Abstract
Optic neuritis (ON) is a common presenting symptom in pediatric CNS demyelinating disorders and may be associated with dramatic visual loss. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. These studies have shown that younger children (<10 years of age) are more likely to present with bilateral ON and older children with unilateral ON. Furthermore, studies focusing on visual recovery have shown excellent recovery of high-contrast visual acuity in the majority of children, but functional and structural studies have shown evidence of irreversible injury and functional decline after ON in children. Although randomized controlled treatment trials have not been performed in children and adolescents with ON, standard of care suggests that the use of high-dose pulse steroids is safe and likely effective. This article reviews current knowledge about the clinical presentation and management of pediatric ON, with attention to associated syndromes and evaluative tools that may inform diagnosis and interventions.
GLOSSARY
- ADEM=
- acute disseminating encephalomyelitis;
- AQP4=
- aquaporin-4;
- HCVA=
- high-contrast VA;
- CRION=
- chronic relapsing inflammatory optic neuropathy;
- IVIg=
- IV immunoglobulin;
- LCLA=
- low-contrast letter acuity;
- LCVA=
- low-contrast VA;
- MOG=
- myelin oligodendrocyte glycoprotein;
- MS=
- multiple sclerosis;
- NMO=
- neuromyelitis optica;
- NMOSD=
- NMO spectrum disorder;
- OCT=
- optical coherence tomography;
- ON=
- optic neuritis;
- ONTT=
- Optic Neuritis Treatment Trial;
- RNFL=
- retinal nerve fiber layer;
- TPE=
- therapeutic plasma exchange;
- VA=
- visual acuity;
- VEP=
- visual evoked potential;
- VF=
- visual field
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received August 19, 2015.
- Accepted in final form January 12, 2016.
- © 2016 American Academy of Neurology
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