Clinical profile and neuroimaging in pediatric optic neuritis in Indian population: A case series

Abstract

Purpose of the study:The purpose of this study was to report clinical features, neuroimaging, and visual outcome in pediatric optic neuritis (ON) in Indian population.Materials and Methods:This is a retrospective study of children up to the age of 16 years, diagnosed with ON, that presented at pediatric and neuroophthalmology clinic of a tertiary eye care center, in South India, within the period of 2010–2015.Results:We identified 62 eyes of 40 children diagnosed as ON within the study period. The mean age was 11.15 ± 3.24 years (1–15 years) with mean follow-up of 13 months. In this series, there was female preponderance (67%). Mean logarithm of the minimum angle of resolution visual acuity at presentation was 1.14 ± 0.93, which after treatment recovered to 0.10 ± 0.26 at final visit (P < 0.001). Involvement was bilateral in 22 children (55%) and recurrent in 3 eyes of 3 children. Preceding febrile illness was reported in seven cases (18%). Four (10%) cases were diagnosed as multiple sclerosis (MS), one with neuromyelitis optica, and one with acute disseminated encephalomyelitis. One case was associated with tuberculous meningitis, 1 with septicemia, and 1 with bilateral maxillary sinusitis. Neuroimaging studies of optic nerve in 14 children demonstrated isolated optic nerve enhancement. Magnetic resonance imaging brain revealed white matter T2 hyperintense lesions separate from optic nerve in ten cases, of which four cases were diagnosed as MS.Conclusions:Bilateral presentation was common, association with MS was low. Papillitis was more frequent than retrobulbar neuritis and prognosis was good in pediatric ON in Indian population.

Etiological Study of Various Retinal Diseases in Paediatric Population at a Tertiary Eye Centre, Telangana State

“…In contrast to adult optic neuritis, pattern evoked potentials in children with optic neuritis, though abnormal at presentation, are more frequently normal at follow-up (55% vs 10% in the adult population), indicating the more benign nature of this disease in the child. 20 Visual outcome in paediatric optic neuritis or papillitis is always good.…”

“…The time of onset of visual recovery was adequately r significant improvement within 24 hours of commencing treatment, whereas 74% showed a definite improvement within 72 hours. 20 The pathologic process that affects optic nerve fibers in paediatric optic neuritis is sparse; however, the clinical and electrophysiologic similarities between the acute stages of adult and paediatric optic neuritis, suggest that demyelination plays a prominent role. The more frequent and sometimes more speedy restoration of normal visual evoked potential latency in children than in adults raise the possibility that the process of remyelination is more rapid in children.…”

“…The more frequent and sometimes more speedy restoration of normal visual evoked potential latency in children than in adults raise the possibility that the process of remyelination is more rapid in children. 20 Female preponderance, bilateral presentation and papillitis more common in adults compared to children. 21 Although children are less likely than adults to develop multiple sclerosis after optic neuritis, multiple sclerosis still develops in many cases, especially in those with multiple attacks.…”

Pediatric optic neuritis: Points to ponder!

“…I read with great interest this article titled, “Clinical profile and neuroimaging in pediatric optic neuritis in Indian population: A case series” by Khadse et al . [ 1 ] The article states that it is the first series of childhood optic neuritis reported in Indian literature and their contribution is impressive. However, after reading the article, I have few concerns and need some clarifications from the authors.…”

Reply to Pediatric optic neuritis: Points to ponder

“…Thank you for showing interest in our study[ 1 ] titled “Clinical profile and neuroimaging in pediatric optic neuritis in Indian population: A case series.” We have tried to provide all details of the cases for the clarification of the queries raised. Although it is common to have optic neuritis following vaccination, we had no cases of the same following vaccination in our series.…”