Important findings on the treatment of optic neuritis.

The December 9, 1993 issue of The New England Journal of Medicine published a study on therapy for optic neuritis,* which suggests that treatment with intravenous (IV) steroids not only speeds visual recovery slightly but may also decrease the likelihood of developing definite MS in the two years following treatment. The study also supports a preference for IV over oral steroids for treating acute attacks of MS, although this was not directly tested.

Optic neuritis, an eye condition involving inflammation and loss of myelin of the optic nerve, is often a first sign of MS. Within two years, about 20 percent of people who develop it are diagnosed with MS; within fifteen years, as many as 80 percent may be. Dr. Roy Beek and his colleagues at the University of South Florida examined data from a 457-patient, fifteen-center trial in which IV steroids, oral steroids, and an oral placebo (or "dummy" pill) were compared to see which of the three would be more effective for treating neuritis. Data on the 389 people in the study who did not have probable or definite MS were analyzed separately to see if the form of treatment they received affected their likelihood of developing MS. At the end of two years, 14.7 percent of those treated with oral steroids and 16.7 percent of those given an oral placebo had definite MS. Only 7.5 percent of those treated with IV steroids had confirmed MS.

The degree of benefit lessened after the first two years, and it is clear that IV steroid use for acute optic neuritis doesn't prevent development of MS. It may simply delay it. Because the study participants were given either pins as outpatients or IV therapy during hospital stays, both they and their examining physicians were not truly "blind" to their treatment, which could have biased the results.

Despite this consideration, the National MS Society's Medical Advisory Board agrees that this and earlier studies support treatment of optic neuritis with IV rather than oral steroids, particularly for people who have positive brain findings on MRI or other MS risk factors. If you are concerned about the use of steroids for optic neuritis or for MS, consult your physician.

. Could Myelin Loss Be Stopped'.2

r. Etty N. Benveniste and her col- Dleagues at the University of Alabama at Binningham are focusing on the activity of astrocytes. Nonnally these brain cells form supports for nerve cells and their very long fibers. It has been known for some time that astrocytes also deposit scar tissue on nerve fibers that have lost myelin. Now it seems they are also involved in destroying myelin in MS.

Dr. Benveniste's team is studying a molecule called IFNEX, which appears on the surface of astrocytes. In MS, this molecule may be a key hnk in a bio- chemical chain of command gone wrong.

This study is funded through the Society by the Southern Area NMSS chapters, which pooled resources to create the first cooperative research- restiicted "honor roll" pledge in Society history. Dr. Benveniste began her research career by winning a National MS Society fellowship for post-doctoral studies in 1986 and has continued to work in MS research since then.

For information on more new NMSS projects, ask your local chapter for a copy of Summaiies of New Research Projects".