Treatment Of Acute Optic Neuritis Research Articles

A Randomized Prospective Trial Comparing Repository Corticotropin Injection and Intravenous Methylprednisolone for Neuroprotection in Acute Optic Neuritis.

Repository corticotrophin injection (RCI, Acthar Gel) and intravenous methylprednisolone (IVMP) improve the rate but not the extent of visual recovery following acute optic neuritis. RCI has adrenal-stimulating and melanocortin receptor-stimulating properties that may endow it with unique anti-inflammatory properties relative to IVMP. Individuals with acute optic neuritis of less than 2 weeks duration were prospectively enrolled and randomized 1:1 to receive either RCI or IVMP. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell plus inner plexiform layer thickness (GC + IPL) were serially evaluated by OCT. In addition, patient-reported outcomes (PROs) for changes in fatigue, mood, visual function, depression, and quality of life (QOL) were measured, and high and low contrast visual acuity were recorded. Thirty-seven subjects were enrolled (19 RCI; 18 IVMP); the average time from symptom to treatment was 8.8 days. At 6 months, there was no difference in the primary outcome: loss of average pRNFL thickness in the affected eye (RCI vs IVMP: -13.1 vs -11.7 µm, P = 0.88) 6 months after randomization. Additional outcomes also showed no difference between treatment groups: 6-month attenuation of GC + IPL thickness (RCI vs IVMP: -13.8 vs -12.0 µm, P = 0.58) and frequency of pRNFL swelling at 1 month (RCI vs IVMP: 63% vs 72%, P = 0.73) and 3 months (RCI vs IVMP: 26% vs 31%, P = 0.99). Both treatments resulted in improvement in visual function and PROs. Treatment of acute optic neuritis with RCI or IVMP produced no clinically meaningful differences in optic nerve structure or visual function.

Dynamics of cellular immunity indicators in the complex treatment of acute optic neuritis

An increase in the incidence of optic neuritis among the working-age population, as well as an unpromising prognosis for vision due to the development of optic nerve atrophy, determines the high social significance of this problem. The aim of the work is to analyze the effect of Imunofan at the parameters of cellular immunity and clinical symptoms of the disease in the complex treatment of optic neuritis associated with herpes virus infection. The study involved 37 people (37 eyes) with acute optic neuritis associated with herpes infection. The treatment regimen included the appointment of a dexamethasone solution according to a decreasing scheme, a 1% solution of the drug Emoxipin 0.5 mL and a 12.5% solution of the drug Dicynone 0.5 mL through an irrigation system implanted in the retrobulbar space, in combination with the neuroprotection drugs (Pikamilon and Semax) for 10 days. All patients were divided into 2 groups. The main group consisted of 20 patients who received Imunofan to the treatment regimen in addition. The comparison group included 17 patients who were treated only according to the method described above. The course of treatment lasted 10 days. The analysis of the data showed a more significant positive dynamics of cellular immunity parameters in those who received immunotherapy. Our studies showed the effectiveness of this drug in the complex treatment of optic neuritis associated with herpes infection, what is confirmed by the acceleration of inflammation relief, a more significant increase in visual functions of patients treated with Imunofan, and a lower percentage of optic nerve atrophy. In this group of patients, changes in the parameters of the cellular link of immunity occurred earlier and remained stable throughout the entire period of observation. According to our data, an intergroup assessment of the immunoregulatory index showed its faster increase in patients of the comparison group who received Imunofan, and reached normal values already 6 months after treatment. The clinical effectiveness of Imunofan in the complex therapy of optic neuritis associated with herpes infection was characterized by a reduction in the period of relief of signs of inflammation in the optic nerve by 2 times or more, by an increase in the maximum corrected visual acuity by 4.5 times, and by a decrease in the incidence of recurrence of optic neuritis by 2 times over a 12 months observation period.

The Acute Optic Neuritis Network (ACON): Study protocol of a non-interventional prospective multicenter study on diagnosis and treatment of acute optic neuritis.

ClinicalTrials.gov, identifier: NCT05605951.

