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Moon Y, Park KA, Han J, Hwang JM, Kim SJ, Han SH, Lee BJ, Kang MC, Goh YH, Lim BC, Yang HK, Jung JH. Risk of central nervous system demyelinating attack or optic neuritis recurrence after pediatric optic neuritis in Korea. Neurol Sci 2024; 45:1173-1183. [PMID: 37853292 DOI: 10.1007/s10072-023-07125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To investigate the rate of development of symptomatic central nervous system (CNS) demyelinating attacks or recurrent optic neuritis (ON) after the first episode of ON and its risk factors for Korean pediatric patients. METHODS This multicenter retrospective cohort study included the patients under 18 years of age (n=132) diagnosed with ON without previous or simultaneous CNS demyelinating diseases. We obtained the clinical data including the results of neuro-ophthalmological examinations, magnetic resonance images (MRIs), antibody assays, and laboratory tests. We investigated the chronological course of demyelinating disease with respect to the occurrence of neurological symptoms and/or signs, and calculated the 5-year cumulative probability of CNS demyelinating disease or ON recurrence. RESULTS: During the follow-up period (63.1±46.7 months), 18 patients had experienced other CNS demyelinating attacks, and the 5-year cumulative probability was 14.0±3.6%. Involvement of the extraorbital optic nerve or optic chiasm and asymptomatic lesions on the brain or spinal MRI at initial presentation were significant predictors for CNS demyelinating attack after the first ON. The 5-year cumulative probability of CNS demyelinating attack was 44.4 ± 24.8% in the AQP4-IgG group, 26.2±11.4% in the MOG-IgG group, and 8.7±5.9% in the double-negative group (P=0.416). Thirty-two patients had experienced a recurrence of ON, and the 5-year cumulative probability was 24.6±4.0%. In the AQP4-IgG group, the 5-year cumulative probability was 83.3±15.2%, which was significantly higher than in the other groups (P<0.001). CONCLUSIONS A careful and multidisciplinary approach including brain/spinal imaging and antibody assay can help predict further demyelinating attacks in pediatric ON patients.
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Affiliation(s)
- Yeji Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul, 03080, South Korea
| | - Sueng-Han Han
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Chae Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Hyu Goh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul, 03080, South Korea.
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Direk MÇ, Besen Ş, Öncel İ, Günbey C, Özdoğan O, Orgun LT, Sahin S, Cansu A, Yıldız N, Kanmaz S, Yılmaz S, Tekgül H, Türkdoğan D, Ünver O, Thomas GÖ, Başıbüyük S, Yılmaz D, Kurt AN, Gültutan P, Özsoy Ö, Yiş U, Kurul SH, Güngör S, Özgör B, Karadağ M, Dündar NO, Gençpınar P, Bildik O, Orak SA, Kabur ÇÇ, Kara B, Karaca Ö, Canpolat M, Gümüş H, Per H, Yılmaz Ü, Karaoğlu P, Ersoy Ö, Tosun A, Öztürk SB, Yüksel D, Atasoy E, Gücüyener K, Yıldırım M, Bektaş Ö, Çavuşoğlu D, Yarar Ç, Güngör O, Mert GG, Sarıgeçili E, Edizer S, Çetin İD, Aydın S, Diler B, Özdemir AA, Erol İ, Okuyaz Ç, Anlar B. Optic neuritis in Turkish children and adolescents: A multicenter retrospective study. Mult Scler Relat Disord 2024; 81:105149. [PMID: 38096730 DOI: 10.1016/j.msard.2023.105149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Various etiologies may underlie optic neuritis, including autoantibody-mediated disorders described in the last decade. We re-examined demographic, clinical, laboratory features and prognostic factors in pediatric patients with autoimmune optic neuritis according to current knowledge. METHODS Cases of pediatric ON from 27 centers in Türkiye diagnosed between 2009 and 2022 were included for retrospective evaluation. RESULTS The study included 279 patients, 174 females and 105 males, with a female-to-male ratio of 1.65. The average age at onset was 12.8 ± 3.4 years, and mean follow-up, 2.1 years (range: 1-12.1 years). Patients <10 years old were grouped as "prepubertal" and those ≥10 years old as "others". The diagnoses made at the end of follow-up were multiple sclerosis associated optic neuritis (n = 90, 32.3 %), single isolated optic neuritis (n = 86, 31 %), clinically isolated syndrome (n = 41, 14.7 %), myelin oligodendrocyte glycoprotein antibody associated optic neuritis (n = 22, 7.9 %), and relapsing isolated optic neuritis (n = 18, 6.5 %). Predominant diagnoses were myelin oligodendrocyte glycoprotein antibody associated optic neuritis and acute disseminated encephalomyelitis associated optic neuritis in the prepubertal group and multiple sclerosis associated optic neuritis in the older group. Recurrences were observed in 67 (24 %) patients, including 28 with multiple sclerosis associated optic neuritis, 18 with relapsing isolated optic neuritis, 11 with myelin oligodendrocyte glycoprotein antibody associated optic neuritis, 8 with aquaporin-4 antibody related optic neuritis, and 2 with chronic relapsing inflammatory optic neuropathy. Recurrences were more common among female patients. Findings supporting the diagnosis of multiple sclerosis included age of onset ≥ 10 years (OR=1.24, p = 0.027), the presence of cranial MRI lesions (OR=26.92, p<0.001), and oligoclonal bands (OR=9.7, p = 0.001). Treatment in the acute phase consisted of intravenous pulse methylprednisolone (n = 46, 16.5 %), pulse methylprednisolone with an oral taper (n = 212, 76 %), and combinations of pulse methylprednisolone, plasmapheresis, or intravenous immunoglobulin (n = 21, 7.5 %). Outcome at 12 months was satisfactory, with 247 out of 279 patients (88.5 %) demonstrating complete recovery. Thirty-two patients exhibited incomplete recovery and further combination treatments were applied. Specifically, patients with relapsing isolated optic neuritis and aquaporin-4 antibody related optic neuritis displayed a less favorable prognosis. CONCLUSION Our results suggest optic neuritis is frequently bilateral in prepubertal and unilateral in peri‑ or postpubertal patients. Age of onset 10 or older, presence of oligoclonal bands, and brain MRI findings reliably predict the development of multiple sclerosis. The risk of developing multiple sclerosis increases mostly during the second and third years of follow-up. Relapsing isolated optic neuritis remains a separate group where the pathogenesis and outcome remain unclear. Investigation of predisposing and diagnostic biomarkers and long follow-up could help to define this group.
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Affiliation(s)
- Meltem Çobanoğulları Direk
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University Faculty of Medicine, Faculty Of Medicine, 34, Cadde, Çiftlikköy Kampüsü, Mersin 33343, Türkiye.
| | - Şeyda Besen
- Department of Pediatrics, Division of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Türkiye
| | - İbrahim Öncel
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ceren Günbey
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Orhan Özdoğan
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Leman Tekin Orgun
- Department of Pediatrics, Division of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Türkiye
| | - Sevim Sahin
- Department of Pediatrics, Division of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Ali Cansu
- Department of Pediatrics, Division of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Nihal Yıldız
- Department of Pediatrics, Division of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Seda Kanmaz
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Sanem Yılmaz
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Hasan Tekgül
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Dilşad Türkdoğan
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Olcay Ünver
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Gülten Öztürk Thomas
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Salih Başıbüyük
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Deniz Yılmaz
- Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Türkiye
| | - Ayşegül Neşe Kurt
- Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Türkiye
| | - Pembe Gültutan
- Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Türkiye
| | - Özlem Özsoy
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Uluç Yiş
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Semra Hız Kurul
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Serdal Güngör
- Department of Pediatrics, Division of Pediatric Neurology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Bilge Özgör
- Department of Pediatrics, Division of Pediatric Neurology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Meral Karadağ
- Department of Pediatrics, Division of Pediatric Neurology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Nihal Olgaç Dündar
- Department of Pediatrics, Division of Pediatric Neurology, Katip Celebi University Faculty of Medicine, İzmir, Türkiye
| | - Pınar Gençpınar
- Department of Pediatrics, Division of Pediatric Neurology, Katip Celebi University Faculty of Medicine, İzmir, Türkiye
| | - Olgay Bildik
- Department of Pediatrics, Division of Pediatric Neurology, Katip Celebi University Faculty of Medicine, İzmir, Türkiye
| | - Sibğatullah Ali Orak
- Department of Pediatrics, Division of Pediatric Neurology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Çişil Çerçi Kabur
- Department of Pediatrics, Division of Pediatric Neurology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Bülent Kara
- Department of Pediatrics, Division of Pediatric Neurology, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Ömer Karaca
- Department of Pediatrics, Division of Pediatric Neurology, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Mehmet Canpolat
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Hakan Gümüş
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Hüseyin Per
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Ünsal Yılmaz
- İzmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences Türkiye, İzmir, Türkiye
| | - Pakize Karaoğlu
- İzmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences Türkiye, İzmir, Türkiye
| | - Özlem Ersoy
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University Faculty of Medicine, Faculty Of Medicine, 34, Cadde, Çiftlikköy Kampüsü, Mersin 33343, Türkiye
| | - Ayşe Tosun
- Department of Pediatrics, Division of Pediatric Neurology, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Semra Büyükkorkmaz Öztürk
- Department of Pediatrics, Division of Pediatric Neurology, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Deniz Yüksel
- Dr Sami Ulus Maternity and Children's Education and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Ergin Atasoy
- Dr Sami Ulus Maternity and Children's Education and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Kıvılcım Gücüyener
- Department of Pediatrics, Division of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Miraç Yıldırım
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Ömer Bektaş
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Dilek Çavuşoğlu
- Department of Pediatrics, Division of Pediatric Neurology, Afyonkarahisar Health Sciences University, Afyon, Türkiye
| | - Çoşkun Yarar
- Department of Pediatrics, Division of Pediatric Neurology, Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Olcay Güngör
- Department of Pediatrics, Division of Pediatric Neurology, Pamukkale University Faculty of Medicine, Denizli, Türkiye
| | - Gülen Gül Mert
- Department of Pediatrics, Division of Pediatric Neurology, Cukurova University Faculty of Medicine, Adana, Türkiye
| | - Esra Sarıgeçili
- Department of Pediatrics, Division of Pediatric Neurology, Adana City Training and Research Hospital, Adana, Türkiye
| | - Selvinaz Edizer
- Department of Pediatrics, Division of Pediatric Neurology, Istanbul Bezm-i Alem Vakıf University Hospital, İstanbul, Türkiye
| | - İpek Dokurel Çetin
- Department of Pediatrics, Division of Pediatric Neurology, Balıkesir Ataturk City Hospital, Balıkesir, Türkiye
| | - Seren Aydın
- Department of Pediatrics, Division of Pediatric Neurology, Samsun Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | - Betül Diler
- Giresun Maternity and Children's Education and Research Hospital, Pediatric Neurology, Giresun, Türkiye
| | - Asena Ayça Özdemir
- Department of Medical Education, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - İlknur Erol
- Department of Pediatrics, Division of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Türkiye
| | - Çetin Okuyaz
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University Faculty of Medicine, Faculty Of Medicine, 34, Cadde, Çiftlikköy Kampüsü, Mersin 33343, Türkiye
| | - Banu Anlar
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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CHAUDHURY PRANATI, MISRA ANITA, MOHANTY SUBHRAJYOTI, BADWAL KALPANA, GUPTA RUPA, SUBUDHI PRIYAMBADA. A STUDY ON CLINICAL PROFILE AND OUTCOME OF VISUAL PARAMETERS OF OPTIC NEURITIS PATIENTS IN A TERTIARY EYE CARE CENTRE. ASIAN JOURNAL OF PHARMACEUTICAL AND CLINICAL RESEARCH 2023:68-70. [DOI: 10.22159/ajpcr.2023.v16i7.48208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
Introduction: Optic neuritis (ON) is the inflammation of the optic nerve secondary to autoimmune, infectious, or inflammatory conditions.
