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Optic Neuritis In Turkish Children: A Multicenter Retrospective Study

Objective: To evaluate the demographic, clinical, laboratory, and outcome of Turkish pediatric patients with optic neuritis (ON).

Methods: A study cohort consisted of 333 patients (female: 201, male: 132) of pediatric ON from 27 centers in Turkey diagnosed between the years 2009 and 2022 were evaluated retrospectively.

Results:. The mean age was 12.65±3.90 years. Eighty-five cases (25.5%) were prepubertal. ON was unilateral in 221 (66%) patients. The most common complaints were blurred vision, vision loss, and painful eye movements. In the prepubertal period MOG antibody positivity and bilateral involvement were more frequent, and the most common final diagnoses were MOGAD and ADEM. In the postpubertal period, unilateral ON, elevated IgG index level, and OCB positivity were more frequent. Follow-up of 22.16±25.43 (0.23-132) months showed ON remained isolated in 54% of prepubertal patients while a possible or definite diagnosis of MS was established in 31.8% of postpubertal patients. Patients with bilateral involvement were more likely to have CSF pleocytosis, MOG antibody positivity, and incomplete recovery of color vision while patients with unilateral ON were older, had a higher rate of OCB positivity, and better recovery of color vision in the affected eye. The treatment modalities were pulse methylprednisolone with oral steroid tapering in 229 (69%) patients, pulse methylprednisolone only in 66 (21%), and combined treatment in 31 (9.3%) patients.

Conclusion: Our results suggest ON is commonly bilateral in prepubertal era and unilateral in postpubertal patients. Patients, particularly those of postpubertal age, need to be followed-up for further demyelinating attacks.