scholarly journals Manajemen Tatalaksana Neuritis Optik Demielinasi

2020 ◽  
Vol 8 (2) ◽  
pp. 73-79
Author(s):  
Okta Della Susmitha ◽  
Muhammad Yusran
Keyword(s):  
Multiple Sclerosis ◽  
High Risk ◽  
Literature Review ◽  
Optic Neuritis ◽  
Early Treatment ◽  
Treatment Trial ◽  
Interferon Β ◽  
Prevention Study ◽  
Optic Neuritis Treatment Trial

Pendahulan: Neuritis Optik (ON) didefinisikan sebagai inflamasi pada saraf optik, yang sebagian besar idiopatik. Namun dapat dikaitkan dengan penyebab lain seperti lesi demielinasi, gangguan autoimun, infeksi dan inflamasi. Dari semua ini, multiple sclerosis (MS) adalah penyebab paling umum dari demielinasi ON. Tujuan: Untuk mengetahui diagnosis dan tatalaksana neuritis optik demielinasi. Metode: Artikel ini dibuat dengan metode literature review, melibatkan 29 pustaka baik buku dan jurnal nasional atau internasional. Hasil: ON terjadi karena proses inflamasi yang mengarah pada aktivasi sel-T yang dapat melewati sawar darah otak dan menyebabkan reaksi hipersensitivitas terhadap struktur saraf. Mekanisme pastinya belum diketahui. Diagnosis klinis ON terdiri dari tiga gejala klasik yaitu kehilangan penglihatan, nyeri periokular dan dischromatopsia. Hal ini membutuhkan pemeriksaan oftalmik, neurologis dan sistemik yang cermat untuk membedakan antara ON spesifik dan tidak. Diagnosis banding diperlukan untuk membuat rencana tatalaksana yang tepat. Pembahasan: Menurut Optic Neuritis Treatment Trial (ONTT), pengobatan pertama adalah metilprednisolon intravena dengan pemulihan yang lebih cepat dan lebih sedikit kemungkinan kasus relaps dan konversi ke MS. Namun prednisolon oral saja dikontraindikasikan karena peningkatan risiko relaps. Controlled High-Risk Subjects Avonex® Multiple Sclerosis Prevention Study (CHAMPS) dan Early Treatment of MS study (ETOMS) dan telah melaporkan bahwa pengobatan dengan interferon β-1a, dengan hasil pengurangan risiko karakteristik MS dari MRI. Sensitivitas kontras, penglihatan warna dan bidang visual adalah parameter yang sebagian besar tetap terganggu bahkan setelah pemulihan ketajaman visual yang baik. Simpulan: Tatalaksana pada neuritis optik demielinasi dominan diberikan steroid dan interferon β-1a.   Kata kunci: demielinasi, multipel skeloris, neuritis optik, tatalaksana  

Optic Neuritis

2019 ◽  
pp. 3-8
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Optic Neuropathy ◽  
Clinical Characteristics ◽  
Acute Onset ◽  
Visual Recovery ◽  
Imaging Findings ◽  
Treatment Trial ◽  
Management Options ◽  
Optic Neuritis Treatment Trial

Optic neuritis is the most frequent cause of acute-onset optic neuropathy in young adults and is often encountered in clinical practice. In this chapter, we begin by reviewing the cardinal signs of optic neuropathy. We review the clinical characteristics and workup of optic neuritis. We review factors that increase the risk for developing multiple sclerosis. We discuss atypical clinical and imaging findings that should prompt further evaluation for other causes of optic neuritis, such as neuromyelitis optica. Lastly, we discuss the management options for optic neuritis, with reference to the findings from the Optic Neuritis Treatment Trial, and the prognosis for visual recovery.

scholarly journals Optic Neuritis in Southeast Asia: a Different Pattern of Disease

1970 ◽  
Vol 12 (4) ◽  
pp. 216-217
Author(s):  
James F. Cullen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Optic Neuritis ◽  
Treatment Trial ◽  
Resonance Imaging ◽  
Optic Disc Swelling ◽  
Retrobulbar Optic Neuritis ◽  
Optic Neuritis Treatment Trial ◽  
Autoimmune Aetiology

This review evaluates a number of recent studies on optic neuritis carried out in Singapore. In Singapore, and probably throughout Asia, the disease is more likely to be of the anterior variety with optic disc swelling, and is sometimes associated with an underlying infective process such as syphilis or tuberculosis, or is of an autoimmune aetiology. Most cases of optic neuritis seen in Singapore are idiopathic; multiple sclerosis is rarely seen in the region, but is likely to be found only in patients with retrobulbar optic neuritis. The 4-year risk for patients in Singapore developing multiple sclerosis is only 9.1% compared with the higher figures reported from the seminal Optic Neuritis Treatment Trial. The usefulness of magnetic resonance imaging in the management of optic neuritis in Singapore is reported.

scholarly journals Effect of fingolimod on MRI outcomes in patients with paediatric-onset multiple sclerosis: results from the phase 3 PARADIGMS study

2020 ◽  
Vol 91 (5) ◽  
pp. 483-492 ◽  
Author(s):  
Douglas L Arnold ◽  
Brenda Banwell ◽  
Amit Bar-Or ◽  
Angelo Ghezzi ◽  
Benjamin M Greenberg ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Early Treatment ◽  
Brain Atrophy ◽  
Treatment Discontinuation ◽  
Interferon Β ◽  
Phase 3 ◽  
Once Daily ◽  
T2 Lesions ◽  
Superior Efficacy

ObjectivePARADIGMS demonstrated superior efficacy and comparable safety of fingolimod versus interferon β-1a (IFN β-1a) in paediatric-onset multiple sclerosis (PoMS). This study aimed to report all predefined MRI outcomes from this study.MethodsPatients with multiple sclerosis (MS) (aged 10–<18 years) were randomised to once-daily oral fingolimod (n=107) or once-weekly intramuscular IFN β-1a (n=108) in this flexible duration study. MRI was performed at baseline and every 6 months for up to 2 years or end of the study (EOS) in case of early treatment discontinuation/completion. Key MRI endpoints included the annualised rate of formation of new/newly enlarging T2 lesions, gadolinium-enhancing (Gd+) T1 lesions, new T1 hypointense lesions and combined unique active (CUA) lesions (6 months onward), changes in T2 and Gd+ T1 lesion volumes and annualised rate of brain atrophy (ARBA).ResultsOf the randomised patients, 107 each were treated with fingolimod and IFN β-1a for up to 2 years. Fingolimod reduced the annualised rate of formation of new/newly enlarging T2 lesions (52.6%, p<0.001), number of Gd+ T1 lesions per scan (66.0%, p<0.001), annualised rate of new T1 hypointense lesions (62.8%, p<0.001) and CUA lesions per scan (60.7%, p<0.001) versus IFN β-1a at EOS. The percent increases from baseline in T2 (18.4% vs 32.4%, p<0.001) and Gd+ T1 (–72.3% vs 4.9%, p=0.001) lesion volumes and ARBA (–0.48% vs −0.80%, p=0.014) were lower with fingolimod versus IFN β-1a, the latter partially due to accelerated atrophy in the IFN β-1a group.ConclusionFingolimod significantly reduced MRI activity and ARBA for up to 2 years versus IFN β-1a in PoMS.

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