The decision for or against plasmapheresis is a difficult one, as spontaneous improvement is possible as late as two months after disease onset. If there is evidence of neuromyelitis optica, rather than typical optic neuritis, methylprednisolone is generally given in a higher dose and for a longer time; if no improvement ensues, early plasmapheresis is performed 30 , However, this treatment approach is currently not supported by randomized and blinded trials.
Beta-interferons and glatiramer acetate have been used for two decades to lessen the number of new and active multiple sclerosis lesions on MRI and the number of clinical relapses, and, in the long term, to slow the progression of neurologic impairment. These drugs have also been used in several clinical trials to treat clinically isolated syndromes 35 — In about one-third of the patients in these trials, the isolated clinical syndrome was optic neuritis.
In all trials, the patients who received the active drug developed a second neurologic manifestation and thus a clinically diagnosable case of multiple sclerosis less frequently, and if at all at a later time, than those given placebo. Even after a second episode, treated patients had a significantly lower annual rate of relapse for the duration of follow-up. Neurologic impairment was relatively mild and not significantly different in the two groups.
These findings are summarized in Table 3. In the light of these findings, the interferons and glatiramer acetate have been approved for the treatment of clinically isolated syndromes as well, including optic neuritis with two or more inactive typical lesions of multiple sclerosis on MRI.
Newer drugs for multiple sclerosis—in particular, oral drugs such as teriflunomide 32 , 33 and dimethyl fumarate 34 —are not approved for this indication. The early treatment of clinically isolated syndromes is not favored by all experts and remains a matter of judgment for the experienced neurologist 35 , In neuromyelitis optica and NMO-spectrum disorders, immune prophylaxis with a beta-interferon or glatiramer acetate is not indicated.
Rather, azathioprine or rituximab is given to prevent recurrences. Pilot trials have shown benefit from erythropoietin and simvastatin, and a prospective controlled trial of erythropoietin is now in progress.
No current treatment can restore the function of a damaged optic nerve. In a phase 2 trial, an antibody against LINGO leucine-rich repeat and Ig domain containing 1, a protein inhibitor of axonal growth was found to shorten the latency of visual evoked potentials; this may reflect optic nerve regeneration Pilot trials have shown benefit from erythropoietin 38 and simvastatin See the following website: cme.
The EFN must be entered in the appropriate field in the cme. Please answer the following questions to participate in our certified Continuing Medical Education program. Only one answer is possible per question. Please select the answer that is most appropriate. What diagnostic test is indispensable for the objective diagnosis of unilateral optic neuritis? For what type of optic neuritis are antibodies to aquaporin-4 pathognomonic?
Which of the following is more compatible with a tumor compressing the optic nerve than with optic neuritis? If a brain MRI in a patient with optic neuritis reveals two non-contrast enhancing lesions in the periventricular white matter, then:.
What test is most suitable for measuring permanent functional damage due to optic neuritis in clinical trials? The MRI findings in what disease are most likely to be misdiagnosed as showing optic neuritis? Conflict of interest statement. National Center for Biotechnology Information , U. Journal List Dtsch Arztebl Int v. Dtsch Arztebl Int. Published online Sep Helmut Wilhelm , Prof. Author information Article notes Copyright and License information Disclaimer.
Received May 29; Accepted Aug Copyright notice. See letter " Additional New Therapeutic Options " in volume on page This article has been cited by other articles in PMC.
Abstract Background Typical optic neuritis is often the presenting manifestation of multiple sclerosis MS.
Results The diagnosis of optic neuritis is based on a constellation of symptoms and signs. Conclusion Optic neuritis is easy to distinguish from other diseases affecting the optic nerve. Learning goals This article is intended to acquaint the reader with the signs and symptoms of optic neuritis, the necessary diagnostic evaluation, the course of the disease, and the options for treatment. Epidemiology The incidence of optic neuritis in central Europe is 5 cases per persons per year.