Objective: The objective is to study the clinical profile and changes in visual parameters after the treatment of patients with ON.
Methods: This prospective interventional research was done at the ophthalmology department of a tertiary eye care center. 36 cases diagnosed with ON have been analyzed, treated, and followed up for 1 year, for the type of clinical presentation, rate of recurrence, and changes in visual parameters.
Results: The prevalence rate was bimodal, more common among age groups between 46 and 55 years at 32% and age group 16–25 at 27%. A higher prevalence rate was seen in females in 63% of cases. The bilateral presentation was observed in 18%. 44% of cases presented as retrobulbar neuritis (RBN) whereas 56% were as papillitis. At 1 year follow up Optic disc edema suggestive of papillitis was seen in 17% of cases, normal disc with RBN in 44% and disc pallor in 32% discs. At the final follow-up after 1 year, 75% of patients could read maximum (10/13) color plates, 64% of cases showed standard contrast sensitivity and 47% showed normal visual field. VA of 6/60 or worse at presentation was seen in 53% cases and <6/12 in (84%) cases which improved to better than 6/12 in 58% cases and better than 6/60 in 67% cases at final follow up at 1 year. The most common visual field abnormality at presentation was generalized field constriction in (34%), central or centrocecal scotoma in (18%), hemianopia or quadrantanopia (12%), and enlarged blind spot in (06%) cases. During the final follow-up at 1 year, 22 cases (61%) showed normal field. Visual Field could not be tested in (30%) at presentation as vision was <3/60, although visual evoked potential was abnormal in all of 36 (100%) cases with mean P 100 latency being 128 ms. Furthermore, 3 (8%) cases demonstrated additional neurological symptoms till the final follow-up and were subsequently identified to be multiple sclerosis (MS). Recurrence rate was 08 (22%) within 1 year follow-up, of which 06 (17%) cases were clinically RBN and 02 (05%) were papillitis.
Conclusion: In our study, findings of clinical profile and visual outcomes of ON patients were different from that of Western studies as well as from those done previously in the Indian population, notably lesser prevalence of MS, although other differences were not very significant.
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Characteristics of Optic Neuritis in South Korean Children and Adolescents: A Retrospective Multicenter Study. J Ophthalmol 2022; 2022:4281772. [PMID: 36119139 PMCID: PMC9473900 DOI: 10.1155/2022/4281772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To analyze the clinical characteristics and prognosis of optic neuritis (ON) in pediatric patients aged <19 years in South Korea. Methods This multicenter retrospective cohort study included 127 pediatric patients (median age: 10.3 (IQR: 7.3–14.2) years; female, 62.2%) who experienced ON for the first time between January 2004 and January 2018, with data obtained from five tertiary university-based hospitals in Korea. When ON was bilateral, the worse eye was selected for analysis. The baseline clinical characteristics and prognoses of patients, as well as the associations between these parameters, were analyzed. Results The baseline clinical characteristics of the patients were as follows: best-corrected visual acuity (BCVA) < 20/200, 65.9%; pain on eye movement, 47.2%; optic disc swelling, 66.9%; and bilateral involvement, 41.7%. Among 101 patients who were followed up for ≥6 months, 48 (47.5%), 12 (11.9%), 19 (18.8%), 13 (12.9%), and 9 (8.9%) had been diagnosed with isolated ON, recurrent ON, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM)-related ON, respectively. At the latest visit, 81.9% and 71.1% had achieved BCVA of ≥20/40 and ≥ 20/25, respectively. Only disc swelling at presentation was associated with poor baseline BCVA (coefficient: 0.31, P=0.004) and greater improvement in BCVA (coefficient: 0.49, P = 0.001P=0.001); there were no significant associations between the baseline factors and final BCVA. Conclusions This study demonstrated pediatric ON-related clinical characteristics and visual outcomes in South Korea. Within this cohort, in about 40.6% of patients, ON was associated with other demyelinating diseases, namely, MS, NMOSD, and ADEM.
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Eusebi A, Zara P, Zarbo IR, Festa S, Dessì V, Pes V, Salis F, Sotgiu G, Carta A, Sotgiu S. Long-term trajectory of acquired demyelinating syndrome and multiple sclerosis in children. Dev Med Child Neurol 2021; 63:1059-1065. [PMID: 33938575 DOI: 10.1111/dmcn.14912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/25/2023]
Abstract
AIM We assessed the frequency, characteristics, and future trajectory of monophasic acquired demyelinating syndromes (ADS) associated with conversion to paediatric multiple sclerosis. METHOD This was a retrospective observational study of Sardinian children (<18y of age) with onset of ADS between 2001 and 2018. RESULTS We identified 44 children with ADS (21 males, 23 females; median age at onset 16y, range 4mo-18y), 21 of whom were already presenting with criteria for paediatric multiple sclerosis. The mean crude prevalence of ADS in Sardinian children was 59.2 per 100 000, while incidence was 3.1 per 100 000 per year (1.3 in children aged ≤10y and 11.9 in those aged 10-17y). After a mean (SD) follow-up of 8 years 5 months (5y 4mo), the most common (n=32) trajectory was conversion to paediatric multiple sclerosis. At onset, the total prevalence and mean annual incidence of paediatric multiple sclerosis were 35.6 per 100 000 and 2.3 per 100 000 respectively (0.5 in individuals aged ≤10y, 10.0 in the older group). INTERPRETATION Sardinia is a very high risk area for ADS in children. Nearly half of this population can already be diagnosed with paediatric multiple sclerosis at onset. Overall, 72% of those with ADS will have paediatric multiple sclerosis after a mean of 8 years. What this paper adds Sardinia is a very high risk area for paediatric acquired demyelinating syndromes (ADS). A high proportion of those with paediatric multiple sclerosis are diagnosed at onset of ADS. After an average 8 years from onset of paediatric ADS, three-quarters of patients are diagnosed with paediatric multiple sclerosis.
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Affiliation(s)
- Anna Eusebi
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Pietro Zara
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Ignazio Roberto Zarbo
- Multiple Sclerosis Centre, Clinical Neurology Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Silvia Festa
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Veronica Dessì
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Valentina Pes
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Francesca Salis
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Alessandra Carta
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Stefano Sotgiu
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
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Gupta V, Luthra S, Maheshwari S, Das SM. Relapsing neuromyelitis optica in an adolescent girl. BMJ Case Rep 2021; 14:e242402. [PMID: 34426420 PMCID: PMC8383875 DOI: 10.1136/bcr-2021-242402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/03/2022] Open
Abstract
Early differentiation of neuromyelitis optica spectrum disorder (NMO-SD) from multiple sclerosis (MS) is of paramount importance as NMO-SD (especially relapsing variant) has more severe morbidity than MS. We describe a case of an adolescent girl who presented with repeated episodes of optic neuritis over a period of 4 years with normal brain MRI scans. She was treated initially as relapsing remitting MS, before showing clinical evidence of transverse myelitis (TM), and eventually being diagnosed as NMO-SD. Pulse intravenous methyl prednisolone along with immunosuppressive therapy led to remission of her disease. However, delay in diagnosis as NMO-SD led to visual disability in the left eye. Therefore, in young patients with recurrent optic neuritis and normal brain MRI, it may be prudent to get spinal MRI done to look for TM, even when asymptomatic. In addition, we should keep a low threshold for requesting aquaporin-4 antibody testing in these patients.