Role of immunotherapy in complex treatment of acute optic neuritis associated with herpesvirus infection

Background. An increase in the incidence of optic neuritis (ON) among the workingage population, the complexity of etiological diagnosis and the choice of adequate etiotropic therapy, as well as a disappointing prognosis for vision due to the development of optic nerve atrophy determines the high social significance of this problem.The aim. Comprehensive clinical, functional, morphometric and laboratory-immunological evaluation of results of using the drug Imunofan® in combined treatment of ON associated with herpesvirus infection (HVI).Materials and methods. The study involved 39 people (39 eyes) with acute ON associated with HVI. The standard treatment regimen for the patients included the appointment of solutions: dexamethasone in a decreasing scheme, a 1 % Emoxypine® preparation 0.5 ml and 12.5 % Dicynone® preparation 0.5 ml through an irrigation system implanted into the retrobulbar space, with subsequent appointment of medicinal means of neuroprotection (Picamilon® and Semax®). All patients were divided into two groups. The main group – 22 patients, whose standard inpatient treatment was supplemented with intramuscular administration of the drug Imunofan®, 50 μg daily for 10 days. The control group consisted of 17 patients, who were treated only according to the standard method.Results. Analysis of obtained data showed that more significant positive dynamics was noted in patients of the main group.Conclusion. The clinical efficacy of the drug Imunofan® in the complex therapy of ON associated with HVI was characterized by relief of signs of inflammation in the optic nerve in the main group immediately after the end of the course of treatment, while in the control group – only after 3 months; an increase in the best corrected visual acuity by 1.3 times, a decrease in the incidence of postneuritic optic nerve atrophy at a follow-up period of 12 months.

Visual outcome is similar in optic neuritis patients treated with oral and i.v. high-dose methylprednisolone: a retrospective study on 56 patients

BackgroundTo investigate visual recovery after treatment of acute optic neuritis (ON) with either oral or intravenous high-dose methylprednisolone, in order to establish the best route of administration.MethodsRetrospective analysis of patients treated with oral or intravenous high-dose (≥500 mg per day) methylprednisolone for acute ON of unknown or demyelinating etiology. Twenty-eight patients were included in each treatment group. Visual acuity was measured with the Snellen letter chart, color vision with Boström-Kugelberg pseudo-isochromatic plates, and visual field with a Humphrey Field Analyzer.ResultsThe treatment results were similar in the two groups at follow-up, with no significant difference in visual acuity (p = 0.54), color vision (p = 0.18), visual field mean deviation (p = 0.39) or the number of highly significantly depressed test points (p = 0.46).ConclusionsThe results show no clinical disadvantage of using oral high-dose corticosteroids compared to intravenous administration in the treatment of acute ON, which would facilitate the clinical management of these patients.

Management of optic neuritis in Ireland: a survey comparing the management practices of acute demyelinating optic neuritis amongst ophthalmologists and neurologists in Ireland.

Acute optic neuritis (ON) is often the first manifestation of multiple sclerosis which is particularly common in Ireland. Despite the specific clinical details regarding investigations and management of ON provided by the Optic Neuritis Treatment Trial (ONTT), international surveys have shown that there are still notable differences in the management of ON between neurologists and ophthalmologists. To compare the investigation and treatment of acute optic neuritis between ophthalmologists and neurologists in Ireland METHOD: A survey consisting of a case scenario and questions regarding treatment and investigations of a patient with ON was emailed to ophthalmology consultants, trainees and medical ophthalmologists registered with the Irish College of Ophthalmologists and to neurology consultants and registrars registered with the Irish Institute of Clinical Neuroscience. One hundred sixty recipients responded out of 350 (46%). The majority of the neurologists would initiate steroid treatment regardless of the patient's vision (75%), treat with 1g IV methylprednisolone (100%) for 5days (57%), perform an MRI brain and orbits with contrast (92%) and multiple laboratory tests (96%). In contrast, the ophthalmologists tended to initiate treatment depending on the patient's vision (48%), treat with 1g IV methylprednisolone (97%) for 3days instead of 5days (93%), perform MRI brain and orbits with contrast (73%) and favour electrophysiology testing (73%) over laboratory testing (68%). Overall, most respondents would follow the ONTT guidelines regarding IV methylprednisolone. There was a significant difference in responses between the ophthalmologists and neurologists regarding who to treat, duration of treatment and appropriate investigations.

Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids

Intravenous (IV) administration of corticosteroids is the standard of care in the treatment of acute optic neuritis. However, it is uncertain whether a bioequivalent dose of corticosteroid administered orally, which may be more cost-efficient and convenient for patients, is as effective as IV administration in the treatment of acute optic neuritis. To determine whether recovery of vision following treatment of acute optic neuritis with a high-dose IV corticosteroid is superior to that with a bioequivalent dose of an oral corticosteroid. This single-blind (participants unblinded) randomized clinical trial with 6-month follow-up was conducted at a single tertiary care center in London, Ontario, Canada. Participants were enrolled from March 2012 to May 2015, with the last participant's final visit occurring November 2015. Patients 18 to 64 years of age presenting within 14 days of acute optic neuritis onset, without any recovery at time of randomization and without history of optic neuritis in the same eye, were screened. Inclusion criteria included best-corrected visual acuity (BCVA) of 20/40 or worse and corticosteroids deemed required by treating physician. In total, 89 participants were screened; 64 were eligible, but 9 declined to participate. Thus, 55 participants were enrolled and randomized. Primary analysis was unadjusted and according to the intention-to-treat principle. Participants were randomized 1:1 to the IV methylprednisolone sodium succinate (1000-mg) or oral prednisone (1250-mg) group. Primary outcome was recovery of the latency of the P100 component of the visual evoked potential at 6 months. Secondary outcomes were the P100 latency at 1 month and BCVA as assessed with Early Treatment Diabetic Retinopathy Study letter scores on the alphabet chart and scores on low-contrast letters at 1 and 6 months. Of 55 randomized participants, the final analyzed cohort comprised 23 participants in the IV and 22 in the oral treatment groups. The mean (SD) age of the cohort was 34.6 (9.5) years, and there were 28 women (62.2%). At 6 months' recovery, P100 latency in the IV group improved by 62.9 milliseconds (from a mean [SD] of 181.9 [53.6] to 119.0 [16.5] milliseconds), and the oral group improved by 66.7 milliseconds (from a mean [SD] of 200.5 [67.2] to 133.8 [31.5] milliseconds), with no significant difference between groups (P = .07). Similarly, no significant group difference was found in the mean P100 latency recovery at 1 month. For BCVA, recovery between the groups did not reach statistical significance at 1 month or 6 months. In addition, improvements in low-contrast (1.25% and 2.5%) BCVA were not significantly different between treatment groups at 1 or 6 months' recovery. This study finds that bioequivalent doses of oral corticosteroids may be used as an alternative to IV corticosteroids to treat acute optic neuritis. clinicaltrials.gov Identifier: NCT01524250.

Immunomodulation and neuroprotection in optic neuritis

To date, high-dose corticosteroids constitute the only established treatment of acute optic neuritis (ON); however, steroids cannot prevent the loss of retinal nerve fibers. New acute therapeutic drugs are therefore being sought for a reduction of ganglion cell death. Literature search comprising clinical studies on treatment of ON with immunomodulatory and neuroprotective drugs. For the immunomodulatory drug simvastatin some evidence for long-term benefits was shown, particularly regarding visual evoked potentials. For the neuroprotective substance memantine a potential positive effect on retinal nerve fiber layer (RNFL) thickness was revealed. Likewise in one publication a reduction in loss of RNFL thickness could be demonstrated for erythropoietin and this drug is currently being extensively investigated in a phase III randomized controlled trial (RCT). The results of studies with phenytoin, amiloride and anti-leucine-rich repeat and immunoglobulin domain containing 1 protein (anti-LINGO-1) antibodies are awaiting publication. According to the data from recent treatment trials, there is hope that neuronal loss in ON can be reduced with the help of immunomodulatory substances, such as simvastatin or neuroprotective agents, such as memantine and erythropoietin.

