Skip to main content

Advertisement

SpringerLink
Log in

Update on Pediatric Optic Neuritis

  • Invited review
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to provide an update on advances in the understanding of pediatric demyelinating optic neuritis.

Recent Findings

In the past decade, the disease phenotypes for demyelinating syndromes in children have been more clearly defined. Pediatric optic neuritis may present as a clinically isolated syndrome or in the setting of underlying neurologic disease. In addition to optic neuritis associated with multiple sclerosis or neuromyelitis optica, recent work has identified antibodies to the myelin oligodendrocyte glycoprotein (MOG IgG) as a unique demyelinating cause with distinct features regarding treatment and prognosis.

Summary

The disease phenotypes for demyelinating pediatric optic neuritis have expanded. Treatment strategies vary and are not universally effective for each cause of demyelinating disease. Accurately distinguishing among these unique clinical syndromes is therefore critical for initiation of appropriate treatment to prevent disability, to maximize visual outcomes, and to provide insight into long-term prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jurynczyk M, Messina S, Woodhall MR, Raza N, Everett R, Roca-Fernandez A, et al. Clinical presentation and prognosis in MOG-antibody disease: a UK study. Brain. 2017;140(12):3128–38.

    Article  PubMed  Google Scholar 

  2. Ramanathan S, Mohammad S, Tantsis E, et al. Clinical course, therapeutic responses and outcomes in relapsing MOG antibody-associated demyelination. J Neurol Neurosurg Psychiatry. 2018;89(2):127–37.

    Article  PubMed  Google Scholar 

  3. Banwell B, Kennedy J, Sadovnick D, Arnold DL, Magalhaes S, Wambera K, et al. Incidence of acquired demyelination of the CNS in Canadian children. Neurology. 2009;72(3):232–9.

    Article  CAS  PubMed  Google Scholar 

  4. Langer-Gould A, Zhang JL, Chung J, Yeung Y, Waubant E, Yao J. Incidence of acquired CNS demyelinating syndromes in a multiethnic cohort of children. Neurology. 2011;77(12):1143–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Rodriguez M, Siva A, Cross SA, O'Brien PC, Kurland LT. Optic neuritis: a population-based study in Olmsted County, Minnesota. Neurology. 1995;45(2):244–50.

    Article  CAS  PubMed  Google Scholar 

  6. Wilejto M, Shroff M, Buncic JR, Kennedy J, Goia C, Banwell B. The clinical features, MRI findings, and outcome of optic neuritis in children. Neurology. 2006;67(2):258–62.

    Article  CAS  PubMed  Google Scholar 

  7. • Wan MJ, Adebona O, Benson LA, Gorman MP, Heidary G. Visual outcomes in pediatric optic neuritis. Am J Ophthalmol. 2014;158(3):503–507 e502 This study was important because it is one of the first to describe visual outcomes in a large cohort of pediatric patients at a tertiary care center.

    Article  PubMed  Google Scholar 

  8. Waldman AT, Stull LB, Galetta SL, Balcer LJ, Liu GT. Pediatric optic neuritis and risk of multiple sclerosis: meta-analysis of observational studies. J AAPOS. 2011;15(5):441–6.

    Article  PubMed  Google Scholar 

  9. Yeh EA, Graves JS, Benson LA, Wassmer E, Waldman A. Pediatric optic neuritis. Neurology. 2016;87(9 Suppl 2):S53–8.

    Article  PubMed  Google Scholar 

  10. Brady KM, Brar AS, Lee AG, Coats DK, Paysse EA, Steinkuller PG. Optic neuritis in children: clinical features and visual outcome. J AAPOS. 1999;3(2):98–103.

    Article  CAS  PubMed  Google Scholar 

  11. Alper G, Heyman R, Wang L. Multiple sclerosis and acute disseminated encephalomyelitis diagnosed in children after long-term follow-up: comparison of presenting features. Dev Med Child Neurol. 2009;51(6):480–6.

    Article  PubMed  Google Scholar 

  12. Chang MY, Pineles SL. Pediatric optic neuritis. Semin Pediatr Neurol. 2017;24(2):122–8.

    Article  PubMed  Google Scholar 

  13. Borchert M, Liu GT, Pineles S, Waldman AT. Pediatric optic neuritis: what is new. J Neuroophthalmol. 2017;37(Suppl 1):S14–22.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Waldman AT, Hiremath G, Avery RA, Conger A, Pineles SL, Loguidice MJ, et al. Monocular and binocular low-contrast visual acuity and optical coherence tomography in pediatric multiple sclerosis. Mult Scler Relat Disord. 2013;3(3):326–34.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dale RC, Brilot F, Banwell B. Pediatric central nervous system inflammatory demyelination: acute disseminated encephalomyelitis, clinically isolated syndromes, neuromyelitis optica, and multiple sclerosis. Curr Opin Neurol. 2009;22(3):233–40.

