In the past, controversy existed as to whether or
not to treat patients with ON with corticosteroids.
The Optic Neuritis Treatment Trial (ONTT) supports
the administration of intravenous methylprednisolone
sodium succinate (Solumedrol, 250 mg. every 6 hours)
for three days followed by oral prednisone (1 mg/kg
per day) for 11 days for the purposes of accelerating
visual recovery. This therapy did not improve visual
outcome after one year but was found to increase the
rate at which patients recover. The ONTT also determined
that the use of oral prednisone (1 mg/kg per day)
alone for 14 days is contraindicated. Patients receiving
this therapy had a higher rate of new attacks of ON
in both the initially affected and fellow eyes than
did the intravenous/oral group and placebo group.
As recorded in the three-year follow-up of patients
in the ONTT, treatment with intravenous methylprednisolone
followed by oral corticosteroid regimens reduced the
two-year rate of development of clinical MS, particularly
in patients with signal abnormalities consistent with
demyelination on MRI of the brain at the time of study
entry. Serious side effects of glucocorticoid therapy
are infrequent. Therefore, outpatient administration
of high-dose intravenous glucocorticoids may be recommended.