Brainstem demyelination or Optic nerve demyelination is a condition which is known to affect the eye of a patient afflicted with Multiple Sclerosis. A significant number of people affected by MS suffer severely from Brainstem demyelination or Optic nerve demyelination, while nearly half of all patients confront it in a milder form during the course of the illness. Patients complain of diminished colour vision, visual acuity and pain exacerbated by eye movement. The symptoms tend to increase over a period of several hours to 10 days. Recovery begins within one month of the onset. Haemorrhages are usually rare and should be investigated to rule out other infections. Patients with Multiple Sclerosis may have asymptomatic involvement of the optic nerves which may occur frequently.


Detection of Brainstem demyelination


This is one of the most common symptoms of Multiple Sclerosis. The diagnosis of Brainstem demyelination or Optic nerve demyelination acts as a yardstick for the prognosis of MS. The severity of this condition is also an indication of how far the disease has progressed. A recent development is the use of low contrast letter acuity as a visual test for patients with Multiple Sclerosis.

This method involves the perception of light grey letters on a white or retro illuminated background. The level of contrast is changed by using letters that are more or less grey. This method is quite reliable and the scores are reduced considerably for patients having Multiple Sclerosis. Another method using to identify this condition is Visual Evoked Potential test where the patient is asked to look at the centre of a chequered board. The patterns on the board are reversed frequently and the response to these changes recorded. Each eye is tested independently. This test is also used to evaluate the predictive potential of the disease, overall disability from Multiple Sclerosis and for visual recovery from optic neuritis. Besides these, Optic MRI and Optical Coherence Tomography are the other tests employed to evaluate the optic nerves of patients suffering from Multiple Sclerosis.


Treatment for Optic nerve demyelination


There are various treatments available for this condition and patients have reported visual acuity being normal to slightly impaired in 90% of treated cases. The main treatment is related to intravenous corticosteroids. The use of plasma exchange, however, did not provide any significant results. A serial brain MRI scan is highly recommended for patients who cannot have a definite diagnosis. This scan should be done on a semi-annual, for at least 2 years. Considering the high risk of developing Multiple Sclerosis for patients having Brainstem demyelination or Optic nerve demyelination, treatment is most effective if started early. It is recognized that treatment should focus on prevention of axonal loss, which helps improve the visual outcome.