    Article  PubMed  Google Scholar 

  16. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69(2):292–302.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wong YYM, de Mol CL, van der Vuurst de Vries RM, van Pelt E, Ketelslegers IA, Catsman-Berrevoets CE, et al. Real-world validation of the 2017 McDonald criteria for pediatric MS. Neurol Neuroimmunol Neuroinflamm. 2019;6(2):e528.

    Article  PubMed  Google Scholar 

  18. Cakmakli G, Kurne A, Guven A, et al. Childhood optic neuritis: the pediatric neurologist's perspective. Eur J Paediatr Neurol. 2009;13(5):452–7.

    Article  PubMed  Google Scholar 

  19. Bonhomme GR, Waldman AT, Balcer LJ, Daniels AB, Tennekoon GI, Forman S, et al. Pediatric optic neuritis: brain MRI abnormalities and risk of multiple sclerosis. Neurology. 2009;72(10):881–5.

    Article  CAS  PubMed  Google Scholar 

  20. Absoud M, Cummins C, Desai N, et al. Childhood optic neuritis clinical features and outcome. Arch Dis Child. 2011;96(9):860–2.

    Article  PubMed  Google Scholar 

  21. Lucchinetti CF, Kiers L, O'Duffy A, Gomez MR, Cross S, Leavitt JA, et al. Risk factors for developing multiple sclerosis after childhood optic neuritis. Neurology. 1997;49(5):1413–8.

    Article  CAS  PubMed  Google Scholar 

  22. Heussinger N, Kontopantelis E, Gburek-Augustat J, Jenke A, Vollrath G, Korinthenberg R, et al. Oligoclonal bands predict multiple sclerosis in children with optic neuritis. Ann Neurol. 2015;77(6):1076–82.

    Article  PubMed  Google Scholar 

  23. Brenton JN, Banwell BL. Therapeutic approach to the Management of Pediatric Demyelinating Disease: multiple sclerosis and acute disseminated encephalomyelitis. Neurotherapeutics. 2016;13(1):84–95.

    Article  CAS  PubMed  Google Scholar 

  24. Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC, et al. International pediatric multiple sclerosis study group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler. 2013;19(10):1261–7.

    Article  PubMed  Google Scholar 

  25. Tenembaum S, Chitnis T, Nakashima I, Collongues N, McKeon A, Levy M, et al. Neuromyelitis optica spectrum disorders in children and adolescents. Neurology. 2016;87(9 Suppl 2):S59–66.

    Article  PubMed  Google Scholar 

  26. Quek AM, McKeon A, Lennon VA, Mandrekar JN, Iorio R, Jiao Y, et al. Effects of age and sex on aquaporin-4 autoimmunity. Arch Neurol. 2012;69(8):1039–43.

    Article  PubMed  PubMed Central  Google Scholar 

  27. McKeon A, Lennon VA, Lotze T, Tenenbaum S, Ness JM, Rensel M, et al. CNS aquaporin-4 autoimmunity in children. Neurology. 2008;71(2):93–100.

    Article  CAS  PubMed  Google Scholar 

  28. • Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177–89 This article provides the foundation for the current diagnostic criteria of Neuromyeltitis opticain both children and adults.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lennon VA, Wingerchuk DM, Kryzer TJ, Pittock SJ, Lucchinetti CF, Fujihara K, et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet. 2004;364(9451):2106–12.

    Article  CAS  PubMed  Google Scholar 

  30. Sepulveda M, Aldea M, Escudero D, Llufriu S, Arrambide G, Otero-Romero S, et al. Epidemiology of NMOSD inCatalonia: Influence of the new 2015 criteria in incidence and prevalence estimates. Mult Scler. 2018;24(14):1843–1851.

  31. Kim HJ, Paul F, Lana-Peixoto MA, Tenembaum S, Asgari N, Palace J, et al. MRI characteristics of neuromyelitis optica spectrum disorder: an international update. Neurology. 2015;84(11):1165–73.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Collongues N, Marignier R, Zephir H, et al. Long-term follow-up of neuromyelitis optica with a pediatric onset. Neurology. 2010;75(12):1084–8.

