Evaluation of the Risk Factors for Developing Demyelinating Disease after Optic Neuritis in Children: A Single Center Experience

Objective: Optic neuritis (ON), an inflammatory disorder of the optic nerve, constitutes 25% of acute demyelinating diseases (DDs) in childhood. It may be isolated (ION), or a manifestation of other DDs such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein-associated disease (MOGAD), and acute disseminated encephalomyelitis (ADEM). We aimed to determine the risk factors for developing DDs after ON. Methods: The data of 43 children (21 boys, 22 girls) presented with ON, between 2008 and 2018, were analyzed. The ION group was compared with the groups of other DDs (DDG) and MS. The patients with ADEM, considering its distinct features, were excluded from the statistical comparison. Results: The final diagnoses were ION (n=26), ADEM (n=3), MS (n=8), probable MS (n=1), NMOSD (n=2), and MOGAD (n=1). In DDG, the number of ON episodes was higher (p=0.027); and the female gender (p= 0.047), presence of a T2-lesion on brain or spinal cord (p<0.001), and autoimmune antibody positivity (p=0.023) were more common. The highest risk factor for DDs was the presence of a brain T2-lesion (OR=28.75). The comparison of ION and MS groups was similar. Additionally, the age at first episode was greater in MS (p=0.003). In the patients greater than 12-years old at the first episode, unilateral involvement of the optic nerve (p=0.001) and developing DDs (p=0.015) were more common. Conclusion: In children with ON, lesion on brain or spinal MRI, presenting age of over 12-years, and female gender were determined as risk factors for developing other DDs.
Keywords: child, demyelinating disease, multiple sclerosis, optic neuritis