Symptoms and signs Typically, optic neuritis first manifests itself with pain on movement of the eyes, followed by a worsening of vision. Open in a separate window. Figure 1. The clinical history. Ophthalmological examination The task of the ophthalmologist is to provide objective evidence for the diagnosis.
Figure 2. Figure 3. Symptoms and signs. Criteria of exclusion. Table 1 The differential diagnosis of optic neuritis and other diseases of the optic nerve. Disease Acute onset?
Pain on eye movement? Spontaneous recovery? Special types of optic neuritis Typical optic neuritis is characterized by: age 18—50 unilaterality pain on eye movement subsequent improvement no evidence of any systemic disease other than multiple sclerosis. Table 2 Atypical types of optic neuritis. Disease Features Course Treatment Neuroretinitis Macular involvement, bacterial infection Longer-lasting and more severe than typical optic neuritis Antibiotics and steroids, immune prophylaxis Chronic recurrent immune optic neuropathy Recurrence as soon as the steroid dose is lowered Many recurrences Long-term steroid therapy Neuromyelitis optica Foci of demyelination in the spinal cord, antibodies against aquaporin-4 Often bilateral; incomplete recovery High-dose steroid therapy, plasmapheresis, immune prophylaxis Optic neuritis due to an autoimmune disease other than multiple sclerosis Other clinical evidence of the underlying disease Rare; course often unfavorable High-dose steroid therapy, treatment of the underlying disease.
Atypical forms. Neuromyelitis optica. Ancillary diagnostic tests Blood tests Extensive laboratory testing is recommended in the neurologic guidelines if multiple sclerosis is suspected Box 2. Box 2 Diagnostic recommendations of the neurologic guidelines. Magnetic resonance imaging. Magnetic resonance imaging Magnetic resonance imaging is certainly the most important ancillary test; it can directly reveal inflammation of the optic nerve, typically as contrast uptake in a contrast-enhanced T1 sequence Figure 3b.
MRI diagnostic criteria for multiple sclerosis. The relation between optic neuritis and multiple sclerosis. Cerebrospinal fluid examination Cerebrospinal fluid CSF examination is generally performed in Germany as part of the clinical evaluation of optic neuritis, but this is not currently an international standard Visual evoked potentials Optic neuritis delays the latency of visual evoked potentials.
The relation between optic neuritis and multiple sclerosis The Optic Neuritis Treatment Trial yielded precise figures on the risk of developing multiple sclerosis. Elevated risk of multiple sclerosis. Clinically isolated syndrome. The role of optical coherence tomography Optical coherence tomography OCT is now an increasingly used tool in research on the pathogenesis and treatment of multiple sclerosis.
Acute treatment A number of randomized, controlled, double-blind trials of cortisone for the treatment of optic neuritis were evaluated in a meta-analysis in Acute treatment.
The special case of neuromyelitis optica. Beta-interferon and glatiramer acetate. Immune prophylaxis of multiple sclerosis Beta-interferons and glatiramer acetate have been used for two decades to lessen the number of new and active multiple sclerosis lesions on MRI and the number of clinical relapses, and, in the long term, to slow the progression of neurologic impairment.
Table 3 Clinical trials on the prevention of conversion of a clinically isolated syndrome to clinically definite multiple sclerosis. Drug treatment to promote optic nerve regeneration. Drug treatment to promote optic nerve regeneration No current treatment can restore the function of a damaged optic nerve. Question 1 What is the incidence of optic neuritis in central Europe? Visual acuity measurement Perimetry Visual evoked potentials VEP Swinging flashlight test Optical coherence tomography Question 3 For what type of optic neuritis are antibodies to aquaporin-4 pathognomonic?
Typical optic neuritis as a presentation of multiple sclerosis Neuromyelitis optica NMO Chronic recurrent immune optic neuritis CRION Neuroretinitis Infection-associated optic neuritis Question 4 Which of the following is more compatible with a tumor compressing the optic nerve than with optic neuritis?
