The clinical profile of childhood optic neuritis

Abstract

-Purpose: To report the clinical features and outcome of a series of children with optic neuritis. Methods: We reviewed the medical records of patients up to 16 years old with optic neuritis. Group 1 comprised children seen up to two weeks after the onset of visual loss; Group 2 comprised patients already harboring optic atrophy. Results: There were 15 boys and 12 girls. The mean age was 10.9 years. Bilateral optic neuritis occurred in 10. Optic disc pallor was found in 35%, edema in 46%, and 19% had normal fundus. During follow-up visual acuity improved in all but one eye in Group 1, and in six of seven eyes in children in Group 2. Just one child converted to multiple sclerosis. Conclusions: This study shows that the clinical features of childhood optic neuritis differ from those observed in adults. In children it has a better visual outcome and a lower conversion rate to multiple sclerosis than in adults.KEY WORDS: childhood optic neuritis, visual outcome, multiple sclerosis. O quadro clínico da neurite óptica na infânciaRESUMO -Objetivos: Descrever as características clínicas e evolutivas da neurite óptica na infância. Métodos: Foram revistos os prontuários de crianças até 16 anos de idade neurite óptica. Os pacientes foram divididos em dois grupos. Grupo 1 referia a crinças examinadas até duas semanas após o início da perda visual; Grupo 2 foi formado por crianças já apresentando atrofia óptica ao primeiro exame. Resultados: Foram encontrados 15 meninos e 12 meninas, com idade média de 10,9 anos. Neurite óptica bilateral foi observada em 10 crianças. O disco óptico estava pálido em 35% dos casos, edemaciado em 46% e normal em 19%. Exame durante follow-up demonstrou melhora da acuidade visual em todos, exceto em um caso no Grupo 1 e em 6 de 7 olhos no Grupo 2. Apenas uma criança desenvolveu esclerose múltipla. Conclusões: Este estudo demonstrou que as características clínicas da neurite óptica na infância diferem das observadas em adultos. Em crianças, a recuperação visual é melhor, e a taxa de conversão para a esclerose múltipla é mais baixa. PALAVRAS-CHAVE: neurite óptica na infância, recuperação visual, esclerose múltipla.

Pediatric optic neuritis and risk of multiple sclerosis: Meta-analysis of observational studies

“…These were further reviewed, and 14 studies met the inclusion criteria. The average number of patients (with individual patient data) included per study was 16 (range, 4-41; Table 1 4,7,8,[10][11][12][13][14][15][16][17][18][19][20].…”

“…Across the studies, MRI technology was not available at the time of optic neuritis presentation for 53 children. 8,18,19,21 MRI was performed in 25 children; however, the individual results were not reported. 8,12,[14][15][16] No MRI was obtained for 3 children.…”

“…2,5,7,8 One aim of this study was to determine the relationship between age and unilaterality versus bilaterality at presentation; therefore, bilateral sequential optic neuritis was counted as a unilateral presentation.…”

Pediatric optic neuritis

“…Pain with eye movement is reported in 33%-77% of pediatric cases [4][5][6][7] and therefore does not consistently differentiate inflammatory from noninflammatory optic neuropathies in children. Of importance, children may have difficulty differentiating pain behind the eyes from headache: headache was reported in 53% of children in one study.…”

“…Physical examination findings also include the presence of a relative afferent pupillary defect, with funduscopic examination often revealing optic nerve abnormalities including papillitis in the acute stage and optic nerve pallor in chronic stages. Papillitis has been noted in 46%-69% 6,8 of children with ON compared to one-third of those in the adult Optic Neuritis Treatment Trial (ONTT). 9 Although MRI is not required to diagnose ON in children, it may show focal abnormalities of the anterior visual pathway.…”