Re-evaluating the treatment of acute optic neuritis

Jeffrey L. Bennett, Molly Nickerson, Fiona Costello, Robert C. Sergott, Jonathan C. Calkwood, Steven L. Galetta, Laura J. Balcer, Clyde E. Markowitz, Timothy Vartanian, Mark Morrow, Mark L. Moster, Andrew W. Taylor, Thaddeus W W Pace, Teresa Frohman, Elliot Frohman

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)799-808
Number of pages10
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume86
Issue number7
DOIs
StatePublished - Jul 1 2015

Fingerprint

Optic Neuritis
Demyelinating Diseases
Aptitude
Adrenal Cortex Hormones
Wounds and Injuries
Therapeutics
Central Nervous System
Optic Nerve Injuries
Motion Perception
Nervous System Trauma
Depth Perception
Biomedical Technology Assessment
Electrophysiology
Response Elements
Optic Nerve
Adrenocorticotropic Hormone
Multiple Sclerosis
Optics

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Surgery
  • Arts and Humanities (miscellaneous)

Cite this

Bennett, J. L., Nickerson, M., Costello, F., Sergott, R. C., Calkwood, J. C., Galetta, S. L., ... Frohman, E. (2015). Re-evaluating the treatment of acute optic neuritis. Journal of Neurology, Neurosurgery and Psychiatry, 86(7), 799-808. https://doi.org/10.1136/jnnp-2014-308185

Re-evaluating the treatment of acute optic neuritis. / Bennett, Jeffrey L.; Nickerson, Molly; Costello, Fiona; Sergott, Robert C.; Calkwood, Jonathan C.; Galetta, Steven L.; Balcer, Laura J.; Markowitz, Clyde E.; Vartanian, Timothy; Morrow, Mark; Moster, Mark L.; Taylor, Andrew W.; Pace, Thaddeus W W; Frohman, Teresa; Frohman, Elliot.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 86, No. 7, 01.07.2015, p. 799-808.

Research output: Contribution to journalArticle

Bennett, JL, Nickerson, M, Costello, F, Sergott, RC, Calkwood, JC, Galetta, SL, Balcer, LJ, Markowitz, CE, Vartanian, T, Morrow, M, Moster, ML, Taylor, AW, Pace, TWW, Frohman, T & Frohman, E 2015, 'Re-evaluating the treatment of acute optic neuritis', Journal of Neurology, Neurosurgery and Psychiatry, vol. 86, no. 7, pp. 799-808. https://doi.org/10.1136/jnnp-2014-308185
Bennett JL, Nickerson M, Costello F, Sergott RC, Calkwood JC, Galetta SL et al. Re-evaluating the treatment of acute optic neuritis. Journal of Neurology, Neurosurgery and Psychiatry. 2015 Jul 1;86(7):799-808. https://doi.org/10.1136/jnnp-2014-308185
Bennett, Jeffrey L. ; Nickerson, Molly ; Costello, Fiona ; Sergott, Robert C. ; Calkwood, Jonathan C. ; Galetta, Steven L. ; Balcer, Laura J. ; Markowitz, Clyde E. ; Vartanian, Timothy ; Morrow, Mark ; Moster, Mark L. ; Taylor, Andrew W. ; Pace, Thaddeus W W ; Frohman, Teresa ; Frohman, Elliot. / Re-evaluating the treatment of acute optic neuritis. In: Journal of Neurology, Neurosurgery and Psychiatry. 2015 ; Vol. 86, No. 7. pp. 799-808.
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