PT - JOURNAL ARTICLE AU - Jeffrey L Bennett AU - Molly Nickerson AU - Fiona Costello AU - Robert C Sergott AU - Jonathan C Calkwood AU - Steven L Galetta AU - Laura J Balcer AU - Clyde E Markowitz AU - Timothy Vartanian AU - Mark Morrow AU - Mark L Moster AU - Andrew W Taylor AU - Thaddeus W W Pace AU - Teresa Frohman AU - Elliot M Frohman TI - Re-evaluating the treatment of acute optic neuritis AID - 10.1136/jnnp-2014-308185 DP - 2015 Jul 01 TA - Journal of Neurology, Neurosurgery & Psychiatry PG - 799--808 VI - 86 IP - 7 4099 - http://jnnp.bmj.com/content/86/7/799.short 4100 - http://jnnp.bmj.com/content/86/7/799.full SO - J Neurol Neurosurg Psychiatry2015 Jul 01; 86 AB - 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, re-establish normal physiology and restore optimal neurological function.