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The clinical features, MRI findings, and outcome of optic neuritis in children

From the Departments of Neuroradiology (M.S.) and Ophthalmology and Visual Science (J.R.B.), Division of Neurology (J.K., B.B.),Department of Paediatrics, and Department of Biostatistics (C.G.), Research Institute, Hospital for Sick Children, University of Toronto (M.W., M.S., J.R.B., B.B.), Ontario, Canada.

Address correspondence and reprint requests to Dr. Brenda L. Banwell, The Hospital for Sick Children, 555 University Avenue, 6th Floor, Toronto, Ontario, Canada M5G 1X8; e-mail: brenda.banwell{at}sickkids.ca

Background: Optic neuritis (ON) in childhood is thought to be more likely bilateral and less likely to lead to multiple sclerosis (MS) vs ON in adults.

Methods: The authors evaluated clinical features, maximal visual deficit and recovery, visual evoked potentials (VEPs), neuroimaging, and outcome in a cohort of children with ON.

Results: Records of 36 children (female/male ratio 1.6), ages 2.2 to 17.8 (mean 12.2) years, were reviewed. ON was unilateral in 58% and bilateral in 42%. Maximal visual deficit was severe in 69%, but full recovery occurred in 39 of 47 affected eyes (83%). VEPs were abnormal in 88%. Neurologic abnormalities in addition to those associated with ON were documented in 13 children. Neuroimaging studies of the optic nerve were abnormal in 55%. Brain MRI in 35 children demonstrated white matter lesions separate from the optic nerves in 54%. Follow-up is 2.4 years (0.3 to 8.3 years). To date, 13 children (36%) have been diagnosed with MS and 1 has Devic disease. Bilateral ON was more likely to be associated with MS outcome (p = 0.03). All 13 children with MS had white matter lesions on brain MRI. None of the children with a normal brain MRI have developed MS to date.

Conclusions: Contrary to expectations, optic neuritis (ON) in childhood was more likely to be unilateral, multiple sclerosis (MS) risk was high (36% at 2 years), and bilateral rather than unilateral ON was associated with a greater likelihood of MS. Clinical findings extrinsic to the visual system on baseline examination (p < 0.0001) and MRI evidence of white matter lesions outside the optic nerves (p < 0.0001) were strongly correlated with MS outcome.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 25 issue to find the title link for this article.

Disclosure: M. Wilejto, C. Goia, and J. Kennedy and Drs. Buncic and Shroff have nothing to disclose. Dr. Banwell has received speaker's honoraria from Biogen-Idec, Teva Marion, Berlex, and Serono and consultant's fees from Biogen-Idec for work unrelated to the current project. There was no industry sponsorship for the current study.

Received May 13, 2005. Accepted in final form March 29, 2006.

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