journal review presentation

7/25/2019 Journal Review Presentation

1/23

Journal Review

Dea Lita Barozha, S.ked

1118011027

dr. Aryanti, Sp. M

Comparing Treatment or !pti" #e$riti%

&Papilitis'


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(ntrod$"tion

!pti" ne$riti% &!#' i% an acute infammatorycondition aecting the optic nervein yo$ngad$)t% predominant)y. (t i% "a$%ed *y idiopathicinfammatory demyelination o the opti"

ner+e, a)tho$gh there i% a)%o e+iden"e o aona))o%%.

The patient-% "omp)aint% in")$de *oth sudden,unilateral worseningo +i%$a) a"$ity rangingrom mi)d +i%$a) di%t$r*an"e to +i%$a) )o%% andmovement induced ocular pain.

a$man D(, Tro*e /D, ggen*erger , hitaker /#,3ra"ti"e parameter4 the ro)e o"orti"o%teroid% in the management o a"$te mono%ymptomati" opti" ne$riti%. eport o

the 5$a)ity Standard% S$*"omitee o the Ameri"an A"ademy o #e$ro)ogy &1', Am /!phtha)mo), 2000610&'491.


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pidemio)ogy

(t% in"iden"e amo$nt% to 1:9 per100,000 per year, *eing more

re;$ent in Ca$"a%ian%,

"o$ntrie% at high )atit$de% and in%pring.

S$*%tantia) ema)epredominan"e among the

patient% i% noted. !# i% o$nd to*e a re;$ent initia)

manie%tation o m$)tip)e%")ero%i% &MS', a% $p to 90 < o!# "a%e% are )ike)y to progre%%

into MS =ithin 19 year%.

a$man D(, Tro*e /D, ggen*erger , hitaker /#,3ra"ti"e parameter4 the ro)e o"orti"o%teroid% in the management o a"$te mono%ymptomati" opti" ne$riti%. eport othe 5$a)ity Standard% S$*"omitee o the Ameri"an A"ademy o #e$ro)ogy &1', Am /

!phtha)mo), 2000610&'491.


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Diagnostic Criteria

!# i% a %e)>)imiting "ondition, progressing over hoursto 10 days and spontaneously improving within upto 8 weeks. S$"h a "ondition not pre%enting re"o+ery=ithin 8 =eek% %ho$)d re;$ire $rther in+e%tigation andmay impo%e other diagno%i% imp)ementation.! can

usually "e diagnosed taking only clinical #eaturesin to consideration.

a$man D(, Tro*e /D, ggen*erger , hitaker /#,3ra"ti"e parameter4 the ro)e o"orti"o%teroid% in the management o a"$te mono%ymptomati" opti" ne$riti%. eport othe 5$a)ity Standard% S$*"omitee o the Ameri"an A"ademy o #e$ro)ogy &1', Am /!phtha)mo), 2000610&'491.


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A $ni)atera) S$*a"$te pain$) +i%$a) )o%% =hi"h i% not a%%o"iated =ith any %y%temi"

di%ea%e or other ne$ro)ogi"a) %ymptom%. ?i%$a) a"$ity might deteriorate to zero )ight per"eption in the

a@e"ted eye minor a% *)$rry +i%ion on)y "o)o$r +i%ion di%t$r*an"e o a non>%pe"i" pattern "ontra%t %en%iti+ity red$"tion 3hotop%ia% re)ati+e a@erent p$pi))ary ree &A3D' and +i%$a) e)d )o%% pre%en"e.

The mo%t

"ommonpre%entation i%

retro*$)*ar ne$riti% "hara"teri%ed *y norma)di%" appearan"e6

papi))iti% =ith %=o))en opti" di%"6 perine$riti% in+o)+ing main)y the opti" ner+e

%heath =ith or =itho$t opti" di%" oedema6 and ne$roretiniti% =ith %=o))en opti" di%" and a

%tar g$re- o ma"$)ar e$date%.

3a$ et a). di+ided!# into o$r

")ini"a)"ategorie%,

depending on theanatomi"

)o"a)i%ation4

rzy*o=%ki A, 3ieniEFek M, Treatment o !pti" #e$riti%. eport oDepartment o !phtha)mo)ogy, 3oznan City Go%pita), $ropean!phtha)mi" /o$rna), 20167&1'492:9 D!(4 10.17H29I!.201.07.01.92


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CJ#T

TATM#T !KACJT !3T(C

#J(T(S


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1. Corti"o%teroid%$n 1%&1' (iller and colleagues

demon%trated that patient% =ith m$)tip)e%")ero%i% &MS', =ho =ere treated =ith

corticotrophin recovered more)uickly and completely #rom acuterelapses than did patients treated

with saline.The emergen"e o intra+eno$%methy)predni%o)one or the treatment oa range o imm$ne>mediated di%order%

prompted it% app)i"ation or thetreatment o a"$te MS ea"er*ation%,

in")$ding A!#, =here*y ear)y *enet%=ere noted regarding the "o$r%e o

")ini"a) re"o+ery.

