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Corticosteroids do not prevent optic nerve atrophy following optic neuritis
  1. S J Hickman1,
  2. R Kapoor2,
  3. S J Jones3,
  4. D R Altmann1,
  5. G T Plant4,
  6. D H Miller1
  1. 1NMR Research Unit, Institute of Neurology, University College London, UK
  2. 2Dept of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
  3. 3Dept of Clinical Neurophysiology, The National Hospital for Neurology and Neurosurgery, London, UK
  4. 4Dept of Neuro-Ophthalmology, Moorfields Eye Hospital, London, UK
  1. Correspondence to:
 Professor D H Miller, NMR Research Unit, 6th Floor, Institute of Neurology, Queen Square, London WC1N 3BG, UK; 
 d.miller{at}ion.ucl.ac.uk

https://doi.org/10.1136/jnnp.74.8.1139

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    Corticosteroids shorten the period of functional impairment following relapses in optic neuritis and multiple sclerosis (MS); however they have not, thus far, been shown to affect the final level of function compared with placebo.1 There has been recent interest in the use of corticosteroids as neuroprotective agents by their effect of decreasing nitric oxide (NO) production by mononuclear cells.2 NO is toxic to axons in vitro.3 Pulsed corticosteroid treatment has been reported to reduce the development of cerebral atrophy, a putative marker of neuronal loss,4 over a five year period in relapsing remitting MS.5 Optic nerve atrophy has been shown to develop following optic neuritis.6 This study assesses whether a single course of intravenous methylprednisolone (IVMP) during an attack of acute optic neuritis prevents the development of optic nerve atrophy following optic neuritis. Magnetic resonance imaging (MRI) data from a recent randomised placebo controlled trial of IVMP in acute optic neuritis were retrospectively evaluated.7

    METHODS

    The design, conduct and clinical results of the trial have been reported previously.7 Briefly, 66 patients with a first episode of acute unilateral optic neuritis within 30 days of onset were enrolled into the study. The median duration of symptoms before randomisation was eight days (range 1–30). Six of the patients had clinically definite MS, another 14 had clinically probable MS, and the rest had clinically isolated optic neuritis. Their optic nerves were imaged with a short tau inversion recovery (STIR) sequence (TR 2500 ms, TE 40 ms, TI 175 ms, matrix 256×128, field of view 16 cm × 16 cm, 2 excitations, 5 mm contiguous slices) and were then randomised to receive either 1 g/day IVMP for three days or intravenous saline. Reimaging was performed six months later. In addition, at six months, a detailed clinical assessment …

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