Long-term visual outcomes and treatment-related prognostic variables in pediatric demyelinating optic neuritis: A...

Demyelinating optic neuritis (ON) is the most common cause of visual loss in children. However, data from a neurological standpoint is limited.

To assess clinical, radiological, immunological, and treatment-related variables in pediatric ON from a neurological perspective.

All cases of demyelinating optic neuritis in the Pediatric Neurology Department of a tertiary care center from 2014 to 2024 were analyzed.

Of 32 patients, 23 were female (71.9 %). The mean age at presentation was 8.9 years (range: 2-16 years), and 18 (56.2 %) showed bilateral involvement. The first symptom at onset in 18 (56.2 %) was visual impairment, although all patients experienced visual impairment during their course. 17 subjects (53.1 %) had a history of recent inflammatory prodrome, and 5 (15.6 %) had fever at the time of presentation. Demyelinating cerebral, infratentorial, or spinal cord MRI lesions were seen in 17 patients (53.1 %). Serum MOG antibody positivity was observed in 13/20 (65 %) patients tested, of which 11 seropositives (84.6 %) were female. Visual status at the latest follow-up was good in all 9 children treated with oral steroids for over 1 month (p = 0.017). Relapses with visual symptoms were noted in 9 patients; children with MOG-ON showed increased risk of relapses (p = 0.033) compared to other diagnoses.

MOG-ON is the leading cause of pediatric demyelinating ON. In about half of the children with ON, visual impairment may not be the presenting complaint. Extended courses of steroids are better associated with improved visual outcomes.