Childhood Optic Neuritis Follow-up
- Author: Martha P Schatz, MD; Chief Editor: Hampton Roy, Sr, MD more...
Further Outpatient Care
Outpatient follow-up care should include monitoring both visual recovery and recovery from neurologic or systemic disorders that were associated with optic neuritis.
Children who do develop MS may be more likely to develop disability at a younger age. Monitoring patients who had no associated neurologic signs or symptoms at the time of their optic neuritis will allow early diagnosis. Treatment of those patients for early onset MS with the disease modifying agents that are used in adults may be an option.
Recurrence of optic neuritis during or shortly after the discontinuation of steroids indicates a steroid-dependent optic neuritis and requires reevaluation and a more prolonged taper of corticosteroids.
The prognosis for visual recovery generally is considered excellent (see Medical Care).
Adults with isolated optic neuritis have a substantial risk of developing MS. Approximately 15% of patients with normal MRIs at the time of their optic neuritis develop MS in the next 4 years. However, MRI findings are strongly correlated with risk of recurrence of demyelinating events, and 50% of patients whose MRIs demonstrate white matter lesions characteristic of MS at the time of their optic neuritis develop clinically definite MS in the next 4 years.
Children with optic neuritis are less likely than adults to develop MS, but the risk is still present. A large study from the Mayo Clinic with a mean follow-up of 20 years produced a life-table analysis showing 13% of children with optic neuritis had progressed to clinically or laboratory-supported definite MS at 10 years (see Table 3 below). As in adult studies, those patients converting to MS were more likely to do so early; however, the longer the follow-up interval, the more patients there were who developed MS.
A smaller study by Wilejto et al found that 36% of children with optic neuritis developed MS. All who did had abnormalities on the initial MRI, and bilateral cases were more likely to go on to develop MS.
|Age||Risk for Development of MS|
MRI abnormalities in children are associated with the likelihood of developing MS.
Both adults and children with more severe optic disc swelling are less likely to develop MS, and those with both severe optic disc swelling and retinal exudates rarely develop MS.
With Uhthoff symptom, patients who have had demyelinating lesions with recovery often have symptoms return with exercise, exposure to heat (eg, hot baths), or febrile illnesses; a rapid return to baseline occurs when body temperature returns to normal. Warning patients about Uhthoff symptom is important so that they do not think they are having a recurrence.
For excellent patient education resources, see eMedicineHealth's patient education article, Multiple Sclerosis.
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|Adult Optic Neuritis||Pediatric Optic Neuritis|
|Retrobulbar optic neuritis||Papillitis|
|Commonly associated with pain on eye movements||Commonly associated with headache|
|Most often idiopathic||Most often postinfectious or postimmunization|
|High probability of recurrent inflammatory demyelinating events in the CNS and a diagnosis of MS||Low probability of recurrent demyelinating events and a diagnosis of MS|
|Corticosteroid Drug||Approximate Equivalent Dose|
|Age||Risk for Development of MS|