Title : Management and outcomes of pediatric optic neuritis in a Tertiary Hospital
Abstract:
Background: Although pediatric optic neuritis (PON) is a rare condition, current advancements in its diagnosis, investigation, and treatment suggest that a more precise risk assessment is necessary given the history of irreversible damage and functional degeneration of the optic nerve. Additionally, after further investigations and/or new neurological events, the initial diagnosis is revised.
Aim: To investigate the treatment and outcome of pediatric optic neuritis (PON) in individuals under the age of 18 years in a tertiary center in the Kingdom of Saudi Arabia (KSA).
Study Method: We analyzed the electronic medical records of 11 pediatric patients under the age of 18 years who first experienced different phenotypes of demyelinating PON between January 2000 and December 2020 as part of this retrospective case series. We studied the clinical characteristics, serology, imaging data, treatment regimens, and follow-up of the patients. We used the statistical package IBM SPSS (release 20) for data management and analysis.
Results: The majority of patients were less than 10 years old (63.6%), and males (63.6%) had bilateral involvement (72.7%). Among the 11 patients diagnosed with PON, 6 (54.5%) had isolated pediatric optic neuritis, 1 (9.1%) had multiple sclerosis (MS), 3 (27.3%) had neuromyelitis optica spectrum disorder (NMOSD), and 1 (9.1%) had acute disseminated encephalomyelitis (ADEM). Despite poor vision (visual acuity<20/40) at presentation, most of the patients improved, 63.3% achieved a BCVA of ≥20/40, and 45.5% attained 20/20 visual acuity. Four patients experienced recurrence.
Conclusions: The overlapping features of disease phenotypes in PON make it difficult to identify the underlying cause. The findings of this retrospective case series suggest the need for a future prospective multicenter study for a better understanding of the different phenotypes.
Keywords: Pediatric Optic Neuritis; Myelin Oligodendrocyte Glycoprotein; Multiple Sclerosis; Neuromyelitis Optica Spectrum Disease; Aquaporin-4 Antibody