    Article  CAS  PubMed  Google Scholar 

  33. Absoud M, Lim MJ, Appleton R, et al. Paediatric neuromyelitis optica: clinical, MRI of the brain and prognostic features. J Neurol Neurosurg Psychiatry. 2015;86(4):470–2.

    Article  PubMed  Google Scholar 

  34. Kremer L, Mealy M, Jacob A, et al. Brainstem manifestations in neuromyelitis optica: a multicenter study of 258 patients. Mult Scler. 2014;20(7):843–7.

    Article  CAS  PubMed  Google Scholar 

  35. Chitnis T, Ness J, Krupp L, Waubant E, Hunt T, Olsen CS, et al. Clinical features of neuromyelitis optica in children: US network of pediatric MS centers report. Neurology. 2016;86(3):245–52.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Fragoso YD, Ferreira ML, Oliveira EM, Domingues RB, Ribeiro TA, Brooks JB, et al. Neuromyelitis optica with onset in childhood and adolescence. Pediatr Neurol. 2014;50(1):66–8.

    Article  PubMed  Google Scholar 

  37. Jarius S, Ruprecht K, Kleiter I, et al. MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 2: Epidemiology, clinical presentation, radiological and laboratory features, treatment responses, and long-term outcome. J Neuroinflammation. 2016;13(1):280.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. van Pelt ED, Wong YY, Ketelslegers IA, Hamann D, Hintzen RQ. Neuromyelitis optica spectrum disorders: comparison of clinical and magnetic resonance imaging characteristics of AQP4-IgG versus MOG-IgG seropositive cases in the Netherlands. Eur J Neurol. 2016;23(3):580–7.

    Article  PubMed  Google Scholar 

  39. Sato DK, Callegaro D, Lana-Peixoto MA, Waters PJ, de Haidar Jorge FM, Takahashi T, et al. Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders. Neurology. 2014;82(6):474–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Kitley J, Waters P, Woodhall M, Leite MI, Murchison A, George J, et al. Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: a comparative study. JAMA Neurol. 2014;71(3):276–83.

    Article  PubMed  Google Scholar 

  41. Hennes EM, Baumann M, Lechner C, Rostasy K. MOG Spectrum disorders and role of MOG-antibodies in clinical practice. Neuropediatrics. 2018;49(1):3–11.

    Article  PubMed  Google Scholar 

  42. Bennett JL, de Seze J, Lana-Peixoto M, Palace J, Waldman A, Schippling S, et al. Neuromyelitis optica and multiple sclerosis: seeing differences through optical coherence tomography. Mult Scler. 2015;21(6):678–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Bonnan M, Valentino R, Debeugny S, et al. Short delay to initiate plasma exchange is the strongest predictor of outcome in severe attacks of NMO spectrum disorders. J Neurol Neurosurg Psychiatry. 2018;89(4):346–51.

    Article  PubMed  Google Scholar 

  44. Hacohen Y, Banwell B. Treatment approaches for MOG-Ab-associated demyelination in children. Curr Treat Options Neurol. 2019;21(1):2.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Hacohen Y, Ciccarelli O, Hemingway C. Abnormal white matter development in children with multiple sclerosis and monophasic acquired demyelination. Brain. 2017;140(5):1172–4.

    Article  PubMed  Google Scholar 

  46. Reindl M, Di Pauli F, Rostasy K, Berger T. The spectrum of MOG autoantibody-associated demyelinating diseases. Nat Rev Neurol. 2013;9(8):455–61.

    Article  CAS  PubMed  Google Scholar 

  47. Hacohen Y, Absoud M, Deiva K, Hemingway C, Nytrova P, Woodhall M, et al. Myelin oligodendrocyte glycoprotein antibodies are associated with a non-MS course in children. Neurol Neuroimmunol Neuroinflamm. 2015;2(2):e81.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Waters P, Fadda G, Woodhall M, O'Mahony J, Brown RA, Castro DA, et al. Serial Anti-Myelin OligodendrocyteGlycoprotein Antibody Analyses and Outcomes in Children With Demyelinating Syndromes. JAMA Neurol. 2020;77(1):82–93.

  49. Hacohen Y, Rossor T, Mankad K, Chong W', Lux A, Wassmer E, et al. 'Leukodystrophy-like' phenotype in children with myelin oligodendrocyte glycoprotein antibody-associated disease. Dev Med Child Neurol. 2018;60(4):417–23.

