Multiple Sclerosis Risk After Optic Neuritis

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Abstract
Optic neuritis, an acute inflammatory disorder of the optic nerve, typically presents with sudden monocular visual loss and eye pain in young adults, more commonly in women. It is a common initial manifestation of multiple sclerosis (MS).1 When optic neuritis occurs, brain magnetic resonance imaging (MRI) often demonstrates white-matter T2-weighted signal abnormalities consistent with demyelination (hereinafter referred to as lesions).2 The Optic Neuritis Treatment Trial (ONTT) was a randomized trial that evaluated the use of corticosteroids in the treatment of acute optic neuritis. The ONTT showed that a 3-day course of methylprednisolone sodium succinate given intravenously in a dose of 250 mg every 6 hours followed by 2 weeks of oral prednisone in a dose of 1 mg/kg/d accelerated visual recovery but did not improve the eventual visual outcome.3,4 Treatment with oral prednisone alone in a dose of 1 mg/kg/d for 2 weeks also did not improve visual outcome and was associated with an increased rate of optic neuritis recurrences. An unexpected finding was that those who received intravenous corticosteroids followed by oral corticosteroids had a temporarily reduced risk of development of a second demyelinating event consistent with MS during the first 2 years compared with subjects who received oral corticosteroids alone or placebo.5