A randomized, controlled trial of oral high-dose methylprednisolone in acute optic neuritis

Abstract

Oral high-dose methylprednisolone treatment improves recovery from ON at 1 and 3 weeks, but no effect could be demonstrated at 8 weeks or on subsequent attack frequency.

Should patients with optic neuritis be treated with steroids?

“…Sixty patients were included in a single-center, randomized, placebo-controlled trial that evaluated oral methyprednisolone at a dose of 500 mg daily for three days, followed by a 10 day oral taper. There was a beneficial effect on vision at one and three weeks following the initiation of treatment, but not at 8 weeks, and there was no increased risk of demyelinating events in the treated group at one year (17) Optic neuritis associated with NMO is typically treated with high-dose IVCS, a practice adopted from the treatment of idiopathic optic neuritis, despite the lack of a clinical trial evaluating its efficacy specifically in NMO (20). The efficacy of high-dose IVCS (IVCS) was recently evaluated in comparison with plasma exchange (PLEX) plus IVCS in acute NMO relapses (21).…”

“…Although the ONTT showed no role for intermediate-dose (1 mg/kg daily) oral prednisone, there is limited data to support the use of high doses of oral prednisone in the treatment of optic neuritis (17). Sixty patients were included in a single-center, randomized, placebo-controlled trial that evaluated oral methyprednisolone at a dose of 500 mg daily for three days, followed by a 10 day oral taper.…”

Time to steroid treatment in severe acute optic neuritis

“…The possible mechanism for the steroid treatment effect may involve a suppression of the inflammation associated with acute ON, which in turn may limit the neuronal damage and accelerate visual function recovery (Beck et al., 1992; Kapoor et al., 1998; Sellebjerg, Nielsen, Frederiksen, & Olesen, 1999). This is supported by the current study's observation that nontreated patients experienced an early reduction in the pRNFL thickness and a delayed improvement of visual acuity and color mixing.…”

“…The finding that patients who received early onset treatment showed a faster recovery but ended with the same final visual function and retinal damage as the patients who were not treated, is in accordance with the results of several studies (Beck & Cleary, 1993; Naismith et al., 2009; Sellebjerg et al., 1999). It would seem logical that the earlier the steroid treatment is initiated, the better the chances of a beneficial effect, but other studies showing this (Nakamura et al., 2010; Plant et al., 2011) may have been hampered by underpowering, heterogeneity of the background diagnoses of the patients and inconsistencies in follow‐up.…”

Bilateral Retrobulbar Optic Neuritis, Guillain-Barre Syndrome and Asymptomatic Central White Matter Lesions Following Adult Measles Infection

“…Our patient regained normal vision three months after the initial steroid therapy. In previous reports (12,13) (25). As for measles encephalitis, most patients are treated with highdose steroids (6,9,21), although others are treated with IVIg with/without steroids (10,22 …”