The effect of optic neuritis treatment trial (ONTT) combined corticosteroid regimen on pattern reversal visual evoked potentials: a prospective follow-up study

Abstract

Background The combined corticosteroid regimen of the original Optic Neuritis Treatment Trial (ONTT) is used in many centers to treat optic neuritis. Though pattern reversal visual evoked potentials (PRVEPs) are a sensitive, standard measure of visual conduction in optic neuritis, no studies hitherto have investigated the effect of combined ONTT regimen on PRVEPs. We aimed to determine the effect of combined corticosteroid regimen of the ONTT on changes of PRVEPs in patients with first-episode optic neuritis over 3 months post-treatment. Methods This is a prospective, observational study in which 44 patients with optic neuritis were seen pre-treatment (baseline) and follow-up, at 1 month (FU1) and 3 months (FU2). Twenty-nine patients were treated with ONTT combined regimen (ONTT+ Group) while 15 were conservatively managed without corticosteroids (ONTT- Group). The median latency and amplitude values of the P100 PRVEP component and the visual acuity (i.e. LogMAR values) at pre-treatment, FU1 and FU2 were compared in the two groups using Friedman’s rank test and Wilcoxon Signed Ranks test. Results Median P100 latency improved significantly (to the normal range) as early as by 1 month after the commencement of treatment in the ONTT+ Group, and then remained significantly lower than the baseline over next 2 months. In the ONTT- Group, the median P100 latency improved more slowly over the two follow up assessments and reached the normal range by 3 months. Median visual acuity values also improved significantly at 1 and 3 months after the commencement of treatment in the ONTT+ Group but not in the ONTT- Group. Conclusion ONTT combined corticosteroid regimen improves conduction in the visual pathways of patients with first-episode optic neuritis earlier than does conservative management. We provide electrodiagnostic evidence that combined ONTT regimen–compared with conservative management–results in early remission of visual conduction abnormalities in first-episode optic neuritis.

Clinical characteristics of patients presenting with the first-episode optic neuritis in a South Asian population: A study from Sri Lanka

“…We followed up 44 patients. Among them, 29 patients have been treated with optic neuritis treatment trial combined corticosteroid regimen, while 15 patients have been conservatively managed [20].…”

Visual electrophysiology in clinical practice: current status and future prospects in Sri Lanka.

“…Given that VEPs were not used as an outcome measure in this ONTT study, or even in other studies done in this regard to assess the efficacy of combined corticosteroid treatment, pattern reversal VEPs (PRVEP) have been used to assess the short-term recovery of visual conduction pathways in a cohort of Sri Lankan patients with optic neuritis who underwent treatment with combined ONTT regimen [9][10][11][12]. In this follow up study, interestingly, it was observed that there is a marked trend of improvement in P100 latency values in PRVEP in affected eyes in the ONTT combined regimen treated group immediately one month after the treatment, and further improvement was observed in 3 months after the pre-treatment, baseline assessment [13]. Therefore, it can be assumed that ONTT combined regimen could have accelerated the rate of recovery faster as shown by the original ONTT.…”