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Affiliation(s)
- Vinita Gupta
- Ophthalmology, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Saurabh Luthra
- Ophthalmology, Drishti Eye Institute, Dehradun, Uttarakhand, India
| | - Shrey Maheshwari
- Ophthalmology, Drishti Eye Institute, Dehradun, Uttarakhand, India
| | - Shrutanjoy M Das
- Ophthalmology, Drishti Eye Institute, Dehradun, Uttarakhand, India
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Monge Galindo L, Martínez de Morentín A, Pueyo Royo V, García Iñiguez J, Sánchez Marco S, López-Pisón J, Peña-Segura J. Optic neuritis in paediatric patients: experience over 27 years and a management protocol. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pineles SL, Repka MX, Liu GT, Waldman AT, Borchert MS, Khanna S, Heidary G, Graves JS, Shah VS, Kupersmith MJ, Kraker RT, Wallace DK, Cotter SA, Holmes JM. Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months. JAMA Ophthalmol 2020; 138:1253-1261. [PMID: 33057592 PMCID: PMC7563662 DOI: 10.1001/jamaophthalmol.2020.4231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
Importance Optic neuritis (ON) in children is uncommon. There are limited prospective data for visual acuity (VA) outcomes, associated diseases, and neuroimaging findings. Prospective data from a large sample would be useful for counseling families on treatment decisions and prognosis. Objective To prospectively study children with a first episode of ON, describe VA after 6 months, and ascertain the network's (Pediatric Eye Disease Investigator Group and Neuro-Ophthalmology Research Disease Investigator Consortium) ability to enroll pediatric patients with ON prospectively. Design, Setting, and Participants This nonrandomized cohort study was conducted from September 20, 2016, to July 20, 2018, at 23 sites in the United States and Canada in pediatric ophthalmology or neuro-ophthalmology clinics. A total of 44 children (aged 3-15 years) presented with a first episode of ON (visual loss, pain on eye movements, or both) within 2 weeks of symptom onset and at least 1 of the following in the affected eye: a distance high-contrast VA (HCVA) deficit of at least 0.2 logMAR below age-based norms, diminished color vision, abnormal visual field, or optic disc swelling. Exclusion criteria included preexisting ocular abnormalities or a previous episode of ON. Main Outcomes and Measures Primary outcomes were monocular HCVA and low-contrast VA at 6 months. Secondary outcomes were neuroimaging, associated diagnoses, and antibodies for neuromyelitis optica and myelin oligodendrocyte glycoprotein. Results A total of 44 children (mean age [SD], 10.2 [3.5] years; 26 boys [59%]; 23 White individuals [52%]; 54 eyes) were enrolled in the study. Sixteen patients (36%) had bilateral ON. Magnetic resonance imaging revealed white matter lesions in 23 children (52%). Of these children, 8 had myelin oligodendrocyte glycoprotein-associated demyelination (18%), 7 had acute disseminated encephalomyelitis (16%), 5 had multiple sclerosis (11%), and 3 had neuromyelitis optica (7%). The baseline mean HCVA was 0.95 logMAR (20/200), which improved by a mean 0.76 logMAR (95% CI, 0.54-0.99; range, -0.70 to 1.80) to 0.12 logMAR (20/25) at 6 months. The baseline mean distance low-contrast VA was 1.49 logMAR (20/640) and improved by a mean 0.72 logMAR (95% CI, 0.54-0.89; range, -0.20 to 1.50) to 0.73 logMAR (20/100) at 6 months. Baseline HCVA was worse in younger participants (aged <10 years) with associated neurologic autoimmune diagnoses, white matter lesions, and in those of non-White race and non-Hispanic ethnicity. The data did not suggest a statistically significant association between baseline factors and improvement in HCVA. Conclusions and Relevance The study network did not reach its targeted enrollment of 100 pediatric patients with ON over 2 years. This indicates that future treatment trials may need to use different inclusion criteria or plan a longer enrollment period to account for the rarity of the disease. Despite poor VA at presentation, most children had marked improvement by 6 months. Associated neurologic autoimmune diagnoses were common. These findings can be used to counsel families about the disease.
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Affiliation(s)
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Grant T Liu
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy T Waldman
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Sangeeta Khanna
- Department of Ophthalmology and Neurology, St Louis University, St Louis, Missouri
| | - Gena Heidary
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - David K Wallace
- Glick Eye Institute, Indiana University School of Medicine, Indianapolis
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
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Lin WS, Chen HM, Yang CC, Chen TC, Lin JW, Lee WT. Multiple sclerosis and neuromyelitis optica after optic neuritis: A nationwide cohort study in Taiwan. Mult Scler Relat Disord 2020; 44:102379. [DOI: 10.1016/j.msard.2020.102379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
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Visual Outcomes and Clinical Manifestations of Pediatric Optic Neuritis in Indian Population: An Institutional Study. J Neuroophthalmol 2020; 38:462-465. [PMID: 29554001 DOI: 10.1097/wno.0000000000000646] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optic neuritis in children is an uncommon disorder which usually occurs after a viral illness or vaccination and, less frequently, occurs as a manifestation of a demyelinating disorder. Pediatric optic neuritis usually is bilateral and presents with optic disc edema, recovers rapidly with steroid therapy, and generally has low conversion rate to multiple sclerosis or neuromyelitis optica spectrum disorder. We report the clinical features and treatment outcomes of pediatric optic neuritis in Indian population, for which little data are available. METHODS We reviewed the medical case records of patients with optic neuritis who were younger than 18 years, from 1999 to 2016. All patients were assessed and managed in the Neuro-Ophthalmology Department of Sankara Nethralaya, a unit of Medical Research Foundation and Pediatric Neurology Department of Kanchi Kamakoti-Childs Trust Hospital, Chennai, India. RESULTS One hundred seventeen eyes of 78 children with mean age of 11.84 (±4.58) years were identified. Forty-two (53.8%) were females and 36 (46.2%) were males. Thirty-nine patients (50%) had bilateral involvement and a similar number had unilateral involvement. Fifty-nine eyes (50.4%) had optic disc edema, 20 eyes (17.1%) had disc pallor, and 38 eyes (32.4%) had normal discs. Of 63 patients who had neuroimaging, 36 had MRI, and 27 underwent computed tomography. Eighty-four eyes (of 59 patients) received steroid therapy according to the protocol of the Optic Neuritis Treatment Trial (ONTT). Thirty-three eyes that were treated with other steroid protocols were excluded from the final visual outcome analyses. Sixty of the 84 eyes (72.3%) recovered visual acuity of 20/40 or better. Visual acuity improvement was statistically significant between initial and final visual acuity (logMAR) in our patients treated with the ONTT protocol (P ≤ 0.001). CONCLUSIONS Our Indian pediatric population had good visual recovery after steroid treatment for optic neuritis. Profound loss of visual acuity on presentation and bilateral involvement were significantly associated with poor visual outcome.
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Current Advances in Pediatric Onset Multiple Sclerosis. Biomedicines 2020; 8:biomedicines8040071. [PMID: 32231060 PMCID: PMC7235875 DOI: 10.3390/biomedicines8040071] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/01/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory disease affecting the central nervous system leading to demyelination. MS in the pediatric population is rare, but has been shown to lead to significant disability over the duration of the disease. As we have learned more about pediatric MS, there has been a development of improved diagnostic criteria leading to earlier diagnosis, earlier initiation of disease-modifying therapies (DMT), and an increasing number of DMT used in the treatment of pediatric MS. Over time, treatment with DMT has trended towards the initiation of higher efficacy treatment at time of diagnosis to help prevent further disease progression and accrual of disability over time, and there is evidence in current literature that supports this change in treatment patterns. In this review, we discuss the current knowledge in diagnosis, treatment, and clinical outcomes in pediatric MS.
