Rodríguez-Acevedo B, Rovira A, Vidal-Jordana A, Moncho D, Pareto D, Sastre-Garriga J
Hospital Universitari Vall d´Hebron - UAB, Barcelona, España.
Rev Neurol. 2022 Feb 1;74(3):93-104. doi: 10.33588/rn.7403.2021473.
The main causes of optic neuritis (ON) are multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease, also known as MOGAD. When all screening is negative, we can speak of idiopathic ON, although this diagnosis should be provisional. ON can be diagnosed clinically and paraclinical tests are not routinely required to confirm it. However, tests such as magnetic resonance imaging (MRI), visual evoked potentials (VEP) and optical coherence tomography (OCT) can lend support to the diagnosis if the clinical presentation is atypical. The use of new MRI sequences, OCT, multifocal VEPs and the determination of neurofilaments has allowed ON to be used as a model for remyelination and neuroprotection, leading to phase II clinical trials. Some of these drugs, such as opicinumab, clemastine, phenytoin or simvastatin, have shown positive results; however, their clinical effect remains to be defined. It is accepted that corticosteroids do not improve the long-term prognosis of ON, although some retrospective studies suggest that there is a therapeutic window from the onset of symptoms. Plasmapheresis has also been shown to be effective in patients with ON. In this review we will address basic aspects of the management of ON, in the fundamental context of MS, NMOSD and MOGAD, with emphasis on etiopathogenic, diagnostic, prognostic and therapeutic developments.
视神经炎(ON)的主要病因包括多发性硬化症(MS)、视神经脊髓炎谱系障碍(NMOSD)以及髓鞘少突胶质细胞糖蛋白抗体病,也称为MOGAD。当所有筛查均为阴性时,我们可以称之为特发性ON,不过这一诊断应为临时性的。ON可通过临床诊断,通常无需辅助检查来确诊。然而,如果临床表现不典型,诸如磁共振成像(MRI)、视觉诱发电位(VEP)和光学相干断层扫描(OCT)等检查可为诊断提供支持。新型MRI序列、OCT、多焦VEP的应用以及神经丝的测定已使ON能够作为再髓鞘化和神经保护的模型,从而开展II期临床试验。其中一些药物,如opicinumab、氯马斯汀、苯妥英或辛伐他汀,已显示出阳性结果;然而,它们的临床效果仍有待确定。尽管一些回顾性研究表明从症状出现开始存在一个治疗窗口期,但普遍认为皮质类固醇并不能改善ON的长期预后。血浆置换在ON患者中也已显示出有效性。在本综述中,我们将探讨在MS、NMOSD和MOGAD的基本背景下ON管理的基本方面,重点关注病因、诊断、预后和治疗进展。