Nerve loss occurs in optic neuritis

Maghzi AH, Graves J, Revirajan N, Spain R, Liu S, McCulloch CE, Pelletier D, Green AJ, Waubant E. Retinal axonal loss in very early stages of multiple sclerosis. Eur J Neurol. 2015 . doi: 10.1111/ene.12722. [Epub ahead of print]

BACKGROUND AND PURPOSE:The lack of surrogates of clinical progression has limited the design of neuroprotection trials in multiple sclerosis (MS). Our aim was to study the association between time-domain optical coherence tomography measures and clinical and magnetic resonance imaging outcomes in early MS.
METHODS: Forty-three relapsing-remitting MS patients within 1 year of onset were followed for up to 3 years.
RESULTS: The peripapillary retinal nerve fiber layer (RNFL) decreased annually by 2 μm (95% confidence interval -3.89, -0.11; P = 0.038). The RNFL tended to be associated with normalized normal appearing white matter volume in cross-sectional (P = 0.08) and longitudinal analyses (P = 0.06).
CONCLUSIONS: There is substantial RNFL loss even in very early MS. Our data suggest that retinal axonal atrophy is associated with atrophy in global white matter volume in early MS.

We know that nerves get damaged during optic neuritis and that this occurs from the earliest stages and that occurs at the the onset of MS. The good news is that ProfG and Dr Kapoor showed that you can protect against this nerve loss by treating with a new protector. So the question posed was what next. They could try and see if this works in progression or see if it saves nerves after a relapse or alternatively maybe they should do the same thing again and show it works again and then maybe people with optic neuritis would get treated, people with optic neuritis would be less likely to lose sight, and ProfG and Kapoor will get an impact statement for their work in Ref 2020.

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  • GIven that MSers are losing their vision, and the results of the early phenytoin trial, neuros should have the guts to start prescribing this safe drug to their patients. I don't want to hear the usual rubbish about licensing etc. If patients have a disease which results in optic nerve loss and there is a safe drug which offers some protection, it is totally unethical for doctors to deny patients this drug.

    • You don't understand how the process works. The drug, phenytoin in this case, has to be licensed for a new application (as I understand it) and this approval will not be granted until further proof (from phase III trials) is presented. At least the process has been started and we are as frustrated by the slowness of the process as you are.

  • What I am finding interesting is that either vitamin B12 or vit B1 deficiency can cause optic neuropathy. Also that these different B vitamins are very important in MS. These different B vitamins have a very inportant role to play with nerves, although this has been known for a long time. B12 deficiency treated with vitamin B complex.

    Am J Ophthalmol. 1977 Apr;83(4):465-8.
    Optic neuropathy associated with vitamin B12 deficiency.
    Stambolian D, Behrens M.

    Also optic neuropathy from vit B1 deficiency.
    Intern Med. 1997 Jul;36(7):532.
    Optic neuropathy from thiamine deficiency.
    Suzuki S, Kumanomido T, Nagata E, Inoue J, Niikawa O.



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