Pediatric Optic Neuritis: What Is New

Abstract

Few diseases blur the margins between their childhood and adult-onset varieties as much as optic neuritis. This report will review our state of knowledge of pediatric optic neuritis, as well as its relationship to the latest consensus definitions of neuroinflammatory disease. Current diagnostic and treatment options will be explored, as well as our potential to uncover an understanding of pediatric optic neuritis through systematic prospective studies. The risk of evolving multiple sclerosis is probably less than in adults, but pediatric optic neuritis is more likely to be an initial manifestation of acute disseminated encephalomyelitis. Steroids may hasten visual recovery, but they do not change visual outcome except in cases because of neuromyelitis optica. The role of puberty in modifying the presentation and risk associations is unknown. Prospective studies are required to resolve these diagnostic and management issues.

Clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein antibody-seropositive paediatric optic neuritis in China

“…A higher prevalence of MOG-Ab seropositivity was found in patients with a paediatric demyelinating disease, particularly ADEM 16. In another study, similar to our results, MOG-Abs were detected in 21 of 37 patients (56.8%) with an acute episode of PON at 6 paediatric hospitals in Germany and Austria 17.…”

Optic neuritis at the nexus of peripheral autoimmunity and central nervous system demyelination: a nationwide cohort study

“…Previous studies showed that pediatric ON has been distinguished from ON in adults in terms of sex ratio, laterality, associated diseases and rate of conversion to MS [13,15]. We found that female patients in this population was associated with much increased risks of MS and NMO.…”

“…Pediatric ON has been distinguished from ON in adults in terms of clinical manifestations and rate of conversion to MS [13,15]. Therefore, the pediatric (0-19 years) and adult (20 years and above) subcohorts were examined separately.…”

“…The standard treatment for ON, intravenous methylprednisolone, has been established on the basis of the Optic Neuritis Treatment Trial, which showed that high-dose methylprednisolone treatment was associated with accelerated visual recovery and delayed onset of MS [11,12]. Steroid treatment is believed to improve visual outcome in NMO-associated ON [13][14][15], whereas the relationship of steroid treatment and subsequent development of NMO remains to be clarified. Interferon beta agents have been used in selected ON patients to delay the progression to clinically definite MS [16], yet they may be potentially detrimental for NMO [17].…”

Plasmapheresis in Ophthalmology

“…In the Central European countries, it occurs in 5 cases per 100 000 of population per year [73]. In pediatric practice it often precedes appearance of acute disseminated encephalomyelitis [74]. To restore the sight, as a rule, aggressive steroid and long-term immunosuppressive therapy is used [75,76].…”