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Review
. 2019 Nov;30(6):418-425.
doi: 10.1097/ICU.0000000000000607.

Update on pediatric optic neuritis

Jane H Lock  1 , Nancy J Newman  1   2   3 , Valérie Biousse  1   2 , Jason H Peragallo  1   4
Affiliations
Review

Update on pediatric optic neuritis

Jane H Lock et al. Curr Opin Ophthalmol. 2019 Nov.

Abstract

Purpose of review: To summarize recent developments in the classification, investigation and management of pediatric optic neuritis (PON).

Recent findings: A recent surge in interest surrounding antibodies to myelin oligodendrocyte glycoprotein antibody (MOG-Ab) has instigated a paradigm shift in our assessment of children with PON. This serological marker is associated with a broad spectrum of demyelinating syndromes that are clinically and radiologically distinct from multiple sclerosis (MS) and aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). Optic neuritis is the most common presenting phenotype of MOG-Ab positive-associated disease (MOG+AD). MOG-Ab seropositivity is much more common in the pediatric population and it predicts a better prognosis than MS or AQP4+NMOSD, except in the subset that exhibit a recurrent phenotype.

Summary: A better grasp of MOG+AD features and its natural history has facilitated more accurate risk stratification of children after a presenting episode of PON. Consequently, the initial investigation of PON has broadened to include serology, along with neuroimaging and cerebrospinal fluid analysis. Acute treatment of PON and chronic immunotherapy is also becoming better tailored to the suspected or confirmed diagnoses of MS, AQP4+NMOSD and MOG+AD.

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Conflict of interest statement

CONFICTS OF INTEREST

There are no conflicts of interest

Figures

Figure 1
Figure 1
Images of a 7-year-old girl presenting with bilateral MOG-ON: (A) fundus photographs showing bilateral disc edema with multiple disc hemorrhages, (B) gadolinium enhanced MRI demonstrating bilateral, longitudinally extensive optic nerve enhancement with nerve sheath enhancement (arrow) and optic disc edema (arrowhead).
Figure 1
Figure 1
Images of a 7-year-old girl presenting with bilateral MOG-ON: (A) fundus photographs showing bilateral disc edema with multiple disc hemorrhages, (B) gadolinium enhanced MRI demonstrating bilateral, longitudinally extensive optic nerve enhancement with nerve sheath enhancement (arrow) and optic disc edema (arrowhead).
See this image and copyright information in PMC

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