Department of Neurology, Bakirkoy Professor Doctor Mazhar Osman Training and Research Hospital, Istanbul, Turkey.
Curr Opin Ophthalmol. 2012 Nov;23(6):472-6. doi: 10.1097/ICU.0b013e328358b202.
This article aims to provide a review of demyelinating optic neuritis as a presenting symptom of multiple sclerosis, clinical features, management options, and recent literature.
To date, several questions remain to be unsolved relating to the presentation, treatment, and implications of optic neuritis. Although some authors recommend high-dose corticosteroids for the treatment of acute demyelinating optic neuritis, there is still no consensus relating to corticosteroids treatment including the dosage and length of treatment. Studies have shown that the risk of developing clinically definite multiple sclerosis (MS) after presenting with a clinically isolated syndrome including optic neuritis is increased in patients with an abnormal brain MRI. Better diagnostic tools are needed to precisely predict the conversion to MS and the factors influencing disease severity to determine the most appropriate therapeutic paradigm and avoid unnecessary treatment.
Management of optic neuritis presenting as a demyelinating first event still remains inconclusive relating to the acute management and long-term treatment. But recent literature suggests high-dose corticosteroids for acute treatment and disease-modifying treatments may be a valuable option for long-term treatment. However, decision is very individualized and is based on the clinical and imaging findings of the patient.
本文旨在综述多发性硬化症以脱髓鞘性视神经炎为首发表现的临床特点、治疗选择及最新文献。
迄今为止，视神经炎的表现、治疗和影响仍存在一些悬而未决的问题。虽然一些作者建议使用大剂量皮质类固醇治疗急性脱髓鞘性视神经炎，但皮质类固醇治疗（包括剂量和治疗时间）仍无共识。研究表明，在以视神经炎为首发表现的临床孤立综合征患者中，脑 MRI 异常者发生临床确诊多发性硬化（MS）的风险增加。需要更好的诊断工具来精确预测向 MS 的转化以及影响疾病严重程度的因素，以确定最合适的治疗方案，避免不必要的治疗。
对于以脱髓鞘性首发事件表现的视神经炎的治疗，在急性治疗和长期治疗方面仍未有定论。但最新文献表明，急性治疗采用大剂量皮质类固醇，疾病修正治疗可能是长期治疗的一个有价值的选择。然而，决策非常个体化，取决于患者的临床和影像学表现。