Opicinumab. Anti-LINGO-1 monoclonal antibody, Treatment of multiple sclerosis, Treatment of acute optic neuritis

Opicinumab. Anti-LINGO-1 monoclonal antibody, Treatment of multiple sclerosis, Treatment of acute optic neuritis

Opicinumab. Anti-LINGO-1 monoclonal antibody, Treatment of multiple sclerosis, Treatment of acute optic neuritis

Opicinumab. Anti-LINGO-1 monoclonal antibody, Treatment of multiple sclerosis, Treatment of acute optic neuritis

Treatment of acute optic neuritis and vision complaints in multiple sclerosis.

Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system, in which almost all patients develop some degree of visual impairment during the disease. Optic neuritis is the most common and known visual affection and may be the initial clinical disease manifestation, but visual complaints can have a wide variety of presentations and some of them can lead to clinical confusion. Most symptoms are the result of acute injury and subsequent axonal loss in the afferent and efferent visual pathway, but others may be consequences of treatments. Currently, we can tell the functional and anatomical damage caused by multiple sclerosis by visual function test, measurement of eye movements, electrophysiological testing, optical coherence tomography, and magnetic resonance imaging. The purpose of this review is to describe the afferent and efferent visual symptoms associated with multiple sclerosis or multiple sclerosis treatment, and review the current and future therapeutic options available for them.

Treatment of Optic Neuritis

Optic neuritis (ON) is a self-limiting condition caused by inflammation-driven demyelination process affecting the optic nerve. Main clinical features are sudden, unilateral worsening of visual acuity, colour vision disturbance, visual field defects and motion-induced ocular pain. Spontaneous recovery appears usually within up to 8 weeks. It is a frequent initial manifestation of multiple sclerosis. Treatment of optic neuritis remains controversial, although many clinical trials have been conducted to establish firm therapeutic guidelines. The most relevant clinical trial is the Optic Neuritis Treatment Trial (ONTT), proving three days’ intravenous methylprednisolone therapy is not able to change the long-term prognosis, however improving visual recovery, what became a therapeutic option in monocular patients, patients with significant visual field loss, as well as those with professional requirements of fast visual recovery. The ONTT showed that 15-year risk of developing multiple sclerosis was 50 % regardless of the treatment regimen. Oral corticosteroids are recommended for treatment of acute optic neuritis.

Treatment of Acute Optic Neuritis

inconclusive because of small sample size. In the 1980s, the Optic Neuritis Treatment Trial was developed to evaluate corticosteroid treatment for optic neuritis. This multicenter randomized clinical trial, supported by the National Eye Institute, was designed to answer the following questions: (1) Does treatment with either oral prednisone or intravenous methylprednisolone followed by oral prednisone improve the visual outcome of acute optic neuritis? (2) Does either treatment speed recovery of vision? and (3) Are the complications of treatment insignificant in relation to the magnitude of the treatment effect? Long-term follow-up of the cohort was performed to investigate the relationship between optic neuritis and the development of multiple sclerosis (MS).

The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists

Objective To determine whether the Optic Neuritis Treatment Trial (ONTT) results have altered the practice patterns of ophthalmologists and neurologists. Design Mail survey. Participants A random sample of 987 ophthalmologists and 900 neurologists practicing in the United States were mailed a questionnaire that inquired into decision-making with regard to management of optic neuritis before and after the publication of the ONTT results. Main outcome measures Responses received from 202 ophthalmologists and 244 neurologists, a response rate of 47%. Results Following the ONTT reports, nearly all ophthalmologists and neurologists have reduced their use of oral prednisone alone, substituting a regimen that includes intravenous methylprednisolone. A large proportion of practitioners in both specialties mistakenly believe that intravenous methylprednisolone treatment improves final visual outcome. Only 7% of neurologists and 36% of ophthalmologists ( P = 0.0001) are adhering to the ONTT suggestion to use magnetic resonance imaging as a basis for initiating treatment. Conclusions The ONTT has led to a dramatic reduction in the use of oral prednisone without a preceding course of intravenous methylprednisolone in the treatment of acute optic neuritis. Ophthalmologists and neurologists have changed some of their practices without fully understanding the results of the ONTT.