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Chromatic visual evoked potentials indicate early dysfunction of color processing in young patients with demyelinating disease. Doc Ophthalmol 2020; 141:157-168. [PMID: 32157494 DOI: 10.1007/s10633-020-09761-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Chromatic visual evoked potentials (cVEP) primarily reflect the parvocellular visual pathway function, which has been shown to be predominantly affected in demyelinating disease (DD). The purpose of this study was to evaluate cVEP responses and to compare them with other structural and functional findings in young patients with DD. METHODS Thirty patients (8-28 years of age) with DD with or without a history of optic neuritis (ON) were investigated. Twenty-five eyes had at least one episode of ON (ON-group) and 35 eyes had no clinically evident episode of ON (nON-group). OCT imaging was performed using a high-resolution spectral-domain OCT (SD-OCT), measuring retinal nerve fiber layer (RNFL) thickness. Pattern reversal electroretinography (PERG) and visual evoked potentials (VEP) were recorded according to the ISCEV standard, and chromatic visual evoked potentials (cVEP) were recorded to isoluminant red-green (R-G) and blue-yellow (B-Y) 7° circle stimuli, composed of horizontal sinusoidal gratings with spatial frequency 2 cycles/°, 90% chromatic contrast and onset-offset (300:700 ms) mode of stimulation. Structural and functional measures were analyzed and compared between the groups. RESULTS Both general (G) and temporal (T) RNFL thicknesses were reduced below normal limits in most of the eyes. However, in the ON-group (G: 77.5 ± 20.6, T: 51.4 ± 23.4 µm), the thinning was more significant (p < 0.001) than in the nON-group (G: 95.4 ± 12.1, T: 70.1 ± 11.5 µm). PERG N95 was within normal limits in the nON-group, while it was significantly more affected in the ON-group (7.4 ± 1.0 vs. 5.1 ± 2.0 μV; p < 0.0001). Similarly, also VEP P100 latency and amplitude showed a greater percentage of abnormality in the ON-group, the latency being longer (117.2 ± 16.9 vs. 99.4 ± 4.6 ms; p < 0.0001) and the amplitude lower (9.1 ± 5.1 vs. 16.4 ± 7.5 μV; p < 0.0001). The cVEP N-wave amplitude to R-G and B-Y stimuli was reduced below normal limits in both ON- and nON-groups; however, cVEP to B-Y stimulation were slightly more affected in the ON-group (4.0 ± 3.8 vs. 5.9 ± 3.3 µm; p = 0.02). A positive correlation between cVEP amplitude and RNFL thickness and between cVEP amplitude and PERG N95 amplitude, as well as a strong negative correlation between cVEP amplitude and P100 latency was observed. CONCLUSIONS These findings demonstrate that cVEP indicate early abnormality of parvocellular pathway function in eyes with or without a history of optic neuritis and can be used together with other structural and functional parameters to evaluate visual pathway integrity of young patients with DD.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on advances in the understanding of pediatric demyelinating optic neuritis. RECENT FINDINGS In the past decade, the disease phenotypes for demyelinating syndromes in children have been more clearly defined. Pediatric optic neuritis may present as a clinically isolated syndrome or in the setting of underlying neurologic disease. In addition to optic neuritis associated with multiple sclerosis or neuromyelitis optica, recent work has identified antibodies to the myelin oligodendrocyte glycoprotein (MOG IgG) as a unique demyelinating cause with distinct features regarding treatment and prognosis. The disease phenotypes for demyelinating pediatric optic neuritis have expanded. Treatment strategies vary and are not universally effective for each cause of demyelinating disease. Accurately distinguishing among these unique clinical syndromes is therefore critical for initiation of appropriate treatment to prevent disability, to maximize visual outcomes, and to provide insight into long-term prognosis.
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Affiliation(s)
- Ryan A Gise
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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Abstract
In this chapter, we will review monophasic and recurrent demyelinating disorders in children. We will first review consensus definitions and provide an approach to the evaluation of children with first episode of acquired demyelinating disorder. We will discuss typical clinical and radiological features of these syndromes. In the second section, we will review features of recurrent demyelinating syndromes in children, focusing on clinical presentation and treatment options.
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Affiliation(s)
- Mustafa A.M. Salih
- College of Medicine Division of Pediatric Neurology, King Saud University, Riyadh, Saudi Arabia
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Choi DD, Park MS, Park KA. Incidence of optic neuritis in Korean children and adolescents: A Nationwide survey and National Registry Analysis. J Neurol Sci 2020; 408:116554. [DOI: 10.1016/j.jns.2019.116554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 11/30/2022]
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Datta R, Sollee JR, Lavery AM, Ficerai-Garland G, Karoscik K, Liu G, Banwell BL, Waldman AT. Effects of Optic Neuritis, T2 Lesions, and Microstructural Diffusion Integrity in the Visual Pathway on Cortical Thickness in Pediatric-Onset Multiple Sclerosis. J Neuroimaging 2019; 29:760-770. [PMID: 31317617 PMCID: PMC10637320 DOI: 10.1111/jon.12654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/06/2019] [Accepted: 06/24/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE Pediatric-onset multiple sclerosis (POMS) is associated with focal inflammatory lesions and the loss of cortical and deep gray matter. Optic neuritis (ON) and white matter (WM) lesions in the visual pathway can directly contribute to visual cortical mantle thinning. We determine the relative contributions of MS insult on anterior and posterior visual pathway integrity. METHODS High- and low-contrast visual acuity, optical coherence tomography (OCT), and 3T MRI scans were obtained from 20 POMS patients (10 with remote ON) and 22 age- and sex-matched healthy controls. Cortical mantle thickness was measured using FreeSurfer. Fractional anisotropy (FA) and mean diffusivity were calculated for postchiasmal optic radiations (with and without WM lesions). Groups were compared using Student's t-test (adjusted for multiple comparisons), and simple linear regression was used to investigate interrelationships between measures. RESULTS Mean cortical thickness of the whole brain was reduced in patients (2.49 mm) versus controls (2.58 mm, P = .0432) and in the visual cortex (2.07 mm vs. 2.17 mm, P = .0059), although the foveal confluence was spared. Mean FA of the optic radiations was reduced in POMS (.40) versus controls (.43, P = .0042) and correlated with visual cortical mantle thickness in POMS (P = .017). Visual acuity, OCT measures, and lesion volumes in the optic radiations were not associated with cortical mantle thickness. CONCLUSIONS POMS negatively impacts the integrity of the anterior visual pathway, but it is the loss of WM integrity that drives anterograde loss of the cortical mantle. Preserved visual acuity and foveal sparing imply some degree of functional and structural resilience.
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Affiliation(s)
- Ritobrato Datta
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - John R Sollee
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Amy M Lavery
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gabriella Ficerai-Garland
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Krystle Karoscik
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Geraldine Liu
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brenda L Banwell
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amy T Waldman
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Lee JY, Han J, Yang M, Oh SY. Population-based Incidence of Pediatric and Adult Optic Neuritis and the Risk of Multiple Sclerosis. Ophthalmology 2019; 127:417-425. [PMID: 31732227 DOI: 10.1016/j.ophtha.2019.09.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/09/2019] [Accepted: 09/19/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the age- and sex-specific prevalence and incidence of demyelinating optic neuritis and the risk of multiple sclerosis (MS) in pediatric and adult populations in South Korea. DESIGN A nationwide, population-based, retrospective study using data from the Korean National Health Claims database from 2010 to 2016. PARTICIPANTS The entire South Korean population aged 65 years of age or younger (n = 44 700 564). All patients with optic neuritis from the entire Korean population were included. METHODS Patients aged 14 years of age or younger were classified as pediatric patients, and those aged 15 to 65 years were classified as adults. Each group was analyzed separately. Patients with optic neuritis had a subsequent diagnosis, including idiopathic, MS, neuromyelitis optica (NMO), and acute disseminated encephalomyelitis. Prevalence and incidence, conversion rate to MS, and treatment modalities (steroids, plasmapheresis, interferon-β, and immunosuppressants) were estimated. MAIN OUTCOME MEASURES Prevalence and incidence of optic neuritis, and conversion rate to MS. RESULTS Among 44 700 564 individuals, 531 pediatric patients (50.7% female) and 7183 adults (53.3% female) were identified as having optic neuritis. Annual incidence was 1.04 (95% confidence interval [CI], 1.01-1.07) per 100 000 pediatric individuals and 3.29 (95% CI, 3.28-3.30) per 100 000 adults. Peak incidence was observed at 10 to 14 years in the pediatric population and at 30 to 34 years and 50 to 54 years in the adult population. Conversion rate to MS was 13.8% in the pediatric population and 11.4% in the adult population. Fourteen percent of all patients were treated with chronic immunosuppressants, 38% of patients with NMO underwent plasmapheresis, and 50% of patients with MS were treated with interferon-β. CONCLUSIONS This is a nationwide epidemiologic study of optic neuritis in individuals of all ages in South Korea. The incidence of optic neuritis and subsequent risk of MS in the pediatric population are comparable to those reported in western countries but are lower in the adult population than in western countries. The incidence rate in adults was 3.2-fold higher than in the pediatric population, and the overall MS conversion rate in the entire Korean population was estimated to be 10.6%.
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Affiliation(s)
- Ju-Yeun Lee
- Department of Ophthalmology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Jinu Han
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Mi Yang
- Statistics and Data Center, Samsung Medical Center, Seoul, South Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Requirement for Head Magnetic Resonance Imaging in Children Who Present to the Emergency Department With Acute Nontraumatic Visual Disturbance. Pediatr Emerg Care 2019; 35:341-346. [PMID: 29768295 DOI: 10.1097/pec.0000000000001506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aimed to investigate the clinical features and head magnetic resonance imaging (MRI) findings in children who presented to the emergency department with acute nontraumatic visual disturbance and to study related clinical factors for discovering positive lesions on head MRI. METHODS We performed a retrospective study of 1-month to 15-year-old children who underwent head MRI as an evaluation for acute nontraumatic visual disturbance as a chief complaint in our pediatric emergency department between March 2010 and March 2015. The symptoms of visual disturbance were blurred vision, diplopia, loss of vision, and visual hallucination. Head MRI findings were considered positive when lesions could explain the symptoms. RESULTS We identified 39 patients (25 with blurred vision, 9 with diplopia, 3 with loss of vision, and 2 with visual hallucination) with a mean age of 8.35 ± 4.06 years. Positive head MRI findings were identified in 13 patients (33.3%). Brain tumors were most common (53.8%), followed by optic nerve inflammations (23.1%), congenital brain lesions (15.4%), and hypertensive encephalopathy (7.7%). Compared with the negative head MRI group, the positive head MRI group showed significantly less transient visual disturbance (duration <1 hour to complete recovery) (P = 0.001), more limited eye movement (P = 0.003), and more pupillary abnormalities (P = 0.030). CONCLUSIONS We suggest performing urgent head MRI in children with acute nontraumatic visual disturbance if the symptoms last longer than 1 hour without complete recovery and are accompanied by limited eye movement or pupillary abnormality.