The patient cannot date the onset of the problem precisely. The opposite eye also has mild visual field defects. Visual field examination reveals a central scotoma. The optic disc is swollen. The visual acuity is 1. Question 5 According to the guidelines, how should optic neuritis be treated? Visual acuity measurement Perimetry Testing of color perception Visual evoked potentials VEP Testing of visual contrast perception Question 8 The MRI findings in what disease are most likely to be misdiagnosed as showing optic neuritis?
Faster recovery of vision Less permanent damage to vision A disability score that is 1. Footnotes Conflict of interest statement Prof. Schabet states that he has no conflict of interest. References 1. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med. The incidence of clinically isolated syndrome in a multi-ethnic cohort. J Neurol.
Morrow MJ, Wingerchuk D. J Neuroophthalmol. Movement phosphenes in optic neuritis: a new clinical sign. The time course and phenotype of Uhthoff phenomenon following optic neuritis.
Mult Scler. Eur Neurol. Baseline visual field profile of optic neuritis. The experience of the optic neuritis treatment trial. Optic Neuritis Study Group. Arch Ophthalmol. Differential diagnoses to MS: experiences from an optic neuritis clinic. Leo-Kottler B, Wissinger B.
Lebersche Optikusneuropathie. Neuroretinitis: review of the literature and new observations. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Petzold A, Plant GT. Chronic relapsing inflammatory optic neuropathy: a systematic review of cases reported. Leitlinie Nr. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up.
Arch Neurol. Diagnostic criteria for multiple sclerosis: revisions to the McDonald criteria. Ann Neurol. Risk of multiple sclerosis after optic neuritis in patients with normal baseline brain MRI. J Clin Neurosci. Retinal damage in multiple sclerosis disease subtypes measured by high-resolution ptical coherence tomography. Mult Scler Int. Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography.
Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev. Beck RW. The optic neuritis treatment trial. Implications for clinical practice.
Methylprednisolone increases neuronal apoptosis during autoimmune CNS inflammation by inhibition of an endogenous neuroprotective pathway. J Neurosci. Methylprednisolone fails to preserve retinal ganglion cells and visual function after ocular ischemia in rats.
Invest Ophthalmol Vis Sci. The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists. Effects of IV methylprednisolone on brain atrophy in relapsing-remitting MS.
Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis COPOUSEP : a randomised, controlled, double-blind, non-inferiority trial. A randomized, controlled trial of oral high-dose methylprednisolone in acute optic neuritis. Treatment of optic neuritis by plasma exchange add-on in neuromyelitis optica. Re-evaluating the treatment of acute optic neuritis. J Neurol Neurosurg Psychiatry. A Phase II study of the safety and efficacy of teriflunomide in multiple sclerosis with relapses.
Randomized trial of oral teriflunomide for relapsing multiple sclerosis. Placebo-controlled phase 3 study of oral BG for relapsing multiple sclerosis.
Ellrichmann G, Gold R. Akt Neurol. Steinbrecher A. LINGO-1 antagonists as therapy for multiple sclerosis: in vitro and in vivo evidence. Expert Opin Biol Ther. A randomized, double-blind, phase II study on erythropoietin in optic neuritis. Simvastatin improves final visual outcome in acute optic neuritis: a randomized study. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. Association between immediate initiation of intramuscular interferon beta-1a at the time of a clinically isolated syndrome and long-term outcomes: a year follow-up of the controlled high-risk avonex multiple sclerosis prevention study in ongoing neurological surveillance.
Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study.
Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome PreCISe study : a randomised, double-blind, placebo-controlled trial. Support Center Support Center. External link. Please review our privacy policy. Foci of demyelination in the spinal cord, antibodies against aquaporin High-dose steroid therapy, plasmapheresis, immune prophylaxis.