    Article  PubMed  Google Scholar 

  50. Chen JJ, Flanagan EP, Jitprapaikulsan J, López-Chiriboga ASS, Fryer JP, Leavitt JA, et al. Myelin Oligodendrocyte glycoprotein antibody-positive optic neuritis: clinical characteristics, radiologic clues, and outcome. Am J Ophthalmol. 2018;195:8–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Song H, Zhou H, Yang M, Xu Q, Sun M, Wei S. Clinical characteristics and outcomes of myelin oligodendrocyte glycoprotein antibody-seropositive optic neuritis in varying age groups: a cohort study in China. J Neurol Sci. 2019;400:83–9.

    Article  PubMed  Google Scholar 

  52. Chen Q, Zhao G, Huang Y, Li Z, Sun X, Lu P, et al. Clinical characteristics of pediatric optic neuritis with myelin Oligodendrocyte glycoprotein seropositive: a cohort study. Pediatr Neurol. 2018;83:42–9.

    Article  PubMed  Google Scholar 

  53. Baumann M, Sahin K, Lechner C, et al. Clinical and neuroradiological differences of paediatric acute disseminating encephalomyelitis with and without antibodies to the myelin oligodendrocyte glycoprotein. J Neurol Neurosurg Psychiatry. 2015;86(3):265–72.

    Article  CAS  PubMed  Google Scholar 

  54. •• Narayan RN, McCreary M, Conger D, Wang C, Greenberg BM. Unique characteristics of optical coherence tomography (OCT) results and visual acuity testing in myelin oligodendrocyte glycoprotein (MOG) antibody positive pediatric patients. Mult Scler Relat Disord. 2019;28:86–90 This study provides insight into the relationship between optic nerve and retinal structure and visual function in pediatric patients with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.

    Article  PubMed  Google Scholar 

  55. Petzold A, Plant GT. Chronic relapsing inflammatory optic neuropathy: a systematic review of 122 cases reported. J Neurol. 2014;261(1):17–26.

    Article  PubMed  Google Scholar 

  56. Kidd D, Burton B, Plant GT, Graham EM. Chronic relapsing inflammatory optic neuropathy (CRION). Brain. 2003;126(Pt 2):276–84.

    Article  CAS  PubMed  Google Scholar 

  57. Waschbisch A, Atiya M, Schaub C, Derfuss T, Schwab S, Lee DH, et al. Aquaporin-4 antibody negative recurrent isolated optic neuritis: clinical evidence for disease heterogeneity. J Neurol Sci. 2013;331(1–2):72–5.

    Article  CAS  PubMed  Google Scholar 

  58. Petzold A, Pittock S, Lennon V, Maggiore C, Weinshenker BG, Plant GT. Neuromyelitis optica-IgG (aquaporin-4) autoantibodies in immune mediated optic neuritis. J Neurol Neurosurg Psychiatry. 2010;81(1):109–11.

    Article  CAS  PubMed  Google Scholar 

  59. Optic Neuritis Study G. Visual function 15 years after optic neuritis: a final follow-up report from the optic neuritis treatment trial. Ophthalmology. 2008;115(6):1079–82 e1075.

    Article  Google Scholar 

  60. Beck RW, Cleary PA, Anderson MM Jr, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The optic neuritis study group. N Engl J Med. 1992;326(9):581–8.

    Article  CAS  PubMed  Google Scholar 

  61. •• Hacohen Y, Wong YY, Lechner C, et al. Disease Course and Treatment Responses in Children With Relapsing Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. JAMA Neurol. 2018;75(4):478–87 This article provides evidence for what treatments are effecttive in patients with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Gmuca S, Xiao R, Weiss PF, Waldman AT, Gerber JS. Use of Rituximab and Risk of Re-hospitalization for Children with Neuromyelitis Optica Spectrum Disorder. Mult Scler Demyelinating Disord. 2018;3,3.

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, USA

    Ryan A. Gise & Gena Heidary

  2. Harvard Medical School, Boston, MA, USA

    Ryan A. Gise & Gena Heidary

Authors
  1. Ryan A. Gise
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gena Heidary
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gena Heidary.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict(s) of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gise, R.A., Heidary, G. Update on Pediatric Optic Neuritis. Curr Neurol Neurosci Rep 20, 4 (2020). https://doi.org/10.1007/s11910-020-1024-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-020-1024-x

Keywords

Search

Navigation