Bennett /L, #i"ker%on M, Co%te))o K, et al.J Neurol NeurosurgPsychiatry 3$*)i%hed !n)ine Kir%t4 please include Day Month earN

doi410.11OI Pnnp>201>08189


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(n 1HH2, the !pti" #e$riti% Treatment Tria) &!#TT' pro+ided ther%t "omprehen%i+e eamination o the *enet% o %teroid therapyor A!# in a )arge and repre%entati+e patient "ohort.

(n the !#TT, patient% =ere randomi%ed to re"ei+e p)a"e*o, ora)&)o=>do%e' predni%one &1 mgIkgIday or 1 day%' or high>do%eintra+eno$% methy)pred> ni%o)one &290 mg time% dai)y or day%', o)> )o=ed *y ora) predni%one &1 mgIkgIday or 11day%'.

At O month%, "o)o$r +i%ion and "ontra%t %en%iti+ity %igni"ant)yimpro+ed in the methy)pred> ni%o)one arm

ho=e+er, ater 1 year, there =a% no %igni"ant di@eren"e *et=eentreated and $ntreated patient% in any $n"tiona) o$t"ome%.


doi410.11OI Pnnp>201>08189


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(ntra+eno$% methy)predni%o)one=a% o$nd to a""e)erate the rate o

+i%$a) re"o+ery o+er the r%t 19day%.

ho=e+er, a %$*%e;$ent %t$dy%ho=ed no e@e"t o "orti"o%teroid%on opti" ner+e atrophy.


doi410.11OI Pnnp>201>08189


10/23

The na) o))o=>$p e+a)$ation %ho=ed that intra+eno$%"orti"o%teroid% o))o=ed *y ora) "orti"o%teroid% en%$red)o=er ri%k o m$)tip)e %")ero%i% &MS' o""$rren"e a% =e)) a%impro+ed +i%$a) re"o+ery period *$t had no impa"t onna) +i%$a) o$t"ome.

(ntere%ting)y, a %ma))er rate o re"$rren"e =ithin r%t 2year% o))o=ing the r%t epi%ode o !# treatment gro$p

"ompared to oral corticosteroids assigned group aswell as place"o group.The *ene"ia) e@e"t ointra+eno$% methy)predni%o)one treatment on thede+e)opment o MS )e%%ened ater 2 year%. By +e year%,the treatment had no %igni"ant e@e"t on thede+e)opment o MS, reported Be"k et a).

rzy*o=%ki A, 3ieniEFek M, Treatment o !pti" #e$riti%. eport oDepartment o !phtha)mo)ogy, 3oznan City Go%pita), $ropean

!phtha)mi" /o$rna), 20167&1'492:9 D!(4 10.17H29I!.201.07.01.92


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2. (ntra+eno$% imm$nog)o*$)in andp)a%ma e"hange

oed et al#ound no eecto (ntra+eno$% imm$nog)o*$)in &(?(g' on)ong>term +i%$a) $n"tion or on the )aten"y o +i%$a) e+oked potentia)&?3' re%pon%e% ater A!#. K$rther, (?(g did not improve visual#unction in patients with persistent vision loss a#ter *!.

$pre"ht et alo*%er+ed a signi+cant improvement in visual recoveryo))o=ing the in%tit$tion o 3LQ in "a%e% o rera"tory A!#6 ho=e+er, therapid $%e o 3LQ in thi% %t$dy may have masked any delayed "ene+tstill to "e derived #rom initial treatment with intravenousmethylprednisolone.(n a"t, the a$thor% noted that there is

signi+cant varia"ility in the magnitude and tempo o# e#+cacyderived #rom corticosteroid use among patients with *!. (ndeed,a %imi)ar degree o +aria*i)ity "an *e o*%er+ed in patient% =ho deri+e")ini"a) *enet% rom 3LQ, either in i%o)ation or o))o=ing "orti"o%teroidtreatment.


doi410.11OI Pnnp>201>08189


12/23

A re"ent %t$dy e+a)$ating the addition op)a%ma e"hange &3LQ' to intra+eno$%methy)predni%o)one in the a"$tetreatment o ne$romye)iti% opti"aM!'>a%%o"iated A!# showedsigni+cant improvements in high,contrast acuity, visual +elds andtemporal retinal nerve +"re layer

-R!/ thick, ness' *$t not )o=>"ontra%t )etter %"ore% or "o)o$r +i%ion.The ear)y, +rst,line use o# /23 in thetreatment o# *!' however' has yetto "e evaluated.


!phtha)mi" /o$rna), 20167&1'492:9 D!(4 10.17H29I!.201.07.01.92


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. rythropoietin

Sy%temi" in$%ion o erythropoietin =ith and=itho$t methy)predni%o)one ha% demon%trated

"ene+cial eects on retina) gang)ion "e))&C' $n"tion and %$r+i+a) in a rat mode) o

eperimenta) a$toimm$ne en"epha)omye)iti%.

rythropoietin admini%tration in"rea%ed protein)e+e)% o pho%pho>Akt, pho%pho>MA3 1 and 2and B")>2, indi"ating that a"ti+ation o the Akt%igna))ing path=ay may *e "riti"a) or )imiting

C apopto%i% ater A!#. $n com"ination withmethylprednisolone' erythropoietin led to

partial recovery o# pattern,reversal 42sand signi+cantly improved fashelectroretinograms -2R5s.

