New developments in the treatment of optic neuritis

evelopments in the treatment of optic neuritis Review (6281) Total Article Views Authors: Thomas M Jenkins, Ahmed T Toosy Published Date June 2010 Volume 2010:2 Pages 83 - 94 DOI: http://dx.doi.org/10.2147/EB.S8386 Thomas M Jenkins1, Ahmed T Toosy2 1Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK; 2Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK Abstract: 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.