Abstract
BackgroundThe combined corticosteroid regimen of the original Optic Neuritis Treatment Trial (ONTT) is used in many centers to treat optic neuritis. Though pattern reversal visual evoked potentials (PRVEPs) are a sensitive, standard measure of visual conduction in optic neuritis, no studies hitherto have investigated the effect of combined ONTT regimen on PRVEPs. We aimed to determine the effect of combined corticosteroid regimen of the ONTT on changes of PRVEPs in patients with first-episode optic neuritis over 3 months post-treatment.MethodsThis is a prospective, observational study in which 44 patients with optic neuritis were seen pre-treatment (baseline) and follow-up, at 1 month (FU1) and 3 months (FU2). Twenty-nine patients were treated with ONTT combined regimen (ONTT+ Group) while 15 were conservatively managed without corticosteroids (ONTT- Group). The median latency and amplitude values of the P100 PRVEP component and the visual acuity (i.e. LogMAR values) at pre-treatment, FU1 and FU2 were compared in the two groups using Friedman’s rank test and Wilcoxon Signed Ranks test.ResultsMedian P100 latency improved significantly (to the normal range) as early as by 1 month after the commencement of treatment in the ONTT+ Group, and then remained significantly lower than the baseline over next 2 months. In the ONTT- Group, the median P100 latency improved more slowly over the two follow up assessments and reached the normal range by 3 months. Median visual acuity values also improved significantly at 1 and 3 months after the commencement of treatment in the ONTT+ Group but not in the ONTT- Group.ConclusionONTT combined corticosteroid regimen improves conduction in the visual pathways of patients with first-episode optic neuritis earlier than does conservative management. We provide electrodiagnostic evidence that combined ONTT regimen–compared with conservative management–results in early remission of visual conduction abnormalities in first-episode optic neuritis.
Highlights
The combined corticosteroid regimen of the original Optic Neuritis Treatment Trial (ONTT) is used in many centers to treat optic neuritis
Pattern-reversal visual evoked potentials (PRVEPs) are a sensitive measure to assess conduction delay in the optic nerve pathway caused by demyelination [2]
Patients were diagnosed based on sudden onset of visual impairment, positive relative afferent pupillary defect (RAPD), fundoscopic changes, and Pattern reversal visual evoked potentials (PRVEP) changes
Summary
The combined corticosteroid regimen of the original Optic Neuritis Treatment Trial (ONTT) is used in many centers to treat optic neuritis. Pattern-reversal visual evoked potentials (PRVEPs) are a sensitive measure to assess conduction delay in the optic nerve pathway caused by demyelination [2]. The outcome measures of the study were visual acuity, contrast sensitivity, colour vision and visual field testing. These are clinically important functional outcome measures, objective assessment of the conduction along the optic pathways using visual evoked potentials (VEPs) would add to the clinicians’ understanding of the recovery of their patients [3, 4]
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