Start with IV and you’ll be full of glee; go straight to PO and you’ll be saying “No!” The Optic Neuritis Treatment Trial (ONTT) sought to determine the optimal treatment for acute optic neuritis. Patients with acute optic neuritis (aged 18-46), excluding those with previous optic neuritis in the same eye, were randomized to three groups: placebo (n = 150), IV methylprednisolone x3 days followed by oral prednisone x11 days (n = 151), and oral prednisone x14 days (n = 156).
Key Points:
Overall, the ONTT is a landmark study because led to a major shift in the treatment of optic neuritis. Before the trial, there was no clear treatment protocol, and the use of corticosteroids was questioned. The study clearly showed that treatment should start with IV methylprednisolone and should avoid starting with oral prednisone. It also showed that the presence of MRI lesions was a key prognostic indicator for the development of MS.
What feels like a brain tumor, acts like a brain tumor, but isn’t a brain tumor? Pseudotumor cerebri! The Idiopathic Intracranial Hypertension Trial (IIHT) sought to determine the effect of acetazolamide in reducing visual loss symptoms after 6 months of treatment, in conjunction with the standard diet and weight loss. Patients with a new diagnosis of IIH by modified Dandy criteria (aged 18-60 years), excluding those with previous IIH or IIH for more than 2 weeks, were randomized to two groups: placebo (n = 79) or acetazolamide (n = 86) for 6 months.
Key Points:
The IIHT showed that acetazolamide is effective medical therapy, both for lowering intracranial pressure and for treating the visual field defect of moderate idiopathic intracranial hypertension vision loss/papilledema. Normally the limitation to high doses are the side effects, and the side effects seen in this trial were known, such as paresthesia of the extremities, a metallic taste in the mouth, fatigue, and frequent urination. Acetazolamide, as well as weight loss, is the first-line treatment for IIH.
Content of The Lens is for medical education purposes only.
Copyright © 2021 The Lens Newsletter LLC - All Rights Reserved.