Multicenter Clinical Trial for Evaluating Methylprednisolone Pulse Treatment of Idiopathic Optic Neuritis in Japan

Wakakura, Masato; Mashimo, Kimiyo; Oono, Shinji; Matsui, Yoshie; Tabuchi, Akio; Kani, Kazutaka; Shikishima, Keigo; Kawai, Kazushige; Nakao, Yosuke; Tazawa, Yutaka; Kiyosawa, Motohiro; Abe, Haruki; Ohba, Norio; Yago, Keiko; Maeda, Shogo; Sugita, Minoru; Ishikawa, Satoshi

doi:10.1016/s0021-5155(98)00071-9

Cited by 51 publications

(24 citation statements)

References 12 publications

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“…Corticosteroids shorten the duration of the attack, but the consensus of several studies and a meta-analysis is that they do not appear to change the long-term outcome. [34][35][36][37][38][39] Steroids have a risk of side effects, even if used short-term, including mood change, weight gain, insomnia, pancreatitis, avascular osteonecrosis, and psychosis. 29 In the UK, corticosteroids tend to be reserved for patients with atypical features, coincident problems in the fellow eye, if pain is particularly severe, or at the patient's request, although practice varies in different countries.…”

Section: Treatment Of Acute Typical Onmentioning

confidence: 99%

New developments in the treatment of optic neuritis

Jenkins

Toosy

2010

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Acute optic neuritis (ON) has various etiologies. The most common presentation is inflammatory, demyelinating, idiopathic, or "typical" ON, which may be associated with multiple sclerosis. This must be differentiated from "atypical" causes of ON, which differ in their clinical presentation, natural history, management, and prognosis. Clinical "red flags" for an atypical cause of ON include absent or persistent pain, exudates and hemorrhages on fundoscopy, very severe, bilateral, or progressive visual loss, and failure to recover. In typical ON, steroids shorten the duration of the attack, but do not influence visual outcome. This is in contrast to atypical ON associated with conditions such as sarcoidosis and neuromyelitis optica, which require aggressive immunosuppression and sometimes plasma exchange. The visual prognosis of typical ON is generally good. The prognosis in atypical ON is more variable. New developments aimed at designing better treatments for patients who fail to recover are discussed, focusing on recent research elucidating mechanisms of damage and recovery in ON. Future therapeutic directions may include enhancing repair processes, such as remyelination or adaptive neuroplasticity, or alternative methods of immunomodulation. Pilot studies investigating the safety and proof-ofprinciple of stem cell treatment are currently underway.

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Section: Treatment Of Acute Typical Onmentioning

confidence: 99%

New developments in the treatment of optic neuritis

Jenkins

Toosy

2010

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“…Um estudo multicêntrico para avaliar a eficácia da metilprednisolona endovenosa no tratamento da neurite óptica idiopática no Japão foi conduzido por Wakakura et al (75) . Os autores compararam dois grupos de pacientes com neurite óptica idiopática, um deles tratado com metilprednisolona IV 1g/dia por três dias, seguido por prednisona por 7 a 10 dias.…”

Section: Neurite óPtica Desmielinizanteunclassified

“…A prednisona oral não apenas demonstrou ser ineficaz, mas também ocasionou aumento da recorrência da neurite óptica. Wakakura et al (75) , no entanto, afirmam que a neurite óptica no Japão pode diferir da encontrada nos Estados Unidos, uma vez que a transformação de neurite ópti-ca idiopática para a EM é muito mais rara naquele país. Eles afirmam que o uso de metilprednisolona endovenosa pode não ter os mesmos benefícios para pacientes com neurite óptica no Japão, como os relatados nos Estados Unidos.…”

Section: Neurite óPtica Desmielinizanteunclassified

Neuro-oftalmologia: Sistema sensorial - parte I revisão 1997-1999

Lana-Peixoto

2002

Arq. Bras. Oftalmol.

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“…33 In 1999, Wakakura et al evaluated 66 patients with optic neuritis treated with either 1000 mg IVMP for 3 days or mecobalamin (500 mg/day) and found that IVMP improved the speed of visual recovery in the first several weeks (p < 0.05) but that visual function at 12 weeks and 1 year did not differ between the two groups. 13,58 Another oral methylprednisolone study has also been reported. The Tübingen study tested 50 patients, 39,57 14 of whom were treated patients with 100 mg of oral methylprednisolone for 3 days, subsequently tapering the dose by 20 mg every 3 days thereafter.…”

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confidence: 98%

“…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.…”

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confidence: 99%