Related Experiment Videos
Risk factors for developing multiple sclerosis after childhood optic neuritis
C F Lucchinetti1, L Kiers, A O'Duffy
1Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Insights
Childhood optic neuritis (ON) has a lower risk of progressing to multiple sclerosis (MS) in children compared to adults. Bilateral or recurrent ON increases MS risk, while preceding infection may decrease it.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neuroimmunology
Background:
- Optic neuritis (ON) is an inflammatory condition affecting the optic nerve.
- Understanding the long-term outcomes of childhood ON is crucial for prognosis and management.
- Previous studies have primarily focused on adult populations.
Purpose of the Study:
- To investigate the long-term risk of developing multiple sclerosis (MS) after childhood optic neuritis (ON).
- To identify factors influencing the progression from ON to MS in pediatric patients.
Main Methods:
- Retrospective review of 94 pediatric ON cases (age < 16) diagnosed at Mayo Clinic (1950-1988).
- Detailed follow-up data available for 79 patients (median 19.4 years).
- Life-table analysis used to determine cumulative incidence of MS development.
Main Results:
- 13% of patients developed definite MS by 10 years, 26% by 40 years.
- Factors like gender, age, visual acuity, or family history did not predict MS development.
- Bilateral/recurrent ON significantly increased MS risk (HR=5.09), while preceding infection decreased risk (HR=0.24).
Conclusions:
- Childhood ON carries a lower risk of progression to MS compared to adults.
- Recurrent or bilateral ON presentation is a significant risk factor for MS development in children.
- Infection preceding ON onset may have a protective effect against MS development.
Abstract:
We reviewed the records of all children (younger than 16 years of age) who presented with a diagnosis of optic neuritis (ON) identified through the comprehensive records-linkage system at the Mayo Clinic and identified 94 cases between 1950 and 1988 with a documented history of idiopathic ON. Detailed follow-up information was available on 79 patients, with a median length of follow-up of 19.4 years. Life-table analysis showed that 13% of the 79 patients with isolated ON had progressed to clinically or laboratory-supported definite multiple sclerosis (MS) by 10 years of follow-up, 19% by 20 years, 22% by 30 years, and 26% by 40 years. Gender, age, funduscopic findings, visual acuity, or family history of either ON or MS did not predict the development of MS. The presence of bilateral sequential or recurrent ON increased the risk of developing MS (p = 0.002; hazard ratio = 5.09), whereas the presence of infection within 2 weeks before the onset of ON decreased the risk of developing MS (p = 0.060; hazard ratio = 0.24). This study of childhood ON supports the lower risk of recurrence and progression to MS compared with adults.