Re-evaluating the treatment of acute optic neuritis Journal Article
| Authors: | Bennett, J. L.; Nickerson, M.; Costello, F.; Sergott, R. C.; Calkwood, J. C.; Galetta, S. L.; Balcer, L. J.; Markowitz, C. E.; Vartanian, T.; Morrow, M.; Moster, M. L.; Taylor, A. W.; Pace, T. W. W.; Frohman, T.; Frohman, E. M. |
| Article Title: | Re-evaluating the treatment of acute optic neuritis |
| 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, reestablish normal physiology and restore optimal neurological function. |
| Keywords: | treatment response; unclassified drug; prednisone; review; placebo; drug efficacy; nonhuman; low drug dose; drug eruption; erythropoietin; immunoglobulin; central nervous system; monoclonal antibody; hyperglycemia; depression; acne; imaging; methylprednisolone; headache; hot flush; corticosteroid; sleep disorder; natalizumab; multiple sclerosis; convalescence; tissue injury; visual disorder; beta interferon; nerve cell degeneration; optic nerve injury; hypothalamus hypophysis adrenal system; optic neuritis; demyelination; face edema; corticotropin; memantine; glatiramer; experimental autoimmune encephalomyelitis; acute pancreatitis; perception disorder; depth perception; ankle edema; fumaric acid dimethyl ester; infusion related reaction; human; priority journal; fingolimod; immune injury; axonal injury; lingo1 antibody; teriflunomide; movement perception; stomach discomfort |
| Journal Title: | Journal of Neurology Neurosurgery and Psychiatry |
| Volume: | 86 |
| Issue: | 7 |
| ISSN: | 0022-3050 |
| Publisher: | BMJ Publishing Group Ltd. |
| Date Published: | 2015-07-01 |
| Start Page: | 799 |
| End Page: | 808 |
| Language: | English |
| DOI: | 10.1136/jnnp-2014-308185 |
| PROVIDER: | scopus |
| PMCID: | PMC4414747 |
| PUBMED: | 25355373 |
| DOI/URL: | |
| Notes: | Export Date: 2 September 2015 -- Source: Scopus |
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