title: Re-evaluating the treatment of acute optic neuritis.
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, re-establish normal physiology and restore optimal neurological function.
authors.affiliation: Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Bennett
authors.affiliation: Department of Medical Affairs, Questcor Pharmaceuticals, Inc., Hayward, California, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Nickerson
authors.affiliation: Departments of Clinical Neurosciences and Surgery, University of Calgary, Hotchkiss Brain Institute, Alberta, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Costello
authors.affiliation: Neuro-Ophthalmology Service, Wills Eye Institute, Thomas Jefferson University Medical College, Philadelphia, Pennsylvania, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Sergott
authors.affiliation: Minneapolis Clinic of Neurology, Minneapolis, Minnesota, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Calkwood
authors.affiliation: Department of Neurology, Division of Neuro-Ophthalmology, NYU Langone Medical Center, New York, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Galetta
authors.affiliation: Department of Neurology, Division of Neuro-Ophthalmology, NYU Langone Medical Center, New York, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Balcer
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Clyde E
authors.initials: CE
authors.lastname: Markowitz
authors.affiliation: Rockefeller University and Memorial Sloan-Kettering Hospital, Weill Cornell Medical College, New York, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Vartanian
authors.affiliation: Department of Neurology, Harbor-University of California Los Angeles Medical Center, Torrance, California, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Morrow
authors.affiliation: Neuro-Ophthalmology Service, Wills Eye Institute, Thomas Jefferson University Medical College, Philadelphia, Pennsylvania, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Moster
authors.affiliation: Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Taylor
authors.affiliation: College of Nursing at the University of Arizona, Tucson, Arizona, USA.
authors.forename: Thaddeus W W
authors.initials: TW
authors.lastname: Pace
authors.affiliation: Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Frohman
authors.affiliation: Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Frohman
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D004921:Erythropoietin / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D010951:Plasma Exchange; D057109:Scanning Laser Polarimetry
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D004921:Erythropoietin
keywords: MULTIPLE SCLEROSIS; NEUROOPHTHALMOLOGY; VISION