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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.
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 of 8% of those with 47 (47%) of the affected areas were reported 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%. Focus-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 assoc iated with MS outcome (p = 0.03) .All 13 children with MS had white matter lesions on brain MRI. None of the children with 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 highly correlated with MS outcome.