The effect of oral prednisolone on visual evoked potential latencies in acute optic neuritis monitored in a prospective, randomized, controlled study

Introduction: Optic neuritis is an inflammation of the optic nerve that usually affects young females. In Western countries, natural history and treatment of optic neuritis(ON) has been studied extensively. However aetiology, natural history, clinical features of ON and their relation to multiple sclerosis in Asian population needs to be defined yet. Methods: 30 patients who were diagnosed as optic neuritis were included between June 2013 to December 2014 at BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). A detailed history was obtained followed by examination of anterior and posterior segment. Assessment of visual acuity, color vision, contrast sensitivity, visual evoked potential (VEP),visual field and MRI of orbit and brain was done in all cases. All patients were treated with intravenous Methylprednisolone 500mg twice daily for 3 days followed by oral steroid for 11 days which was tapered in the next 4 days.The patients were reassessed at 2 weeks, 1 month and 3months. Results: Commonest presenting symptom was diminution of vision(65%). MRI showed multiple paraventricular oval plaques definite of multiple sclerosis in one patient and one was diagnosed as probable MS who had a single periventricular plaque. Visual evoked potential (VEP) showed increase in the mean P100 latency at 60’ and reduction in amplitude in eyes affected with optic neuritis compared to normal eyes. At 3 months follow up, 70% had good visual recovery (>6/18). The cause of non-improvement in vision was disc pallor. Optic disc pallor was detected in 37.5% of the eyes during follow up. Conclusions: Good visual recovery was observed in most eyes with acute optic neuritis. Multiple sclerosis was seen in 1 patient who had recurrent optic neuritis.

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Multifocal visual evoked potential evaluation for diagnosis of acute optic neuritis and for prediction of visual outcome and ganglion cell layer thinning following optic neuritis

Multiple Sclerosis Journal ◽

10.1177/1352458520975732 ◽

2020 ◽

pp. 135245852097573

Author(s):

Gorm Pihl-Jensen ◽

Benedikte Wanscher ◽

Jette Lautrup Frederiksen

Keyword(s):

Optic Neuritis ◽

Ganglion Cell ◽

Visual Function ◽

Visual Evoked Potential ◽

Evoked Potential ◽

Conduction Block ◽

Visual Outcome ◽

Multifocal Visual Evoked Potential ◽

Visual Evoked

Background:: While damage to the optic nerve following optic neuritis (ON) is readily quantifiable, the evaluation of prognosis for visual function and neuroaxonal loss in the acute ON is challenging. Objective:: The objective of this study is to investigate the value of multifocal visual evoked potential (mfVEP) in acute ON, diagnostically for acute ON and prognostically for visual outcome and subsequent ganglion cell/inner plexiform layer thickness (GCLIPLt). Methods:: A prospective cohort study of mfVEP and full-field visual evoked potential (ffVEP) in acute, unilateral ON (onset < 31 days) was conducted. Comparisons with healthy controls ( n = 30) and association analysis with follow-up optical coherence tomography (OCT) measurements (of the GCLIPLt) and visual function (Sloan low-contrast visual acuity (LCVA)) were conducted. Results:: Seventy-nine ON patients were included (mean: 17 days from onset). Excluding measurements with conduction block, ffVEP ( n = 54) and mfVEP ( n = 44) showed sensitivities of 89% and 84% to a specificity of 97%. 65/79 patients were re-examined (mean: 200 days follow-up). mfVEP amplitude and latency inter-eye asymmetry in acute ON correlated with GCLIPLt ( r = 0.587 and Spearman’s ρ = 0.597, for both, p < 0.001). mfVEP amplitude correlated with LCVA inter-eye asymmetry at follow-up ( r = 0.421, p < 0.001), mfVEP latency did not. Conclusion: mfVEP may support the prognostic evaluation of acute ON patients and prove valuable in future neuroprotective and remyelinating trials. In acute ON, the increase in diagnostic value of mfVEP to ffVEP may be limited due to widespread conduction block.

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Reader response: Longitudinal optic neuritis-unrelated visual evoked potential changes in NMO spectrum disorders

Neurology ◽

10.1212/wnl.0000000000010627 ◽

2020 ◽

Vol 95 (13) ◽

pp. 609-610

Author(s):

John J. Chen

Keyword(s):

Optic Neuritis ◽

Reader Response ◽

Visual Evoked Potential ◽

Evoked Potential ◽

Longitudinal Optic ◽

Spectrum Disorders ◽

Visual Evoked

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Interleukin-8 is associated with acute and persistent dysfunction after optic neuritis

Multiple Sclerosis Journal ◽

10.1177/1352458514537365 ◽

2014 ◽

Vol 20 (14) ◽

pp. 1841-1850 ◽

Cited By ~ 7

Author(s):

S Rossi ◽

C Motta ◽

V Studer ◽

C Rocchi ◽

G Macchiarulo ◽

...

Keyword(s):

Visual Acuity ◽

Optic Neuritis ◽

Proinflammatory Cytokines ◽

Inflammatory Cytokine ◽

Visual Evoked Potential ◽

Evoked Potential ◽

Neuronal Damage ◽

Low Contrast ◽

Acute Optic Neuritis ◽

Csf Levels

Background: Acute optic neuritis is often in association with multiple sclerosis (MS). Proinflammatory cytokines trigger neuronal damage in neuroinflammatory disorders but their role in optic neuritis is poorly investigated. Objective: The objective of this work is to investigate the associations of intrathecal contents of proinflammatory cytokines with transient and persistent dysfunctions after optic neuritis. Methods: In 50 MS patients followed for up to six months, cerebrospinal fluid (CSF) levels of IL-1β, TNF and IL-8 were determined, along with clinical, neurophysiological and morphological measures of optic neuritis severity. Results: Visual impairment, measured by high- and low-contrast visual acuity, and delayed visual-evoked potential (VEP) latencies were significantly correlated to IL-8 levels during optic neuritis. IL-8 at the time of optic neuritis was also associated with persistent demyelination and final axonal loss, inferred by VEP and optical coherence tomography measures, respectively. Contents of IL-8 were correlated to functional visual outcomes, being higher among patients with incomplete recovery. Multivariate analysis confirmed that IL-8 significantly predicted final visual acuity, at equal values of demographics and baseline visual scores. Conclusion: Our study points to IL-8 as the main inflammatory cytokine associated with demyelination and secondary neurodegeneration in the optic nerve after optic neuritis.

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