Childhood optic neuritis clinical features and outcome

Absoud, Michael; Cummins, Carole; Desai, Nivedita; Gika, Artemis; McSweeney, Niamh; Munot, Pinki; Hemingway, Cheryl; Lim, Ming; Nischal, Ken K.; Wassmer, Evangeline

doi:10.1136/adc.2009.175422

Cited by 71 publications

(41 citation statements)

References 13 publications

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“…7,8,19 Conversely, confirmation of an MS diagnosis after a single episode of ON in childhood with no brain lesions is infrequent. In one prospective study (3 years follow-up), only 1.9% of children experiencing acute demyelination with no brain lesions were later confirmed to have MS. 29 CSF markers may help to establish risk for MS in the setting of an isolated ON event.…”

Section: Neurology 87 (Suppl 2) August 30 2016 S55mentioning

confidence: 99%

“…18 FUNCTIONAL AND STRUCTURAL OUTCOMES The majority (58%-97%) of children have been found to experience full high-contrast visual acuity (HCVA) recovery (better than 20/30 or 20/40) in separate observational US (n 5 15 and n 5 29), Canadian (n 5 36), and UK (n 5 44) cohorts. 2,7,16,19 Although recovery of HCVA is excellent, children often report subjective visual abnormalities after ON that HCVA cannot capture, likely secondary to injury to the optic nerve, including axonal degeneration.…”

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confidence: 99%

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Pediatric optic neuritis

et al. 2016

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Optic neuritis (ON) is a common presenting symptom in pediatric CNS demyelinating disorders and may be associated with dramatic visual loss. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. These studies have shown that younger children (,10 years of age) are more likely to present with bilateral ON and older children with unilateral ON. Furthermore, studies focusing on visual recovery have shown excellent recovery of high-contrast visual acuity in the majority of children, but functional and structural studies have shown evidence of irreversible injury and functional decline after ON in children. Although randomized controlled treatment trials have not been performed in children and adolescents with ON, standard of care suggests that the use of highdose pulse steroids is safe and likely effective. This article reviews current knowledge about the clinical presentation and management of pediatric ON, with attention to associated syndromes and evaluative tools that may inform diagnosis and interventions. Neurology ® 2016;87 (Suppl 2): S53-S58 GLOSSARY ADEM 5 acute disseminating encephalomyelitis; AQP4 5 aquaporin-4; HCVA 5 high-contrast VA; CRION 5 chronic relapsing inflammatory optic neuropathy; IVIg 5 IV immunoglobulin; LCLA 5 low-contrast letter acuity; LCVA 5 low-contrast VA; MOG 5 myelin oligodendrocyte glycoprotein; MS 5 multiple sclerosis; NMO 5 neuromyelitis optica; NMOSD 5 NMO spectrum disorder; OCT 5 optical coherence tomography; ON 5 optic neuritis; ONTT 5 Optic Neuritis Treatment Trial; RNFL 5 retinal nerve fiber layer; TPE 5 therapeutic plasma exchange; VA 5 visual acuity; VEP 5 visual evoked potential; VF 5 visual field.

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Section: Neurology 87 (Suppl 2) August 30 2016 S55mentioning

confidence: 99%

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confidence: 99%

Pediatric optic neuritis

et al. 2016

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“…15 In an important recent German-speaking retrospective multicenter cohort of 357 children with ON followed for a median of 4.0 years, the strongest predictors were the presence of CSF oligoclonal bands and abnormal cranial MRI, whereas features such as sex or laterality (unilateral vs bilaterality) were not predictive of MS. 16 Table 1 demonstrates features that are predictive of MS (older age, female sex, polyfocal signs). In children with ADS, those presenting with ADEM and longitudinally extensive myelitis and patients younger than 12 years are less likely to be manifesting with the first attack of MS and are more likely to have a monophasic illness.…”

Section: Clinical Manifestations Of Ads In Childrenmentioning

confidence: 99%

“…When evaluating MRI features associated with monophasic ON, as compared to those features indicative of MS or NMO, the presence of $1 brain T2 hyperintense lesion was a strong predictor for development of MS, 15 while the coexistence (or subsequent development) of longitudinally extensive myelitis or diencephalic lesions should prompt consideration of NMO. A normal brain MRI at the time of ON conveys a very low likelihood of MS, at least as evidenced by studies with up to 7 years observation.…”

