RT Journal Article
SR Electronic
T1 Re-evaluating the treatment of acute optic neuritis
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 799
OP 808
DO 10.1136/jnnp-2014-308185
VO 86
IS 7
A1 Jeffrey L Bennett
A1 Molly Nickerson
A1 Fiona Costello
A1 Robert C Sergott
A1 Jonathan C Calkwood
A1 Steven L Galetta
A1 Laura J Balcer
A1 Clyde E Markowitz
A1 Timothy Vartanian
A1 Mark Morrow
A1 Mark L Moster
A1 Andrew W Taylor
A1 Thaddeus W W Pace
A1 Teresa Frohman
A1 Elliot M Frohman
YR 2015
UL http://jnnp.bmj.com/content/86/7/799.abstract
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.