Management of optic neuritis
ABSTRACT Optic neuritis is an inflammatory condition of the optic nerve characterized by a sudden onset of unilateral visual loss, usually affecting young females. Demyelination associated with multiple sclerosis (MS) is the most common cause in regions where MS is prevalent; while in other places, there are a substantial proportion of cases where infective or autoimmune causes are seen. Optic Neuritis Treatment Trial (ONTT) was the first major study that provided information on the natural history, role of steroids in treatment and risk of development of MS. Subsequently, numerous clinical trials have evaluated different modalities of management of optic neuritis and MS. The Controlled High-Risk Subjects Avonex Multiple Sclerosis Prevention Study (CHAMPS); the Prevention of Relapses and Disability by Interferon β-1a Subcutaneously in Multiple Sclerosis (PRISMS) Trial; and, most recently, the Betaferon in Newly Emerging Multiple Sclerosis for Initial Treatment (BENEFIT) Study have provided large amount of information on the natural history of optic neuritis and management options available. However, due to the low prevalence of MS reported in Asian studies, high cost of therapy and indefinite time period of treatment, it may not be cost effective to start interferon therapy in most cases.
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ABSTRACT: Synopsis Physical therapists have an important role on the interprofessional team to provide care for people with temporomandibular disorders (TMDs). Diagnostic classification is a challenge in this population, given the complexities inherent in presentations of headache and orofacial pain, and is critical to selecting the appropriate intervention. The objectives of this paper were (1) to characterize the epidemiology and pathophysiology of the TMDs most commonly seen in the outpatient clinic, (2) to describe a systems screen to be used in the physical therapy examination to determine the need for interprofessional referral, and (3) to propose an approach for physical therapists to examine, evaluate, and classify patients with TMDs, based on previously validated methodologies. A modification of the diagnostic framework of the International Headache Society has provided the basis for the systems screen of people presenting with orofacial pain. The physical therapy examination and evaluation is based on the Diagnostic Criteria for TMD, developed and validated by a consortium of specialists from the American Academy of Orofacial Pain. Level of Evidence Diagnosis, level 5. J Orthop Sports Phys Ther 2014;44(3):182-197. doi:10.2519/jospt.2014.4847.03/2014; 44(3):182-97. DOI:10.2519/jospt.2014.4847
Article: More about Retinal disordersIndian Journal of Ophthalmology 03/2014; 62(3):263-4. DOI:10.4103/0301-4738.130427 · 0.93 Impact Factor
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ABSTRACT: Aim: To analyze the clinical signs of multiple sclerosis (MS) and show that optic neuritis is one of the first event, which indicates the development of disease. Patients and methods: The study involved 89 cases in which it confirmed MS at the time of the March 2009–2011. Since ophthalmological parameters were analyzed visual acuity (VA), visual field (VF), and retinal nerve fibre layer (RNFL) thickness of peripapillary rim by optic coherent tomography (OCT). Results: Ten(10) patients had ON as the first clinical manifestation of the disease which was statistically significant (X2 =9,7 p=0,01) compared to the manifestation of other clinical signs of disease. In VF, centrocecal scotomas were predominant in 50% of the subjects; the RNFL thinning of the neuroretinal rim was verified in all patients, most often in the upper quadrant. A month after pulse corticosteroid therapy, visual acuity in all patients with ON ranged from 0.6 to 1.0. Conclusion: ON is one of the first MS clinical manifestation. In VF, the most common disturbances are in the centrocecal area. The RNFL thinning was verified in all patients with OCT.Materia Socio Medica 08/2014; 26(4):246-8. DOI:10.5455/msm.2014.246-2481