Section: Mri Abnormalities Associated With Msmentioning

confidence: 99%

Pediatric acquired CNS demyelinating syndromes

et al. 2016

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Approximately one-third of children with an acquired demyelinating syndrome (ADS) will be diagnosed with multiple sclerosis (MS), either at onset according to the 2010 McDonald criteria, or on the basis of clinical or MRI evidence of relapsing disease, in the majority of patients within 2-4 years. ADS in adolescents, female patients, and patients with polyfocal deficits is associated with the highest likelihood of MS, while children with acute disseminated encephalomyelitis, those with documented preceding infection, and ADS presentation in young children more commonly portends a monophasic outcome. While pediatric MS associates with similar genetic risk alleles as have been documented in adult-onset MS, such associations are not diagnostically valuable at the individual level. The presence of antibodies directed against aquaporin-4 strongly supports a diagnosis of neuromyelitis optica, and should be assayed in children manifesting with severe optic neuritis, longitudinally extensive myelitis, or brainstem/hypothalamic syndromes. Further research will determine whether other antibody signatures are indicative of relapsing demyelination distinct from MS. Neurology ® 2016;87 (Suppl 2):S67-S73 GLOSSARY ADEM 5 acute disseminated encephalomyelitis; ADS 5 acquired demyelinating syndromes; CI 5 confidence interval; CIS 5 clinically isolated syndrome; HLA 5 human leukocyte antigen; HR 5 hazard ratio; MOG 5 myelin oligodendrocyte glycoprotein; MS 5 multiple sclerosis; NMO 5 neuromyelitis optica; NPV 5 negative predictive value; OCB 5 oligoclonal band; ON 5 optic neuritis; OR 5 odds ratio; PPV 5 positive predictive value; SNP 5 single nucleotide polymorphism; TM 5 transverse myelitis.

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“…The published data has quoted 42-100% of the pediatric patients to have a bilateral presentation. [10][11][12][13][14][15][16][17][18][19][20] A second noteworthy ocular finding in pediatric optic neuritis is the large number of patients who had papillitis. Kennedy et al 10 noted that more than 70% of the children had some degree of papillitis, normal discs being noted in only three cases (10%).…”

Section: -19mentioning

confidence: 99%

Clinical Spectrum of Pediatric Optic Neuritis in Indian Children

Singh¹,

Phuljhele²,

Sharma³

et al. 2017

Ophthalmol Open J

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Purpose: To study the clinical spectrum of pediatric optic neuritis in Indian children at a tertiary care centre. Methods: A retrospective study of patients diagnosed with optic neuritis below 20 years of age at a tertiary care centre in India over a 3 year period were reviewed. The ophthalmological examination findings, Goldmann perimetry, electrophysiological tests and magnetic resonance imaging (MRI) were reviewed. Results: The study reviewed 28 patients (44 eyes) and found a mean age of 12.6±4.9 years (2-20 years) having a follow-up record for a mean period of 6.3±4.9 months (0.3-38 months). 32.1% were females (F: M-0.47). Six patients (20.7%) had a viral prodrome and 12 (42.9%) complained of painful ocular movements. The mean baseline visual acuity (VA) was 1.80±0.6 logMAR units (Range=0.2-3.0 logMAR units) and the last best visual acuity was 0.43±0.4 log MAR units (Range=0-1.79 logMAR units). Thirty six eyes (81.8%) had a visual acuity at or below 3/60 and 40 eyes (90.9%) of 6/60 or lower of the snellen chart at the time of presentation. The mean contrast sensitivity at presentation was 1.02±0.46 (range=0-1.65). 16 pts (57.1%) had a bilateral presentation and 20 patients (71.4%) had either unilateral or bilateral papillitis. All the patients were given pulse dexamethasone (3-5 mg/kg/d) for three consecutive days followed by oral prednisolone (1-1.5 mgKg/day) for 11 days. At 1 week, 21 out of 44 eyes (47.7%) had a visual acuity ≥6/18 of the snellen chart. Three patients showed demyelination suggestive of multiple sclerosis (MS) on MRI brain and were diagnosed as probable MS. A total of 9 eyes (20.5%) of 6 patients (20.7%) had a recurrence. Those below 10 years of age presented more commonly with papillitis compared to teenagers (p value=0.01). All the parameters were similar in males and females. Conclusion: Pediatric optic neuritis patients are associated with a good visual outcome and a faster recovery. There are no gender differences in either the presentation or the visual recovery. Papillitis was more often seen in the children below 10 years of age. None of the patients developed clinically definite multiple sclerosis.

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Childhood optic neuritis clinical features and outcome

Abstract: Childhood optic neuritis is associated with severe visual deficit with good recovery. An initial abnormal MRI brain scan or relapsing optic neuritis should alert the clinician to MS or NMO diagnosis.

Cited by 71 publications

References 13 publications

Pediatric optic neuritis

Pediatric optic neuritis

Pediatric acquired CNS demyelinating syndromes

Clinical Spectrum of Pediatric Optic Neuritis in Indian Children

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