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Association of MMP-2 (⁻1306 C/T) Gene Polymorphism with Predisposition to Optic Neuritis and Optic Neuritis Together with Multiple Sclerosis. ACTA ACUST UNITED AC 2018; 54:medicina54020029. [PMID: 30344260 PMCID: PMC6037261 DOI: 10.3390/medicina54020029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
Background and objective: Optic neuritis (ON) is characterized by painful, usually monocular vision loss with decreased visual acuity and defects of the visual field and color vision. The etiology and pathophysiology of ON is not completely clear. It is thought that a matrix metalloproteinase 2 (MMP-2) gene plays an essential role in this autoimmune inflammatory disease. The aim of this study was to determine the relationship between the MMP-2 (-1306 C/T)rs243865 gene polymorphism and ON, and that of ON with multiple sclerosis. Materials and methods: Patients with ON/ON and multiple sclerosis and a control group of healthy individuals were enrolled in this study. The genotyping test of the MMP-2 (-1306 C/T) was carried out using a real-time polymerase chain reaction (PCR) method. Results: Analysis revealed that T allele at the MMP-2 (-1306 C/T) was less frequent in the ON group compared to the control group (14.5% vs. 23.3%, p = 0.031), and was associated with decreased likelihood of ON development (OR = 0.566; 95% CI: 0.333-0.962; p = 0.036). No significant associations were revealed while comparing the subgroups of ON patients with and without multiple sclerosis. Conclusion: The MMP-2 (-1306 C/T) gene polymorphism was found to be associated with ON development.
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Monge Galindo L, Martínez de Morentín AL, Pueyo Royo V, García Iñiguez JP, Sánchez Marco S, López-Pisón J, Peña-Segura JL. Optic neuritis in paediatric patients: Experience over 27 years and a management protocol. Neurologia 2018. [PMID: 29526320 DOI: 10.1016/j.nrl.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents. MATERIAL AND METHODS We conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet. RESULTS Our neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients' age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided. CONCLUSIONS ON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important.
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Affiliation(s)
- L Monge Galindo
- Sección de Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
| | | | - V Pueyo Royo
- Servicio de Oftalmología, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - J P García Iñiguez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - S Sánchez Marco
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - J López-Pisón
- Sección de Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - J L Peña-Segura
- Sección de Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
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Averseng-Peaureaux D, Mizzi M, Colineaux H, Mahieu L, Pera MC, Brassat D, Chaix Y, Berard E, Deiva K, Cheuret E. Paediatric optic neuritis: factors leading to unfavourable outcome and relapses. Br J Ophthalmol 2017; 102:808-813. [DOI: 10.1136/bjophthalmol-2016-309978] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 11/04/2022]
Abstract
ObjectivesTo identify prognostic factors associated with poor visual recovery and chronic relapsing diseases, for example, multiple sclerosis (MS), in children with optic neuritis (ON) at onset.MethodsThis multicentre retrospective study included 102 children with a first ON episode between 1990 and 2012. The primary criterion was poor visual recovery determined by visual acuity, and the secondary was relapses following ON.ResultsMedian age was 11 years, 66% were girls and mean follow-up was 24 months. 58% of children were diagnosed with idiopathic isolated ON, 22% had MS, 5% had Devic’s neuromyelitis optica and 6% chronic relapsing inflammatory ON. Complete visual acuity recovery rate was 57% (95% CI=[46%-69%]) at 6 months and 71% (95% CI=[60%-81%]) at 1 and 2 years but was lower in MS (p<0.01), with recovery rate of only 27% (95% CI=[12%-54%]) at 1 year. Age ≥10 years, optic disc pallor at funduscopy and MS were the principal factors associated with poor visual recovery. Age ≥10 years, abnormal brain MRI at onset and oligoclonal banding were significantly associated with MS (p<0.01).ConclusionAge ≥10, optic disc pallor and MS were associated with poor recovery. Better identification of these patients may help to adapt treatment and lead to a prospective treatment study.
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Khadse R, Ravindran M, Pawar N, Maharajan P, Rengappa R. Clinical profile and neuroimaging in pediatric optic neuritis in Indian population: A case series. Indian J Ophthalmol 2017; 65:242-245. [PMID: 28440255 PMCID: PMC5426131 DOI: 10.4103/ijo.ijo_939_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
- Rutika Khadse
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Neelam Pawar
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Padmavathy Maharajan
- Department of Neurophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Ramakrishnan Rengappa
- Department of Neurophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
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Abstract
Optic neuritis is rare in children in comparison to adults, but accounts for approximately 25% of pediatric acute demyelinating syndromes. Features of pediatric optic neuritis that differ from adults include a higher rate of bilaterality, poor visual acuity on presentation, and papillitis. Diagnostic work-up includes brain magnetic resonance imaging, lumbar puncture, and blood tests to exclude infectious and inflammatory disorders. Pediatric optic neuritis may occur following infection or vaccination, or in association with a systemic demyelinating process such as acute disseminated encephalomyelitis, neuromyelitis optica, or multiple sclerosis. Treatment is controversial, but most practitioners administer corticosteroids. Most children with optic neuritis experience full visual recovery. The recently launched Pediatric Optic Neuritis Prospective Data Collection Study (PON1) aims to provide estimates of visual acuity outcome and assess the potential to recruit for a future pediatric optic neuritis treatment trial.
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Affiliation(s)
- Melinda Y Chang
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, CA
| | - Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, CA.
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Ramdas S, Morrison D, Absoud M, Lim M. Acute onset blindness: a case of optic neuritis and review of childhood optic neuritis. BMJ Case Rep 2016; 2016:bcr-2016-214929. [PMID: 27702928 DOI: 10.1136/bcr-2016-214929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Optic neuritis (ON) is an acquired disorder of the optic nerve due to inflammation, demyelination or degeneration. We report a child who presented with acute onset bilateral visual loss who, following a diagnosis of ON, was treated and had excellent visual recovery. Paediatric ON is considered to be different clinical entity to adult ON. Although in children ON is usually parainfectious or postinfectious, it can be the first presenting feature of multiple sclerosis or neuromyelitis optica spectrum disease. In this paper, we discuss the literature on treatment of ON and prediction of risk of recurrence.
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Affiliation(s)
- Sithara Ramdas
- Department of Paediatric Neurology, Evelina London Children's Hospital at Guy's and St Thomas' NHS Trust, London, UK
| | - Danny Morrison
- Children's Eye Department, Guy's and St Thomas' NHS Trust, London, UK
| | - Michael Absoud
- Department of Paediatric Neurology, Evelina London Children's Hospital at Guy's and St Thomas' NHS Trust, London, UK
| | - Ming Lim
- Department of Paediatric Neurology, Evelina London Children's Hospital at Guy's and St Thomas' NHS Trust, London, UK
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27
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Banwell B. Pediatric multiple sclerosis. Neurology 2016; 87:822-6. [DOI: 10.1212/wnl.0000000000003014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/12/2016] [Indexed: 11/15/2022] Open
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28
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Heussinger N, Kontopantelis E, Gburek-Augustat J, Jenke A, Vollrath G, Korinthenberg R, Hofstetter P, Meyer S, Brecht I, Kornek B, Herkenrath P, Schimmel M, Wenner K, Häusler M, Lutz S, Karenfort M, Blaschek A, Smitka M, Karch S, Piepkorn M, Rostasy K, Lücke T, Weber P, Trollmann R, Klepper J, Häussler M, Hofmann R, Weissert R, Merkenschlager A, Buttmann M. Oligoclonal bands predict multiple sclerosis in children with optic neuritis. Ann Neurol 2015; 77:1076-82. [PMID: 25820181 DOI: 10.1002/ana.24409] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 03/16/2015] [Accepted: 03/22/2015] [Indexed: 11/08/2022]
Abstract
We retrospectively evaluated predictors of conversion to multiple sclerosis (MS) in 357 children with isolated optic neuritis (ON) as a first demyelinating event who had a median follow-up of 4.0 years. Multiple Cox proportional-hazards regressions revealed abnormal cranial magnet resonance imaging (cMRI; hazard ratio [HR] = 5.94, 95% confidence interval [CI] = 3.39-10.39, p < 0.001), presence of cerebrospinal fluid immunoglobulin G oligoclonal bands (OCB; HR = 3.69, 95% CI = 2.32-5.86, p < 0.001), and age (HR = 1.08 per year of age, 95% CI = 1.02-1.13, p = 0.003) as independent predictors of conversion, whereas sex and laterality (unilateral vs bilateral) had no influence. Combined cMRI and OCB positivity indicated a 26.84-fold higher HR for developing MS compared to double negativity (95% CI = 12.26-58.74, p < 0.001). Accordingly, cerebrospinal fluid analysis may supplement cMRI to determine the risk of MS in children with isolated ON.
