Early Diagnosis, Monitoring, and Treatment of Optic Neuritis

Department of Medicine, Division of Neurology, University of Nevada School of Medicine, 1000 Locust St., Reno, NV 89502, USA.
The Neurologist (Impact Factor: 1.16). 01/2012; 18(1):23-31. DOI: 10.1097/NRL.0b013e31823d7acd
Source: PubMed


About half of multiple sclerosis patients present with optic neuritis (ON) as a clinically isolated syndrome (CIS). In the Optic Neuritis Treatment Trial study, 28% of patients with ON and an abnormal brain magnetic resonance imaging (MRI) did not have a relapse at the end of 15 years. It is still difficult to predict which CIS patients will go on to develop clinically definite multiple sclerosis and which will have a benign course.
This review focuses on more advanced methods of detecting and quantifying ON in multiple sclerosis that have been developed in the past 15 years, especially on recent developments in optical coherence tomography measurement of the retinal nerve fiber layer and its role in monitoring axonal loss in the course of the disease. New clinical trial methods of measuring visual acuity include high-contrast visual acuity testing with the Early Treatment Diabetic Retinopathy Study charts, low-contrast letter acuity, and contrast sensitivity testing. More advanced neuroimaging techniques include magnetization transfer imaging and diffusion tensor imaging to quantify visual pathway lesions. Other tests of visual function, such as multifocal visual-evoked potentials and functional MRI, have been shown to be more sensitive than conventional visual-evoked potentials or MRI in detecting early, subtle visual impairment in ON and early recovery of visual function related to cortical plasticity. Newer agents are currently being investigated for CIS in ongoing clinical trials.
Better methods are being developed for the earlier diagnosis, monitoring, and treatment of ON. In the future, CIS patients may be stratified according to their risk of development of clinically definite multiple sclerosis and therefore, receive the appropriate treatment.

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    • "The diagnosis of ON is usually made clinically, but earlier diagnosis has been shown to be possible with multifocal visual evoked potentials or functional MRI.4 More comprehensive features regarding diagnosis, epidemiology, and detailed clinical characteristics of demyelinating ON are beyond the scope of this review, but can be found in several other manuscripts.1,4,5 "
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    ABSTRACT: Optic neuritis can be defined as typical (associated with multiple sclerosis, improving independent of steroid treatment), or atypical (not associated with multiple sclerosis, steroid-dependent improvement). Causes of atypical optic neuritis include connective tissue diseases (eg, lupus), vasculitis, sarcoidosis, or neuromyelitis optica. In this manuscript, updated treatment options for both typical and atypical optic neuritis are reviewed. Conventional treatments, such as corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin therapy are all discussed with commentary regarding evidence-based outcomes. Less commonly used treatments and novel purported therapies for optic neuritis are also reviewed. Special scenarios in the treatment of optic neuritis - pediatric optic neuritis, acute demyelinating encephalomyelitis, and optic neuritis occurring during pregnancy - are specifically examined.
    Clinical Ophthalmology 07/2012; 6(1):1211-23. DOI:10.2147/OPTH.S28112 · 0.76 Impact Factor
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    ABSTRACT: Multiple sclerosis is an inflammatory neurological disease of young adults that leads to numerous therapeutic problems and to severe disability. Glatiramer acetate (GA) is a disease-modifying drug used frequently for long-term treatment of the disease. We investigated the impact of GA treatment on the parameters of reversal-pattern visual evoked potentials and event-related P300 wave (reflecting visual acuity and cognitive dysfunction). Relapsing-remitting multiple sclerosis patients either subjected to one-year-long continuous treatment with GA or without any disease-modifying therapy and also healthy controls were involved in the study. The above-mentioned parameters were analyzed at two time points, at the first recording and after one year. It was found that GA did not exert a significant influence on the phenomena studied at least during the one-year follow-up. This finding is in contrast to most of the clinical observations.
    Neurophysiology 05/2013; 45(3). DOI:10.1007/s11062-013-9361-x · 0.20 Impact Factor
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    ABSTRACT: This article aims to provide a review of demyelinating optic neuritis as a presenting symptom of multiple sclerosis, clinical features, management options, and recent literature. To date, several questions remain to be unsolved relating to the presentation, treatment, and implications of optic neuritis. Although some authors recommend high-dose corticosteroids for the treatment of acute demyelinating optic neuritis, there is still no consensus relating to corticosteroids treatment including the dosage and length of treatment. Studies have shown that the risk of developing clinically definite multiple sclerosis (MS) after presenting with a clinically isolated syndrome including optic neuritis is increased in patients with an abnormal brain MRI. Better diagnostic tools are needed to precisely predict the conversion to MS and the factors influencing disease severity to determine the most appropriate therapeutic paradigm and avoid unnecessary treatment. Management of optic neuritis presenting as a demyelinating first event still remains inconclusive relating to the acute management and long-term treatment. But recent literature suggests high-dose corticosteroids for acute treatment and disease-modifying treatments may be a valuable option for long-term treatment. However, decision is very individualized and is based on the clinical and imaging findings of the patient.
    Current opinion in ophthalmology 09/2012; 23(6):472-6. DOI:10.1097/ICU.0b013e328358b202 · 2.50 Impact Factor
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