Diem , SRtt)er MB, Merk)er D, et al. Com*ined therapy=ith methy)predni%o)one and erythropoietin in a mode) o

m$)tip)e %")ero%i%. Brain (J) 20196128479:89.


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Treatment =ith erythropoietin re%$)ted in%igni"ant impro+ement in the a+erage

thi"kne%% o the peripapi))ary #KL &a% mea%$red*y opti"a) "oheren"e tomography &!CT'' and

impro+ed ?3 )aten"ie% at =eek 1O.

e"ent)y, a pha%e 2 ")ini"a) tria) "ompared%y%temi" erythropoi> etin =ith p)a"e*o in the

treatment o A!# in a %ma)) "ohort o patient%.


doi410.11OI Pnnp>201>08189


15/23

C4J%er%$%erDo"$ment%data.do"
http://c/Users/user/Documents/data.docxhttp://c/Users/user/Documents/data.docx


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!ew therapies #or

the treatment o#acute

demyelinatingin6ury


17/23

The array o MS therapie%ha% in"rea%ed rapid)y o+erthe pa%t de"ade. Therapie%appro+ed in the 1HH0%, >intereron and g)atiramera"etate, ha+e *een Poined

*y ne= treatment%

ho=e+er, ha% rare)y *een

e+a)$ated. Ba%ed on theirrapid on%et and C#S

penetration, %ome o the%ene=er MS therapie% mayo@er promi%e in )imiting

+i%ion )o%% and a"i)itating

re"o+ery ater A!#.


18/23

A %ing)e do%e o nata)iz$ma*, admini%tered %oon ater the on%et o an MSre)ap%e, did not ha%ten ")ini"a) re"o+ery *$t de"rea%ed enhan"ing )e%ion+o)$me

ngo)imod re"ent)y ha% %ho=n e"a"y in ame)iorating A!# in theeperimenta) a$toimm$ne opti" ne$riti% anima) mode) =hen admini%teredd$ring the e@e"tor pha%e o the di%ea%e.OO

A %imi)ar e@e"t ha% *een noted $%ing dimethy) $marate ater the on%et oC#S inammation in the eperimenta) a$toimm$ne en"epha)omye)iti%

mode).O7


doi410.11OI Pnnp>201>08189


19/23

The potentia)

ne$roprote"ti+ea"tion o ngo)imodand dimethy)

$marate in the%eanima) mode)%

%$gge%t% that the%eagent% may *e

idea))y %$ited orthe a"$te treatment

o A!#.


doi410.11OI Pnnp>201>08189


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The Betaeron in

#e=)y mergingM$)tip)e S")ero%i% or(nitia) Treatment&B#K(T' tria)

in+e%tigated thee@e"t o treatment

=ith intereron *eta>1* ater a ")ini"a))yi%o)ated %yndrome.

A% de%"ri*ed *yappo% et a).


!phtha)mi" /o$rna), 20167&1'492:9 D!(4 10.17H29I!.201.07.01.92


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Con")$%ion

The treatment regimen in the a"$te !# remain%a "ontro+er%ia) topi" in "$rrent ne$ro>

ophtha)mo)ogy.

!# i% a "ommon %e)>)imiting inammatory"ondition a@e"ting opti" ner+e, )inked =ith high

ri%k o de+e)oping MS. (t "a$%e% mi)d toimportant +i%$a) di%t$r*an"e% =hi"h $%$a))y

re"o+er =itho$t treatment.


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Sma)) %amp)e ")ini"a) tria)% pro+ing that the $%e o theadreno"orti"otrophi" hormone &ACTG' may ha%ten the %peed anddegree o re"o+ery o +i%$a) $n"tion in per%on% =ith a"$te

mono%ymptomati" !# ha+e *een "ond$"ted, a)tho$gh theirimp)ementation in the ")ini"a) pra"ti"e i% ar rom *eing +a%t and

proo$nd.

(ntra+eno$% imm$nog)o*$)in and p)a%ma e"hange ha+e notpro+en potent eno$gh to *e re"ommended on a ro$tine *a%i%.

Treatment =ith ora) predni%o)one in %tandard do%e% i%"ontraindi"ated in the treatment o a"$te !# d$e to in"rea%ing

the re"$rren"e rate% o !#.


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M$)tip)e ")ini"a) tria)% ha+e*een "ond$"ted in order toe%ta*)i%h the treatment

g$ide)ine% or a"$te !#,a)tho$gh the treatmentapproa"h remain%

"ontro+er%ia) and re;$ire%$rther in+e%tigationin")$ding )arge gro$p, )ong>

term o))o= $p %t$die%