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Affiliation(s)
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Janina Gburek-Augustat
- Department of Neuropaediatrics, Developmental Neurology and Social Paediatrics, University Children's Hospital Tübingen, Tübingen, Germany
| | - Andreas Jenke
- HELIOS Children's Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Gesa Vollrath
- Department of Paediatrics, University of Rostock, Rostock, Germany
| | - Rudolf Korinthenberg
- Department of Neuropediatrics and Muscular Disorders, Center of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Peter Hofstetter
- Department of Child Neurology, Center of Paediatrics, University Hospital Frankfurt/Main, Frankfurt am Main, Germany
| | - Sascha Meyer
- Department of Neuropediatrics, University Children's Hospital of Saarland, Homburg, Germany
| | - Isabel Brecht
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Herkenrath
- Department of Pediatrics, University of Cologne, Cologne, Germany
| | | | - Kirsten Wenner
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Häusler
- Department of Pediatrics, Division of Neuropediatrics and Social Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
| | - Soeren Lutz
- Department of Neuropediatrics, Developmental Neurology, and Social Pediatrics, University of Essen, Essen, Germany
| | - Michael Karenfort
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Astrid Blaschek
- Department of Paediatric Neurology and Developmental Medicine, Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Martin Smitka
- Department of Pediatric Neurology, Technical University Dresden, Dresden, Germany
| | - Stephanie Karch
- University Hospital for Pediatric and Adolescent Medicine, Department of Pediatric Neurology, Heidelberg, Germany
| | - Martin Piepkorn
- Department for Neuropediatrics, Children's and Youth Hospital "Auf der Bult", Hannover, Germany
| | - Kevin Rostasy
- Division of Pediatric Neurology, Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria and Pediatric Neurology, Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany
| | - Thomas Lücke
- Department of Neuropediatrics, University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Peter Weber
- Division of Neuropediatrics and Developmental Medicine, University Children's Hospital Basel, Basel, Switzerland
| | - Regina Trollmann
- Department of Pediatrics, Division of Neuropediatrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Klepper
- Children's Hospital Aschaffenburg, Aschaffenburg, Germany
| | | | - Regina Hofmann
- Department of Pediatric Neurology, Justus Liebig University Giessen, Giessen, Germany
| | - Robert Weissert
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Andreas Merkenschlager
- Department of Neuropediatrics, Children's Hospital of the University of Leipzig, Leipzig, Germany
| | - Mathias Buttmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
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Vianello FA, Osnaghi S, Laicini EA, Milani GP, Tardini G, Cappellari AM, Lunghi G, Agostoni CV, Fossali EF. Optic neuritis associated with influenza B virus meningoencephalitis. J Clin Virol 2014; 61:463-5. [PMID: 25308101 DOI: 10.1016/j.jcv.2014.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 11/26/2022]
Abstract
Various postinfectious neurological manifestations have been described associated to influenza viruses. Optic neuritis is a serious, often reversible disease reported among several infectious diseases and vaccines complications. We report a case of optic neuritis following an influenza B virus infection in a 10-year-old male.
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Affiliation(s)
- F A Vianello
- Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy.
| | - S Osnaghi
- Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Oculistic Department, Milan, Italy
| | - E A Laicini
- Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy
| | - G P Milani
- Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy.
| | - G Tardini
- Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy
| | - A M Cappellari
- Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - G Lunghi
- Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Laboratory Department, Virology Unit, Milan, Italy
| | - C V Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Ospedale Maggiore Policlinico, Pediatric Clinic 2, Milan, Italy
| | - E F Fossali
- Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy
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30
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Du Y, Li JJ, Zhang YJ, Li K, He JF. Risk factors for idiopathic optic neuritis recurrence. PLoS One 2014; 9:e108580. [PMID: 25255372 PMCID: PMC4177903 DOI: 10.1371/journal.pone.0108580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 09/01/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Approximately 30-50% of idiopathic optic neuritis (ION) patients experience one or multiple episodes of recurrence. The aim of this study was to search for risk factors for ION recurrence. METHODS Clinical data on hospitalized patients diagnosed with ION between January 2003 and January 2011 at the First Affiliated Hospital of Guangxi Medical University were retrospectively collected. Univariate and multivariate analyses were performed on factors that might cause ION recurrence. In total, 115 ION cases (32 recurrent and 83 non-recurrent cases) with complete data were analyzed. The length of the follow-up period ranged from 12 to 108 months (median: 42 months). RESULTS The univariate analysis showed that the recurrence rate for unilateral ION was higher than that for bilateral ION (40% vs. 12%, p=0.001). Underlying diseases had a significant impact on recurrence (p<0.001): the recurrence rates due to neuromyelitis optica (NMO), multiple sclerosis (MS), demyelinating lesions alone of the central nervous system, and unknown causes were 89%, 70%, 41%, and 8.7%, respectively. The multivariate analysis showed that the factors causing relatively high recurrence rates included NMO (odds ratio [OR], 73.5; 95% confidence interval [CI], 7.3 to 740.9), MS (OR, 33.9; 95% CI, 5.2 to 222.2), and demyelinating lesions alone (OR, 8.9; 95% CI, 2.3 to 34.4), unilateral involvement (OR, 5.7; 95% CI, 1.5 to 21.3), relatively low initial glucocorticoid dosage (equivalent to ≤ 100 mg prednisone/day) (OR, 4.3; 95% CI, 1.0 to 17.9). CONCLUSION Underlying diseases, laterality (unilateral or bilateral), and initial glucocorticoid dosage are important risk factors of ION recurrence. Clinical physicians are advised to treat ION patients with a sufficient dose of glucocorticoid in the initial treatment stage to reduce the recurrence risk.
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Affiliation(s)
- Yi Du
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jing-Jing Li
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yu-Jiao Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Kaijun Li
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jian-Feng He
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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31
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Wan MJ, Adebona O, Benson LA, Gorman MP, Heidary G. Visual outcomes in pediatric optic neuritis. Am J Ophthalmol 2014; 158:503-7.e2. [PMID: 24907434 DOI: 10.1016/j.ajo.2014.05.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the visual outcomes of a large cohort of pediatric patients presenting to a tertiary care pediatric hospital with first-episode optic neuritis. DESIGN Retrospective, observational cohort study. METHODS In a tertiary care pediatric hospital, patients with first-episode optic neuritis and at least 3 months of follow-up over a 10-year period were assessed and followed-up in the ophthalmology department. The main outcome measures were visual acuity at 3 months and 1 year of follow-up, with analysis of risk factors for poor visual outcomes and the time course of visual recovery. RESULTS Of the 59 pediatric patients with first-episode optic neuritis, 46 had at least 3 months of follow-up and 36 had at least 1 year of follow-up. The mean age was 12.6 years old; 72% were female, 41% had bilateral involvement, 52% had or developed an underlying diagnosis (39% multiple sclerosis, 7% acute disseminated encephalomyelitis, 7% neuromyelitis optica), and 91% received treatment (85% steroids, 7% multimodal). At 1 year, 81% were at least 20/20 and 89% were at least 20/40. A poor visual outcome at 1 year (<20/40) was associated with vision of <20/20 at 3 months (P = 0.041). Other clinical characteristics, including visual acuity at presentation, sex, bilateral involvement, optic nerve edema, and underlying diagnoses were not significantly associated with poor visual outcomes. CONCLUSIONS In this cohort of pediatric patients with optic neuritis, the majority of patients regained normal visual acuity at 1 year, regardless of baseline clinical characteristics.
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Affiliation(s)
- Michael J Wan
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olumuyiwa Adebona
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leslie A Benson
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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32
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Pérez-Cambrodí RJ, Gómez-Hurtado Cubillana A, Merino-Suárez ML, Piñero-Llorens DP, Laria-Ochaita C. Optic neuritis in pediatric population: a review in current tendencies of diagnosis and management. JOURNAL OF OPTOMETRY 2014; 7:125-130. [PMID: 25000867 PMCID: PMC4087179 DOI: 10.1016/j.optom.2013.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 06/03/2023]
Abstract
Optic neuritis is an inflammation of the optic nerve and may be related to different systemic conditions. The clinical presentation of this pathology usually includes sudden loss of visual acuity (VA) which may be unilateral or bilateral, visual field restriction, pain with eye movements, dyschromatopsia, a relative afferent pupillary defect and optic disk swelling. Optic neuritis in children has specific clinical features and a better prognosis than in adulthood. Although usually appears an underlying viral disease, the main concern for practitioners is the relationship of optic neuritis with multiple sclerosis. In addition to the classical techniques as magnetic resonance imaging (MRI), current tendencies of diagnosis for eye practitioners include new imaging devices as optical coherence tomography (OCT), useful to show a thinning of the retinal fibers layer (RFL) after the inflammatory episode. Regarding the management of these patients, short-term intravenous steroid dosages seem to be the best option to treat acute attacks characterized by a very poor bilateral VA.
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Affiliation(s)
| | | | - María L Merino-Suárez
- Oftalmar, Ophthalmology Department, Hospital Internacional Medimar, Alicante, Spain; Department of Optics, Anatomy and Pharmacology, University of Alicante, Spain
| | - David P Piñero-Llorens
- Oftalmar, Ophthalmology Department, Hospital Internacional Medimar, Alicante, Spain; Department of Optics, Anatomy and Pharmacology, University of Alicante, Spain
| | - Carlos Laria-Ochaita
- Oftalmar, Ophthalmology Department, Hospital Internacional Medimar, Alicante, Spain
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34
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Peche SS, Alshekhlee A, Kelly J, Lenox J, Mar S. A long-term follow-up study using IPMSSG criteria in children with CNS demyelination. Pediatr Neurol 2013; 49:329-34. [PMID: 23993834 DOI: 10.1016/j.pediatrneurol.2013.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/17/2013] [Accepted: 06/30/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the practical application of International Pediatrics Multiple Sclerosis study group definitions in children with inflammatory demyelination of the central nervous system and to identify predictors of multiple sclerosis. METHODS Baseline data on 123 children with a first episode of acute central nervous system demyelination were collected. The initial diagnosis according to the International Pediatrics Multiple Sclerosis study group was recorded and compared with final diagnosis. RESULTS Forty-seven (38.2%) children met International Pediatrics Multiple Sclerosis study group criteria for acute disseminated encephalomyelitis and 67 (54.4%) had clinically isolated syndrome at the initial presentation. Four (3.2%) had the diagnosis of neuromyelitis optica and five (4%) did not meet any specific diagnosis per the study group criteria. Clinical follow-up was available on 118 of 123 children (95.9%), with a median of 61.5 months (quartile range 23, 110 months). Conversion from clinically isolated syndrome to multiple sclerosis occurred in 26 of 67 children (38.8%); acute disseminated encephalomyelitis to multiple sclerosis occurred in 4 of 47 children (8.5%). Adjusted multivariate logistic regression analysis for an outcome of future development of multiple sclerosis showed the following predictors: female gender (odds ratio 12.44; 95% confidence interval 1.03-149.3); initial diagnosis of monofocal brain stem or hemispheric dysfunction (odds ratio 24.57; 95% confidence interval 3.06-196.78); and Callen magnetic resonance imaging criteria if met (odds ratio 122.45; 95% confidence interval 16.57-904.57). CONCLUSION International Pediatrics Multiple Sclerosis study group criteria affirm that children with initial clinically isolated syndrome are more likely to develop future multiple sclerosis compared with those with an acute disseminated encephalomyelitis initial diagnosis. In addition, female gender, brain stem or hemispheric involvement, and Callen magnetic resonance imaging criteria predict the diagnosis of multiple sclerosis.
