Practice parameter: The role of corticosteroids in the management of acute monosymptomatic optic neuritis [RETIRED]

Kaufman, David I.; Trobe, Jonathan D.; Eggenberger, Eric; Whitaker, J. N.

doi:10.1212/wnl.54.11.2039

Cited by 111 publications

(54 citation statements)

References 79 publications

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“…In patients with ON a treatment with intravenous methylprednisolone (1 g per day for 35 days) can be considered to hasten recovery of visual acuity, however, this does not affect the longterm visual outcome [Brusaferri and Candelise, 2000;Kaufman et al 2000;Beck et al 1992]. A second steroid pulse (2 g per day) can be Figure 4.…”

Section: Discussionmentioning

confidence: 99%

Clinical approach to optic neuritis: pitfalls, red flags and differential diagnosis

Voß

Raab

Trebst

et al. 2011

Ther Adv Neurol Disord

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Demyelinating optic neuritis (ON) is the most common cause of optic neuropathy typically presenting with a subacute painful visual loss. In 20% of patients with multiple sclerosis (MS), ON is the presenting symptom and half of the patients with isolated ON develop MS within 15 years. The diagnosis of ON plays an important role in neurological practice. A correct and early diagnosis is necessary to ensure optimal further investigations and treatment. Other causes of optic neuropathies such as connective tissue disorders, infectious diseases, tumours or ischaemic neuropathies are less frequent but clinical and therapeutic management can differ dramatically. We present five patients admitted to our hospital with suspected demyelinating ON, but the clinical work up revealed different causes of optic neuropathy. We discuss the differential diagnosis of ON and clinical red flags that require careful diagnostic assessment of other diseases. A workflow for the diagnosis of optic neuropathies is presented.

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Section: Discussionmentioning

confidence: 99%

Clinical approach to optic neuritis: pitfalls, red flags and differential diagnosis

Voß

Raab

Trebst

et al. 2011

Ther Adv Neurol Disord

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“…However, she markedly improved within two weeks by increasing the cortisone equivalent dosage tenfold. Short term high dose cortisone treatment is regularly employed in infectious diseases like optic neuritis [12]. Th is treatment of high dose corticosteroids is considerably safe [13] and therefore a therapeutic attempt seemed reasonable.…”

Section: Discussionmentioning

confidence: 99%

Acute pandysautonomia – restitutio ad integrum by high prednisolone therapy

Struhal¹,

Hödl²,

Mazhar³

et al. 2011

Wien Klin Wochenschr

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Acute pandysautonomia is a rare disease defined as acute widespread and severe sympathetic and parasympathetic failure and sparing of somatic nerve fibers. The causes of this syndrome are often an autoimmune disease leading to autonomic ganglionopathy. The majority of cases have a poor prognosis with a chronic debilitating course. We present a previously healthy 24-year-old female patient, who developed a loss of accommodation, pupillotonia, lacrimation, swallowing disturbances, gastrointestinal symptoms and an atonic bladder with 750 ml residual volume. The Ewing battery showed signs of parasympathetic and sympathetic dysfunction leading to the diagnosis of acute pandysautonomia. Further tests failed to find a cause of acute neuropathy especially where there was no evidence for paraneoplastic or infectious etiology. The patient was treated with high dose intravenous prednisolone and completely recovered.

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“…Despite an abundance of useful data gathered from the ONTT and other clinical trials and case series, important questions remain regarding the use of corticosteroids in the treatment of optic neuritis, such as the optimal dose, timing, specific formulation, and route of administration (31,32) …”

Section: Future Researchmentioning

confidence: 99%

Should patients with optic neuritis be treated with steroids?

Mackay

2015

Current Opinion in Ophthalmology

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Summary: High-dose IVCS are effective in hastening visual recovery in acute typical optic neuritis, but do not affect the final visual outcome. In optic neuritis patients, IVCS may delay progression to clinically definite multiple sclerosis (CDMS) at 2 years, but not at 5 or 10 years. It is reasonable to recommend high-dose IVCS for acute optic neuritis patients with significant vision loss, severe pain, and/or white matter lesions on brain MRI in whom the potential for benefit outweighs the risks.

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Practice parameter: The role of corticosteroids in the management of acute monosymptomatic optic neuritis [RETIRED]

Cited by 111 publications

References 79 publications

Clinical approach to optic neuritis: pitfalls, red flags and differential diagnosis

Clinical approach to optic neuritis: pitfalls, red flags and differential diagnosis

Acute pandysautonomia – restitutio ad integrum by high prednisolone therapy

Should patients with optic neuritis be treated with steroids?

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