Cerebrospinal fluid in acute optic neuritis: Experience of the Optic Neuritis Treatment Trial

The Optic Neuritis Treatment Trial (ONTT) is a prospective study of corticosteroid treatment of acute optic neuritis (ON), with subsequent longitudinal follow-up to determine development of clinically definite multiple sclerosis (CDMS). We analyzed the CSF of 83 patients with clinically isolated ON who underwent lumbar puncture within 24 hours of enrollment into the ONTT to determine the value of CSF changes in ON, especially regarding diagnostic utility, immunologic changes, MRI correlations, and progression to CDMS All patients had baseline MRI scans graded for changes typical of MS CSF measurements included immunoglobulin G (IgG) synthesis, IgG ratio, myelin basic protein, IgG kappa light chains, and oligoclonal banding. No patients had their diagnosis or management altered as a result of CSF findings. Except for oligoclonal bands, few patients showed any abnormalities on CSF tests, and no tests correlated with the 2-year development of CDMS. Oligoclonal banding, present at baseline in 11 of 13 patients who developed CDMS, did predict progression to CDMS, but this was not independent of MRI abnormalities. Two patients with oligoclonal bands and a normal MRI did progress to CDMS. We conclude that CSF analysis may not be necessary in the routine evaluation of patients presenting with a typical clinical profile of acute ON, and that most CSF tests add little additional information to MRI results for predicting the 2-year development of CDMS. However, the precise role of oligoclonal banding in the analysis of such patients awaits longer follow-up of this cohort. NEUROLOGY 1996,46 368-372

Corticosteroid treatment of acute optic neuritis and multiple sclerosis

Corticosteroid treatment of acute optic neuritis and multiple sclerosis

Intravenous methylprednisolone sped the recovery of vision but only marginally improved long-term vision in optic neuritis

TherapeuticsJuly 1, 1992Intravenous methylprednisolone sped the recovery of vision but only marginally improved long-term vision in optic neuritisBarbara Scherokman, MDBarbara Scherokman, MDUniformed Services University of the Health Sciences, Bethesda, Maryland, USA (B.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1992-117-1-009 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationBeck RW, Cleary PA, Anderson MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. N Engl J Med. 1992 Feb 27;326:581-8. Author, Article, and Disclosure InformationAffiliations: Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (B.S.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails July 1, 1992Volume 117, Issue 1Page: 9KeywordsBody weightMultiple sclerosisSystemic diseasesVision ePublished: 9 March 2020 Issue Published: July 1, 1992 Copyright & PermissionsCopyright © 1992 by American College of Physicians. All Rights Reserved.Loading ...

A Randomized, Controlled Trial of Corticosteroids in the Treatment of Acute Optic Neuritis

The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period. Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95). Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

Corticosteroid Treatment of Acute Optic Neuritis

OPTIC neuritis is an acute inflammatory optic neuropathy with an average annual incidence of 6.4 cases per 100,000 in Olmsted County, Minnesota — the only American population for which such data are available.1 About half the cases are idiopathic, and the other half are associated with multiple sclerosis. The clinical picture of optic neuritis has been fully characterized in retrospective and prospective analyses.2 3 4 It is found in persons of all ages, with the peak incidence in the third and fourth decades. Cases in females outnumber those in males by two to one. The disorder is overwhelmingly uniocular in adults. Pain, . . .

The treatment of acute optic neuritis. An analysis of eighty cases.

Optic neuritis is a disease for which a precise etiology or pathogenesis is frequently unknown. No specific treatment, accordingly, has received universal acceptance. Nonspecific remedies such as vasodilators, typhoid H antigen, and, more recently, steroids, have all been employed therapeutically. This paper represents an effort to assess the relative merits of the various therapeutic agents heretofore employed in the treatment of acute optic neuritis of unknown etiology and in optic neuritis associated with multiple sclerosis in the hope that such information may serve as a guide to better treatment, or possibly suggest fruitful avenues for future research. The recent literature includes case reports indicating success or failure of treatment with these various agents.1-3In 1952 Carroll4reported on 240 cases of optic neuritis, concluding that no therapeutic agent proved itself superior. Although clinical publications far outnumbered basic scientific contributions in the treatment of optic neuritis, two experimental reports