Optic Neuritis Flashcards
What are the 4 types of optic neuritis?
- Perioptic Neuritis
- Neuroretinitis
- Papillitis
- Retrobulbar
This type of ON is inflammation is around the nerve sheath and ON. What 2 things cause this?
- Perioptic Neuritis
- Syphilis, Sarcoid
This type of ON is inflammation in ON and Retina.
Neuroretinitis
Is neuroretinitis related to MS?
No
What 2 workups are needed for a patient presenting with Neuroretinitis?
- Toxoplasmosis
2. Cat-Scratch Disease
What labs are used to rule out cat scratch disease?
- Bartonella Quintana
2. Bartonella Henselae
What is the tx for cat-scratch disease?
- Bactrim
- Gentamicin
- Ciprofloxacin
- Rifampin
- Azithromycin
This is ON inflammation at the optic disc only. What % of idiopathic ON cases is this?
Papillitis
- found in 35% of cases
This is ON inflammation behind the eye. What % of idiopathic ON cases is this?
Retrobulbar neuritis
- found in 65% of cases
Uhtoff’s phenomenon states what?
Tasks that raise the body temp worsen ON and cause transient blur
What area of the VF is mainly affected in ON?
Central 30 degrees 97.1%
Peripheral = 70%
NMO tends to affect what channels?
Aquaporin-4 channels
- causes demyelination
What does NMO affect in the body?
- Spinal Cord
- Optic Neuritis
(not brain!!!)
What are the typical features of NMO?
- Muscle Weakness
- Sensory dysfunction
- Bladder dysfunction
- Optic Neuritis
What is the workup for NMO?
Order NMO-IgG antibody testing
What is the acute tx for NMO?
- IV Methylprednisolone
2. Plasma Exchange (PLEX)
What is the maintenance therapy for NMO?
- IvIgG
2. Immunosuppressants
What are the top 3 low risk features that prove that MS may not be the cause?
- Severe disc edema
- Hemorrhages
- Absence of Pain
CSF analysis looks for what that’s presence in almost all MS patients?
- Oligoclonal bands
- bands with elevated IgG
What type of MRI is used to evaluate white matter in MS patients?
FLAIR
An MRI should be performed within how many days of an idiopathic ON?
- w/in 8 days
What tx should be started when an idiopathic optic neuritis is found?
- IV Methylprednisolone x 3 days
- Oral prednisone x 10 days
What is the chance of a patient developing MS in 15 years with 0 lesions and one or more lesions?
- 0 lesions = 25% chance
2. 1+ lesions = 75% chance
Via the ONTT study, treatment with prednisone alone is ?
Contraindicated
What is the treatment for ON w/ an abnormal MRI?
- IV methylprednisolone
- Oral prednisone taper
- Immunomodulating therapy
What is the most commonly used medications for MS?
Injectables
What are the 2 types of injectables?
- Interferon Beta
2. Copaxone
Extavia & Betaseron (IFN 1b) is administered how?
subcutaneous injection QOD
Avonex (IFN-b 1a) is administered how?
Intramuscular Injection QW
Rebif (1a) is administered how?
subcutaneous injection 3x a week
Plegridy (1a) is adminstered how?
subcutaneous injection q 14 days
Capaxone (Glatiramer Acetate) is administered how?
SC QD
Are orals safer than injectables? Why?
No, orals are not
- They cause PML
PML is caused by what virus?
JC virus - crosses the BBB
What is the mortality rate of pts with PML?
30-50% in the first few months
What was the first oral MS med? How is it adminstered?
Gilenya (fingolimod)
- PO QD
What type of MS is associated with optic neuritis?
Relapsing/Remitting form
What are the 5 type of injectable IFN-betas?
- Betaseron (SC QOD)
- Extavia (SC QOD)
- Avonex (IM QW)
- Rebif (SC 3x/w)
- Plegridy (SC q14days)
Which oral med is associated with increased macular edema?
Gilenya (Fingolimod)
If a pt needs steroids while on Gilenya, what will the doctor do to stop herpes virus reactivation?
Tx prophylactically w/ Valacyclovir
What class of meds must a patient on Gilenya avoid?
Class 1a and III antiarrhythmics, Calcium Channel and beta blockers
Tecfidera (Dimethyl fumarate) is an oral medication administered how many times a day?
PO BID
What are the SEs of Tecfidera?
- GI upsent and flushing
2. PML
What is the only oral med not associated with PML? What’s the pregnancy category?
Aubagio (Teriflunomide) (PO QD)
- Preg. Category X
Aubagio’s (Teriflunomide) efficacy is equal to what?
= to injectables
What oral med is indicated to tx motor dysfunction and gait impairment? This is taken how many times a day?
Fampyra (Fampridine)
- BID
What oral med is useful in the tx of acquired pendular nystagmus?
Namenda (Memantine)
What infusion has a definite association w/ PML having > 400 cases?
Tysabri (Natalizumab)
How many times is Tysabri administered?
IV infusion q 28 days (once a month)
Discontinuing Tysabri (natalizumab) abrudptly causes _____ and an aggressive recurrence of disease.
Immune reconstitution syndrome
Zinbryta (Daclizumab) is a monoclonal antibody thats INJECTED how? and how often?
SC injection a 4 weeks (every month)
How does Zinbryta (Daclizumab) compare to IFN-betas?
Superior efficacy w/ worse SEs (infection, rash, liver issues)
Lemtrada (Alemtuzumab) is a monoclonal INFUSION that is administered how?
2 IV infusions total
- 1st infusion (5 days total)
- 2nd infusion, 1 year after 1st (3 days total)
What are the 2 possible side effects of Lemtrada?
- Idiopathic Thrombocytopenic Purpura (ITP)
2. Hyperthyroidism
What is the only approved drug for the relapsing and primary progressive forms of MS?
Ocrevus (ocrelizumab)
