients with ON (Nippon Ganka Gakkai Zasshi, 1996; 100: 381-7).

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Written by What Doctors Don't Tell You

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