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Affiliation(s)
- Shubhangi S Peche
- Department of Pediatrics, Division of Child and Adolescent Neurology, Southern Illinois University, Springfield, Illinois.
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35
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Benoilid A, Tilikete C, Collongues N, Arndt C, Vighetto A, Vignal C, de Seze J. Relapsing optic neuritis: a multicentre study of 62 patients. Mult Scler 2013; 20:848-53. [DOI: 10.1177/1352458513510223] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/11/2013] [Indexed: 11/17/2022]
Abstract
Background: Optic neuritis (ON) may be the first symptom of a central nervous system demyelinating, systemic or infectious disease but few patients experience recurrent episodes and have a negative workup. Objective: This disorder, named relapsing optic neuritis (RON), is poorly described in the literature and still presents a particular challenge in diagnosis and management. Methods: We describe the clinical, laboratory, magnetic resonance imaging (MRI) and disability course of RON in a French cohort of 62 patients, based on a multicentre, retrospective, observational study. Results: In our cohort, we identified two distinct groups of RON patients. The first is characterised by relapsing inflammatory optic neuritis (RION, 68%), which is non-progressive, whereas the second presented as a chronic relapsing inflammatory optic neuritis (CRION, 32%), which is progressive. We have noted more cases with steroid dependence in the CRION group than the RION group (42% vs 10%). The long-term visual prognosis was more severe in CRION patients and neuromyelitis optica-immunoglobulin G (NMO-IgG)-positive patients. Conclusion: RON is likely a separate entity corresponding to an autoimmune disease that differs from multiple sclerosis (MS), NMO and vasculitis. We provide a new classification system based on a better understanding of RON which could allow an improved management by early treatment of poor prognosis forms.
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Affiliation(s)
- Aurélien Benoilid
- University Hospital, France
- Clinical Investigation Centre, INSERM 10002, France
| | | | - Nicolas Collongues
- University Hospital, France
- Clinical Investigation Centre, INSERM 10002, France
| | | | | | | | - Jérôme de Seze
- University Hospital, France
- Clinical Investigation Centre, INSERM 10002, France
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37
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de Seze J. Inflammatory Optic Neuritis: From Multiple Sclerosis to Neuromyelitis Optica. Neuroophthalmology 2013; 37:141-145. [PMID: 28167977 DOI: 10.3109/01658107.2013.804232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/02/2013] [Indexed: 11/13/2022] Open
Abstract
Inflammatory optic neuritis represents a frequent clinical situation in neurology and ophthalmology. In those parts of the world where multiple sclerosis is common, it is the condition most discussed as the cause of optic neuritis. However, the risk for conversion from optic neuritis to multiple sclerosis is evaluated at only around 50% after 15 years of follow-up. The risk is higher in cases in whom abnormalities typical of multiple sclerosis are found on magnetic resonance imaging of the brain and oligoclonal bands found on cerebrospinal fluid protein electrophoresis with no corresponding bands in serum. When these investigations are normal, optic neuritis is usually considered as "idiopathic" with a suspected viral aetiology, but in some cases, a systemic disease such as sarcoidosis, systemic lupus erythematosis, or Sjögren syndrome may be diagnosed. In rare cases, either recurrent optic neuritis or myelitis may occur without any evidence for multiple sclerosis. In the first case, it corresponds to a recently characterised disorder referred to as chronic relapsing inflammatory optic neuropathy and in the second case to a recently better identified entity, neuromyelitis optica. In the present paper, the differential diagnosis of inflammatory optic neuritis is presented from multiple sclerosis to infectious optic neuritis, systemic disease, and neuromyelitis optica.
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Affiliation(s)
- Jérôme de Seze
- Departement de Neurologie, Hôpital Hautepierre CHU de Strasbourg, Strasbourg France
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38
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Heussinger N, Kontopantelis E, Rompel O, Paulides M, Trollmann R. Predicting multiple sclerosis following isolated optic neuritis in children. Eur J Neurol 2013; 20:1292-6. [DOI: 10.1111/ene.12184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 03/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- N. Heussinger
- Department of Pediatrics; University Clinic of Erlangen-Nuremberg; Erlangen Germany
| | - E. Kontopantelis
- Institute of Population Health; University of Manchester; Manchester UK
| | - O. Rompel
- Department of Radiology; University Clinic of Erlangen-Nuremberg; Erlangen Germany
| | - M. Paulides
- Department of Pediatrics; University Clinic of Erlangen-Nuremberg; Erlangen Germany
| | - R. Trollmann
- Department of Pediatrics; University Clinic of Erlangen-Nuremberg; Erlangen Germany
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Pediatric multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2013. [PMID: 23622337 DOI: 10.1016/b978-0-444-52910-7.00049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Recognition of multiple sclerosis (MS) and other acquired demyelinating disorders in children has increased significantly in the last decade. Consensus definitions that characterize the varied clinical presentations of acute demyelination, and proposed clinical and MRI criteria specific for MS in children have aided diagnostic consistency. Care of children with an acute demyelinating attack is influenced by clinical severity, with corticosteroids, immunoglobulin, and plasma exchange being the most commonly employed therapies. Children with confirmed MS are often managed with immunomodulatory therapies (interferon and glatiramer acetate) approved for the treatment of MS in adults. Routine assessment of hepatic and hematological cell indices are important to monitor for safety of interferon therapy. While clinical treatment trials of interferon and glatiramer acetate in pediatric MS have yet to be conducted, case series evidence supports clinical safety and relapse rate reduction in the pediatric MS population. Epidemiological studies have implicated place of residence during childhood as a key determinant of MS risk. As such, pediatric-onset MS provides an opportunity to explore these risk factors contemporaneous with the clinical onset of disease. Studies of vitamin D, microbial exposures, and parental smoking are areas under active investigation. Finally, research exploring primary immunological mechanisms and host responses in patients with pediatric-onset MS, who by virtue of their young age may harbor fewer extraneous immune abnormalities, may yield new insights into the fundamental pathobiology of MS.
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O'Mahony J, Bar-Or A, Arnold DL, Sadovnick AD, Marrie RA, Banwell B. Masquerades of acquired demyelination in children: experiences of a national demyelinating disease program. J Child Neurol 2013; 28:184-97. [PMID: 22573735 DOI: 10.1177/0883073812443006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnosis of acquired demyelinating syndromes of the central nervous system in children requires exclusion of other acute central nervous system disorders. In a 23-site national demyelinating disease study, standardized clinical, laboratory, and magnetic resonance imaging (MRI) data were obtained prospectively from onset, and serially at 3, 6, and 12 months and annually. Twenty of 332 (6%) participants (mean [SD] age, 10.21 [4.32] years; 12 (60%) female) were ultimately diagnosed with vascular disorders (primary or secondary central nervous system vasculitis, vasculopathy, stroke, or migraine, n = 11 children), central nervous system malignancy (n = 3), mitochondrial disease (n = 2), or central nervous system symptoms in the accompaniment of confirmed infection (n = 4). Red flags that may serve to distinguish disorders in the differential of acquired demyelination are described.
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Affiliation(s)
- Julia O'Mahony
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Toronto, Canada.
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Abstract
OPINION STATEMENT Pediatric optic neuritis is a rare disorder causing a subacute loss of vision (often bilateral) in children, often of a severe degree. Common clinical findings include dense visual field loss, afferent pupillary defect (APD) in unilateral cases, and papillitis that is often bilateral. Contrary to optic neuritis in the adult population, the differential diagnosis for this disorder in pediatric patients is quite extensive, so neuroimaging and serologic evaluation are necessary to exclude an infectious or neoplastic process. Pediatric optic neuritis may occur as a clinically isolated syndrome, or in association with diffuse neurologic dysfunction, such as acute disseminated encephalomyelitis (ADEM). Optic neuritis may also be the first episode heralding the onset of pediatric multiple sclerosis or neuromyelitis optica (NMO or Devic's disease). Therefore, formal neurologic evaluation and follow-up are indicated. Although the management of this disorder in adults is well described, there is a paucity of evidence-based, prospective clinical data on its management and treatment in a pediatric population. The current treatment of pediatric optic neuritis consists of 3 to 5 days of intravenous methylprednisolone (4-30 mg/kg per day), followed by a prolonged oral corticosteroid taper. A prolonged course of oral steroid (2-4 weeks) is recommended to avoid recurrence, which is common in this age group. Some controversy persists concerning the exposure of children to high-dose parenteral corticosteroids to treat an entity that is usually self-limited, but given the severity of vision loss in one or both eyes in this population, this intervention is standard in neuro-ophthalmologic practice.
