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Management of optic neuritis.

Menon V, Saxena R, Misra R, Phuljhele S - Indian J Ophthalmol (2011 Mar-Apr)

Bottom Line: Optic neuritis is an inflammatory condition of the optic nerve characterized by a sudden onset of unilateral visual loss, usually affecting young females.Demyelination associated with multiple sclerosis (MS) is the most common cause in regions where MS is prevalent; while in other places, there are a substantial proportion of cases where infective or autoimmune causes are seen.However, due to the low prevalence of MS reported in Asian studies, high cost of therapy and indefinite time period of treatment, it may not be cost effective to start interferon therapy in most cases.

View Article: PubMed Central - PubMed

Affiliation: Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Optic neuritis is an inflammatory condition of the optic nerve characterized by a sudden onset of unilateral visual loss, usually affecting young females. Demyelination associated with multiple sclerosis (MS) is the most common cause in regions where MS is prevalent; while in other places, there are a substantial proportion of cases where infective or autoimmune causes are seen. Optic Neuritis Treatment Trial (ONTT) was the first major study that provided information on the natural history, role of steroids in treatment and risk of development of MS. Subsequently, numerous clinical trials have evaluated different modalities of management of optic neuritis and MS. The Controlled High-Risk Subjects Avonex Multiple Sclerosis Prevention Study (CHAMPS); the Prevention of Relapses and Disability by Interferon β-1a Subcutaneously in Multiple Sclerosis (PRISMS) Trial; and, most recently, the Betaferon in Newly Emerging Multiple Sclerosis for Initial Treatment (BENEFIT) Study have provided large amount of information on the natural history of optic neuritis and management options available. However, due to the low prevalence of MS reported in Asian studies, high cost of therapy and indefinite time period of treatment, it may not be cost effective to start interferon therapy in most cases.

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Management protocol for patients of optic neuritis
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Figure 0002: Management protocol for patients of optic neuritis

Mentions: Region-wise estimates of the incidence of demyelinating optic neuritis are unavailable. Optic neuritis is reported to have an incidence of 1-5 cases per 100,000/year; higher the latitude, higher was found to be the incidence of optic neuritis.[18–20] While the estimated prevalence of MS in the United States and England is 46 per 100,000 and 93 per 100,000, respectively,[2] the prevalence in eastern countries varies from 0.77 to 1.8 per 100,000,[2122] suggesting that the profile of optic neuritis patients is different in the eastern and western parts of the world. The optico-spinal variant of MS, which is characterized by involvement of only the optic nerves and spinal cord with no brain lesions, is more prevalent in this part of the world and can be easily misdiagnosed as NMO, which again is widespread in this region.[1323] Pandit et al.[24] found 47% of their MS cases to have clinical attacks confined to the optic nerve and spinal cord. There are no large-scale epidemiological studies from India on the incidence and prevalence of MS. Indian studies have shown that MS constitutes 0.32% to 1.58% of neurology admissions in hospitals,[25–28] and a prevalence of approximately 1.33/100,000 was reported by Singhal et al. in the mid-eighties from the west coast of India.[29] However, the incidence of NMO has been reported to be 9.5% in a recent study in India.[24]


Management of optic neuritis.

Menon V, Saxena R, Misra R, Phuljhele S - Indian J Ophthalmol (2011 Mar-Apr)

Management protocol for patients of optic neuritis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116540&req=5

Figure 0002: Management protocol for patients of optic neuritis
Mentions: Region-wise estimates of the incidence of demyelinating optic neuritis are unavailable. Optic neuritis is reported to have an incidence of 1-5 cases per 100,000/year; higher the latitude, higher was found to be the incidence of optic neuritis.[18–20] While the estimated prevalence of MS in the United States and England is 46 per 100,000 and 93 per 100,000, respectively,[2] the prevalence in eastern countries varies from 0.77 to 1.8 per 100,000,[2122] suggesting that the profile of optic neuritis patients is different in the eastern and western parts of the world. The optico-spinal variant of MS, which is characterized by involvement of only the optic nerves and spinal cord with no brain lesions, is more prevalent in this part of the world and can be easily misdiagnosed as NMO, which again is widespread in this region.[1323] Pandit et al.[24] found 47% of their MS cases to have clinical attacks confined to the optic nerve and spinal cord. There are no large-scale epidemiological studies from India on the incidence and prevalence of MS. Indian studies have shown that MS constitutes 0.32% to 1.58% of neurology admissions in hospitals,[25–28] and a prevalence of approximately 1.33/100,000 was reported by Singhal et al. in the mid-eighties from the west coast of India.[29] However, the incidence of NMO has been reported to be 9.5% in a recent study in India.[24]

Bottom Line: Optic neuritis is an inflammatory condition of the optic nerve characterized by a sudden onset of unilateral visual loss, usually affecting young females.Demyelination associated with multiple sclerosis (MS) is the most common cause in regions where MS is prevalent; while in other places, there are a substantial proportion of cases where infective or autoimmune causes are seen.However, due to the low prevalence of MS reported in Asian studies, high cost of therapy and indefinite time period of treatment, it may not be cost effective to start interferon therapy in most cases.

View Article: PubMed Central - PubMed

Affiliation: Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Optic neuritis is an inflammatory condition of the optic nerve characterized by a sudden onset of unilateral visual loss, usually affecting young females. Demyelination associated with multiple sclerosis (MS) is the most common cause in regions where MS is prevalent; while in other places, there are a substantial proportion of cases where infective or autoimmune causes are seen. Optic Neuritis Treatment Trial (ONTT) was the first major study that provided information on the natural history, role of steroids in treatment and risk of development of MS. Subsequently, numerous clinical trials have evaluated different modalities of management of optic neuritis and MS. The Controlled High-Risk Subjects Avonex Multiple Sclerosis Prevention Study (CHAMPS); the Prevention of Relapses and Disability by Interferon β-1a Subcutaneously in Multiple Sclerosis (PRISMS) Trial; and, most recently, the Betaferon in Newly Emerging Multiple Sclerosis for Initial Treatment (BENEFIT) Study have provided large amount of information on the natural history of optic neuritis and management options available. However, due to the low prevalence of MS reported in Asian studies, high cost of therapy and indefinite time period of treatment, it may not be cost effective to start interferon therapy in most cases.

Show MeSH
Related in: MedlinePlus