Treatment and Relapse Prevention of Typical and Atypical Optic Neuritis

Saitakis, George; Chwalisz, Bart K

doi:10.3390/ijms23179769

Cited by 8 publications

(7 citation statements)

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“…Appropriate and timely diagnosis is essential to rapidly decide on the appropriate treatment, maximize visual recovery, and minimize recurrences. Saitakis and Chwalisz [ 8 ] review the currently available state-of-the-art treatment strategies for many of these forms of optic neuritis, both in the acute phase and in the long term. The authors also discuss emerging therapeutic approaches and novel steps in the direction of achieving remyelination.…”

Section: Reviewsmentioning

confidence: 99%

“…As noted in the review by Saitakis and Chwalisz [ 8 ], one of the causes of acute optic neuritis, particularly that associated with simultaneous or sequential transverse myelitis, is the aquaporin 4 (AQP4) antibody-driven condition called neuromyelitis optica. Over the past decade, there have been significant advances in the biologic knowledge on NMOSD, which have resulted in the identification of variable disease phenotypes, biomarkers, and complex inflammatory cascades involved in the disease pathogenesis.…”

Section: Reviewsmentioning

confidence: 99%

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Optic Neuropathies: Current and Future Strategies for Optic Nerve Protection and Repair

Miller

Tsai

2023

IJMS

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Section: Reviewsmentioning

confidence: 99%

Section: Reviewsmentioning

confidence: 99%

Optic Neuropathies: Current and Future Strategies for Optic Nerve Protection and Repair

Miller

Tsai

2023

IJMS

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“…[9] Thus, it is essential to maximize visual recovery and minimize recurrences of OA. [30] Future research is required to determine the optimal long-term disease management strategy. [4]…”

Section: 5mentioning

confidence: 99%

Clinical characteristics and long-term follow-up outcomes of myelin oligodendrocyte glycoprotein antibody-associated disease in Han Chinese participants

Zeng,

Yu,

et al. 2023

Medicine

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Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an immune-mediated inflammatory demyelinating disease of the central nervous system. This study aimed to delineate the clinical manifestations, imaging features, and long-term outcomes in Chinese patients with MOGAD and analyze the recurrence-associated factors. The phenotypic and neuroimaging characteristics of 15 Han Chinese patients with MOGAD were retrospectively analyzed. Demyelinating attacks, MOG antibodies in the cerebrospinal fluid/serum, response to immunotherapy, follow-up outcomes, and recurrence-associated factors were recorded. The median age at disease onset was 34 years (range, 4–65 years). The most common initial presentations included vision loss (10/15, 66.7%) and seizures (5/15, 33.3%). Serum MOG-Ab titers in 14/15 cases were higher than those in the cerebrospinal fluid and were detected in 3/6 relapsed patients. Brain magnetic resonance imaging during acute attacks showed lesions in 10/15 patients (66.7%), mostly in the cortex/subcortical white matter (5/15, 33.3%). Recurrence occurred in 6/15 patients (40.0%); in 4 patients, recurrence occurred shortly after immunotherapy discontinuation. Residual neurological deficits were present in 5/15 patients (33.3%), including visual impairment, incapacitation, cognitive impairment, and speech reduction. Optic neuritis was the most common clinical manifestation of MOGAD. magnetic resonance imaging findings were heterogeneous and the cerebral cortex/subcortical white matter was the most susceptible brain region. Although patients in the acute phase responded well to methylprednisolone pulse therapy, the long-term recurrence rate was high. Consistently detected serum MOG antibodies and inappropriate maintenance immunotherapy may be associated with recurrence, and residual neurological deficits should not be ignored.

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“…A single demyelinating event failing to meet diagnostic criteria for MS, NMOSD, or MOGAD is referred to as clinically isolated syndrome (CIS). Some experts advocate for early treatment of CIS in patients deemed to be at high risk of conversion to MS [8 ▪▪ ], and some disease-modifying therapies (DMT) for MS have been approved for the chronic treatment of both MS and CIS. Several clinical trials, including the CHAMPS [9] (Controlled High-Risk Subjects Avonex Multiple Sclerosis Prevention Study), ETOMS [10] (Early Treatment of Multiple Sclerosis), BENEFIT [11] (Betaseron in Newly Emerging Multiple Sclerosis for Initial Treatment) and REFLEX [12] (REbif FLEXible dosing in early MS) trials, have demonstrated that interferon-β-1a reduces the rate of development of clinically definite MS in patients with CIS and two or more inactive typical lesions of multiple sclerosis on brain MRI.…”

Section: Idiopathic Optic Neuritis and Multiple-sclerosis Associated ...mentioning

confidence: 99%

“…It is not our practice to advocate for DMTs in patients with clinically isolated syndrome as not all will convert to clinically definite multiple sclerosis, potentially leading to unnecessary chronic immunomodulatory therapy. Further, there is limited data to suggest that early initiation of a DMT in patients with a diagnosis of CIS (as opposed to deferring DMT until a diagnosis of MS is reached) prevents long-term disability [8 ▪▪ ]. The studies discussed above did not specifically assess the role of those therapies in patients presenting with isolated optic neuritis and it is our practice to refer patients with 1 or more brain lesions to a neurologist with subspecialty training in demyelinating disease.…”

Section: Idiopathic Optic Neuritis and Multiple-sclerosis Associated ...mentioning

confidence: 99%

Evidence-based management of optic neuritis

Bergeron,

Bouffard

2023

Current Opinion in Ophthalmology

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Purpose of review Optic neuritis can result from several distinct causes, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody disease (MOGAD), when not idiopathic. This review discusses evidence-based treatment approaches contingent upon each specific cause of optic neuritis. Recent findings Current evidence highlights the need for prompt plasmapheresis as adjunct to intravenous methylprednisolone (IVMP) in patients with NMOSD-associated optic neuritis. Recent advances have included a proliferation of novel disease modifying therapies (DMTs) for long-term management of NMOSD and an understanding of how existing therapeutic options can be leveraged to optimally treat MOGAD. Summary In acute idiopathic or MS-associated optic neuritis, IVMP hastens visual recovery, though it does not substantially affect final visual outcomes. IVMP and adjunctive plasmapheresis are beneficial in the treatment of NMOSD-associated optic neuritis, with a shorter time-to-treatment associated with a higher likelihood of recovery. The natural history of untreated MOGAD-associated optic neuritis is unclear but treatment with IVMP is near-universal given phenotypic similarities with NMOSD. Long-term immunosuppressive therapy is warranted in patients with NMOSD as well as in patients with MOGAD with poor visual recovery or recurrent attacks.

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Treatment and Relapse Prevention of Typical and Atypical Optic Neuritis

Cited by 8 publications

References 188 publications

Optic Neuropathies: Current and Future Strategies for Optic Nerve Protection and Repair

Optic Neuropathies: Current and Future Strategies for Optic Nerve Protection and Repair

Clinical characteristics and long-term follow-up outcomes of myelin oligodendrocyte glycoprotein antibody-associated disease in Han Chinese participants

Evidence-based management of optic neuritis

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