Optic neuritis due to an autoimmune disease other than multiple sclerosis. High-dose steroid therapy, treatment of the underlying disease. ETOMS e2. Estudio de autoinmundad ANA, etc. Estudio Gram y cultivo de virus y bacterias. Los episodios leves que no limitan la actividad o la asistencia al colegio no requieren corticoterapia. Neurology Perspectives. ISSN: Read this article in English. DOI: Optic neuritis in paediatric patients: Experience over 27 years and a management protocol.
Descargar PDF. Monge Galindo a ,. Autor para correspondencia. Under a Creative Commons license. Recibido 11 septiembre Aceptado 06 enero Tabla 1. Tabla 2. Conclusiones Habitual curso favorable. Palabras clave:. Material and methods We conducted a descriptive, retrospective study of patients with ON over a year period A review of the available scientific evidence was performed in order to draft the protocol and fact sheet.
Results Our neuropaediatrics department has assessed 20, patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis MS , 1 had clinically isolated syndrome CIS , 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously.
A management protocol and fact sheet are provided. Conclusions ON usually has a favourable clinical course. The use of protocols and fact sheets is important.
Texto completo. Figura 1. Figura 2. Clinics, in Developmental Medicine N. Inflammatory and autoimmune disorders of the nervous system in children. Optic neuritis in Children. London: Mac Keith Press; Neuro-Ophthalmology: Diagnosis and Management,. The clinical profile of optic, neuritis. Monge-Galindo, M. Lafuente-Hidalgo, R. Demand for neuropediatric services in a general referral hospital.
Rev Neurol, 25 , pp. Monge Galindo, J. Samper Villagrasa, J. Changes in the demand for paediatric neurology care in a spanish tertiary care hospital over a year period. Neurologia, 29 , pp. Optic neuritis in pediatric population: A review in current tendencies of diagnosis and management. J Optom, 7 , pp. Mizota, M.
Niimura, E. Clinical characteristics of Japanese children with optic neuritis. Pediatr Neurol, 31 , pp. Brady, A. Brar, A. Lee, D. Coats, E. Paysse, P. Optic neuritis in children: Clinical features and visual outcome. Wilejto, M. Shroff, J. Buncic, J. Kennedy, C. Goia, B. The clinical features, MRI findings, and outcome of optic neuritis in children. Neurology, 67 , pp. Hwang, Y. Lee, M. J Pediatr Ophthalmol Strabismus, 39 , pp.
Waldman, G. Liu, A. Lavery, G. Liu, W. Gaetz, T. Aleman, et al. Optical coherence tomography and visual evoked potentials in pediatric MS. Neurol Neuroimmunol Neuroinflamm. Dalton, P. Brex, K. Miszkiel, K. Fernando, D. MacManus, G. Plant, et al. Spinal cord MRI in clinically isolated optic neuritis.
J Neurol Neurosurg Psychiatry, 74 , pp. Waldman, L. Stull, S. Galetta, L. Balcer, G. Pediatric optic neuritis and risk of multiple sclerosis: meta-analysis of observational studies. Bonhomme, A. Balcer, A. Daniels, G. Tennekoon, S. Forman, et al. Pediatric optic neuritis: Brain MRI abnormalities and risk of multiple sclerosis.
Nilsson, E. Larsson, P. Maly-Sundgren, R. Perfekt, M. Predicting the outcome of optic neuritis: Evaluation of risk factors after 30 years of follow-up. J Neurol, , pp. Pirko, L. Blauwet, T. Lesnick, B.
The natural history of recurrent optic neuritis. Arch Neurol, 61 , pp. Matiello, V. Lennon, A. Jacob, S. Pittock, C. Lucchinetti, D. Wingerchuk, et al. NMO-IgG predicts the outcome of recurrent optic neuritis. Neurology, 70 , pp. Takagi, K. Tanaka, T. Suzuki, A. Miki, M. Nishizawa, H. Anti-aquaporin-4 antibody-positive optic neuritis. Acta Ophthalmol, 87 , pp.
Graus, M. Titulaer, R. Balu, S. Benseler, C. Bien, T. Cellucci, et al.
0コメント