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Re-evaluating the treatment of acute optic neuritis.

TitleRe-evaluating the treatment of acute optic neuritis.
Publication TypeJournal Article
Year of Publication2015
AuthorsBennett JL, Nickerson M, Costello F, Sergott RC, Calkwood JC, Galetta SL, Balcer LJ, Markowitz CE, Vartanian T, Morrow M, Moster ML, Taylor AW, Pace TWW, Frohman T, Frohman EM
JournalJ Neurol Neurosurg Psychiatry
Volume86
Issue7
Pagination799-808
Date Published2015 Jul
ISSN1468-330X
KeywordsAcute Disease, Adrenal Cortex Hormones, Erythropoietin, Humans, Immunoglobulins, Intravenous, Magnetic Resonance Imaging, Optic Neuritis, Plasma Exchange, Scanning Laser Polarimetry
Abstract

Clinical case reports and prospective trials have demonstrated a reproducible benefit of hypothalamic-pituitary-adrenal (HPA) axis modulation on the rate of recovery from acute inflammatory central nervous system (CNS) demyelination. As a result, corticosteroid preparations and adrenocorticotrophic hormones are the current mainstays of therapy for the treatment of acute optic neuritis (AON) and acute demyelination in multiple sclerosis.Despite facilitating the pace of recovery, HPA axis modulation and corticosteroids have failed to demonstrate long-term benefit on functional recovery. After AON, patients frequently report visual problems, motion perception difficulties and abnormal depth perception despite 'normal' (20/20) vision. In light of this disparity, the efficacy of these and other therapies for acute demyelination require re-evaluation using modern, high-precision paraclinical tools capable of monitoring tissue injury.In no arena is this more amenable than AON, where a new array of tools in retinal imaging and electrophysiology has advanced our ability to measure the anatomic and functional consequences of optic nerve injury. As a result, AON provides a unique clinical model for evaluating the treatment response of the derivative elements of acute inflammatory CNS injury: demyelination, axonal injury and neuronal degeneration.In this article, we examine current thinking on the mechanisms of immune injury in AON, discuss novel technologies for the assessment of optic nerve structure and function, and assess current and future treatment modalities. The primary aim is to develop a framework for rigorously evaluating interventions in AON and to assess their ability to preserve tissue architecture, re-establish normal physiology and restore optimal neurological function.

DOI10.1136/jnnp-2014-308185
Alternate JournalJ. Neurol. Neurosurg. Psychiatry
PubMed ID25355373
PubMed Central IDPMC4414747
Grant ListR01 EY022936 / EY / NEI NIH HHS / United States
EY022936 / EY / NEI NIH HHS / United States