Treatment of Acute Retrobulbar Neuritis With Corticotrophin

A trial of corticotrophin gelatin injection in acute optic neuritis

“…These conclusions are contrary to general opinion and to the conclusions reached in other trials, which have been that ACTH speeds recovery in acute episodes of multiple sclerosis (Miller et al, 1961;Rinne et al, 1968) including acute optic neuritis (Rawson et al, 1966(Rawson et al, , 1969.…”

“…The presenting features and follow-up findings in the present series of patients with acute unilateral optic neuritis are essentially the same as those reported in the literature for untreated patients (Wybar, 1952;Lynn, 1959;Hyllested and Moller, 1961;Bradley and Whitty, 1967;Rawson et al, 1966Rawson et al, , 1969. The only significant difference is the high incidence of residual central visual field defects in the present series, which probably reflects the greater sensitivity of the method used for analysing the central visual field.…”

“…A recent survey found that by one and six months after the attack, 50%4 and 75%0 respectively ofpatients had regained normal vision (Bradley and Whitty, 1967). Corticotrophin (ACTH) is widely used in the treatment of acute optic neuritis, though the evidence that it favourably affects the natural history comes from one trial in which (1) only patients presenting within 10 days of the onset of visual blurring were included; (2) the only measure of visual function used was acuity for near vision; and (3) significant benefit was shown only in the first month of treatment with corticotrophin gel (Rawson et al, 1966(Rawson et al, , 1969. However, many patients with acute optic neuritis are not seen within 10 days of the onset of visual impairment, and, though their vision may be improving when they are first seen, it is important to know whether to use ACTH.…”

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

“…For example, Rawson et al found that the speed of recovery in visual acuity was faster in patients receiving ACTH (40 units IM daily for 30 days; p < 0.01) compared to placebo over the first 30 days, although by 12 months there was no significant difference between groups. 30,31 Bowden et al 32 similarly demonstrated that visual acuity was the same at 12 months in patients treated with either ACTH (40 units IM daily for 30 days) or placebo. Kapoor et al showed no effect of IVMP (1000 mg/d × 3 days) compared to placebo on the visual outcome at 6 months in 66 individuals with ON lesions involving the optic canal.…”

“…76 All patient forms were reviewed without knowledge of the treatment arm by a neurologist experienced in MS. 76 Four other Class I and three other Class II corticosteroid treatment trials in ON that were relevant to this practice parameter were identified (see table 2). [30][31][32][33]39,[56][57][58][59] All were prospective, randomized, and placebo-controlled studies, although employing sample sizes considerably smaller than the ONTT. Thus, these studies lack the statistical power to exclude a therapeutic benefit to steroid treatment.…”