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Affiliation(s)
- Gabrielle R Bonhomme
- Eye and Ear Institute, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, 15213, USA,
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de Seze J. Atypical forms of optic neuritis. Rev Neurol (Paris) 2012; 168:697-701. [DOI: 10.1016/j.neurol.2012.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 07/20/2012] [Indexed: 11/29/2022]
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Shatriah I, Adlina AR, Alshaarawi S, Wan-Hitam WH. Clinical profile of Malay children with optic neuritis. Pediatr Neurol 2012; 46:293-7. [PMID: 22520350 DOI: 10.1016/j.pediatrneurol.2012.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
Abstract
Limited data are available on optic neuritis in Asian children. Clinical profiles tend to vary with different races. We aimed to determine the clinical manifestations, visual outcomes, and etiologies of optic neuritis in Malaysian children, and discuss the literature of optic neuritis in Asian children. A retrospective study involving 14 children with optic neuritis was performed at Hospital Universiti Sains Malaysia between July 2005 and January 2010 (follow-up, 18-60 months). Clinical features, laboratory results, possible etiologies, and visual acuity after 1 year were studied. Females were predominant (mean age at presentation, 11.1 years). All patients manifested bilateral involvement. Swollen optic discs were observed in 92.9% of eyes; 60.7% of patients demonstrated a visual acuity of 6/60 (or 20/200) or worse on presentation, whereas 14.3% remained at 6/60 (or 20/200) or worse, 1 year after their attack. Cecocentral scotoma comprised the most common visual field defect. Infection contributed to 50.0% of cases; 14.3% progressed to multiple sclerosis during follow-up, with no evidence of recurrent optic neuritis. The clinical profiles and etiologies of optic neuritis in Malay children differ slightly compared with other optic neuritis studies of Asian children. The frequency of progression to multiple sclerosis is relatively lower.
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Affiliation(s)
- Ismail Shatriah
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
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Affiliation(s)
- Mays A El-Dairi
- Department of Ophthalmology, Duke University Eye Center, DUMC 3802, Durham, NC 27710, USA
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Waldman AT, Stull LB, Galetta SL, Balcer LJ, Liu GT. Pediatric optic neuritis and risk of multiple sclerosis: meta-analysis of observational studies. J AAPOS 2011; 15:441-6. [PMID: 22108356 DOI: 10.1016/j.jaapos.2011.05.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/07/2011] [Accepted: 05/18/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the relationships among age, unilateral versus bilateral simultaneous presentation, magnetic resonance imaging (MRI) lesions, and the risk of multiple sclerosis (MS) in children with optic neuritis. METHODS A systematic literature review and meta-analysis were performed by the use of a MEDLINE search to identify published studies containing individual patient data for children with optic neuritis. Age, laterality (unilateral vs bilateral simultaneous optic neuritis), presence of brain MRI abnormalities, and development of MS were recorded. Logistic regression was used to determine the relationships among these parameters. RESULTS Fourteen studies met inclusion criteria. Data for 223 patients (age range 2-17.8 years) were analyzed. Unilateral optic neuritis occurred more frequently in older children but was not associated with an increased risk of MS, after adjusting for age (odds ratio [OR] = 1.9, P = 0.11; 95% confidence interval [CI], 0.9-4.3). For every 1-year increase in age, the odds of developing MS increased by 32% (OR = 1.3, P = 0.005; 95% CI, 1.1-1.6, adjusted for the presence of MRI lesions). The risk of MS was greater in children with abnormal brain MRI scans at presentation compared with normal MRIs (OR = 28.0, P < 0.001, 95% CI, 6.3-125.1, adjusted for age). CONCLUSIONS The relationship between unilateral and bilateral optic neuritis and the development of MS is dependent on age. Older children and those with brain MRI abnormalities at presentation, are at greater risk for MS. Long-term follow-up of children with optic neuritis is needed to establish the true risk for the development of MS.
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Affiliation(s)
- Amy T Waldman
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Abstract
PURPOSE To document the etiology, clinical presentation, and visual prognosis of optic neuritis in Taiwanese children. METHODS Retrospectively reviewed children younger than 18 years old with optic neuritis in Chang Gung Memorial Hospital and Chang Gung Children's Hospital from 1998 to 2009. RESULTS There were 24 children (38 eyes) with optic neuritis in that period. Overall, 14 patients (58.3%) were female and 10 patients (41.7%) were male. In total, 14 patients (58.3%) had bilateral involvement, and 10 patients (41.7%) had unilateral involvement. Out of 38 eyes, 24 (63.2%) had disc swelling. Out of 24 patients, 21 (87.5%) underwent intravenous steroid therapy (10 to 30 mg/kg/day) for 3-5 days, and followed by an oral taper. Out of 24 patients, 20 (83.3%) achieved final visual acuity (VA) of 20/40 or better. However, a poor visual outcome (four patients) (VA<20/40) was correlated with pale disc at presentation (P=0.002, Pearson χ (2)-test) and age older than 10 years (P=0.012, Fisher's exact test). Five patients were diagnosed with acute disseminated encephalomyelitis (ADEM) (21%), and three patients were diagnosed with multiple sclerosis (MS) (12.5%). Patients with ADEM did not have a better visual outcome than patients with MS (P=0.643, Fisher's exact test). CONCLUSIONS Visual recovery from optic neuritis was favorable in Taiwanese children. A poor visual outcome was correlated with pale disc at presentation and patients' age older than 10 years. ADEM is the most common associated systemic disease; MS is relatively rare.
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Abstract
Optic neuritis is an inflammatory condition of the optic nerve characterized by a sudden onset of unilateral visual loss, usually affecting young females. Demyelination associated with multiple sclerosis (MS) is the most common cause in regions where MS is prevalent; while in other places, there are a substantial proportion of cases where infective or autoimmune causes are seen. Optic Neuritis Treatment Trial (ONTT) was the first major study that provided information on the natural history, role of steroids in treatment and risk of development of MS. Subsequently, numerous clinical trials have evaluated different modalities of management of optic neuritis and MS. The Controlled High-Risk Subjects Avonex Multiple Sclerosis Prevention Study (CHAMPS); the Prevention of Relapses and Disability by Interferon β-1a Subcutaneously in Multiple Sclerosis (PRISMS) Trial; and, most recently, the Betaferon in Newly Emerging Multiple Sclerosis for Initial Treatment (BENEFIT) Study have provided large amount of information on the natural history of optic neuritis and management options available. However, due to the low prevalence of MS reported in Asian studies, high cost of therapy and indefinite time period of treatment, it may not be cost effective to start interferon therapy in most cases.
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Affiliation(s)
- Vimla Menon
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Celebisoy N, Kocaman AS, Gulluoglu H, Yuceyar AN, Gokcay F, Kose T. Optic Neuritis: Visual Outcome and Risk Factors for the Development of Multiple Sclerosis in Western Turkey. Neuroophthalmology 2011. [DOI: 10.3109/01658107.2011.580888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
AIMS The aim of this study is to provide a clinical update on optic neuritis (ON), its association with multiple sclerosis (MS), and neuromyelitis optica (NMO). METHODS This study included a PubMed review of the literature written in the English language. RESULTS ON in adults is typically idiopathic or demyelinating, and is characterised by unilateral, subacute, painful loss of vision that is not associated with any systemic or other neurological symptoms. Demyelinating ON is associated with MS, and we review the key studies of ON including the ON treatment trial and several other MS treatment trials and NMO. CONCLUSION Acute demyelinating ON can occur in isolation or be associated with MS. Typical ON does not require additional evaluation other than cranial magnetic resonance imaging. NMO is likely a separate disorder from MS and the ON in NMO has a different treatment and prognosis. METHODOLOGY The authors conducted an English language search using Pubmed from the years 1964 to 2010 using the search terms 'ON', 'MS' and 'NMO'. The authors included original articles, review articles, and case reports, which revealed new aspects as far as epidemiology, histopathology, clinical manifestations, imaging, genetics, and treatment of ON. Titles were reviewed for topicality and full references were obtained. Letters to the editor, unpublished work, and abstracts were not included in this review.
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Woung LC, Chung HC, Jou JR, Wang KC, Peng PH. A Comparison of Optic Neuritis in Asian and in Western Countries. Neuroophthalmology 2011; 35:65-72. [PMID: 30151023 DOI: 10.3109/01658107.2011.557851] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 10/27/2010] [Accepted: 11/03/2010] [Indexed: 11/13/2022] Open
Abstract
Acute demyelinating optic neuritis is a common optic neuropathy in young adults. There is usually satisfactory visual recovery. However, some patients convert to multiple sclerosis (MS) with potential sequelae of neurological disability. The Optic Neuritis Treatment Trial in the United States was conducted prospectively for 15 years and provided valuable data about clinical course, efficacy of steroid treatment, and risk of conversion to MS. Compared to the many studies in Western countries, research concerning optic neuritis in Asia has so far not been extensive. However, cumulative evidence shows that various features of this disorder differ between patients of Caucasian and Oriental descent. In this article we review up-to-date studies on optic neuritis in Asia and compare the results with prior literature. Prospective and multi-centre studies are currently underway in these regions to increase our understanding of optic neuritis in Asia.
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Affiliation(s)
| | - Hui-Chuan Chung
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Jieh-Ren Jou
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Chen Wang
- Department of Neurology, Cheng-Hsin General Hospital, Taipei, Taiwan
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