eMedicine Specialties > Ophthalmology > Optic Nerve
Optic Neuritis, Childhood: Follow-up
Updated: Aug 29, 2008
Follow-up
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.
Prognosis
- The prognosis for visual recovery generally is considered excellent (see Medical Care).
- Multiple sclerosis
- 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.1 All who did had abnormalities on the initial MRI, and bilateral cases were more likely to go on to develop MS.
Table 3. Life-Table Analysis of the Risk for Development of MS in Children With an Isolated Attack of Optic Neuritis2
Open table in new window
Age Risk for Development of MS 10 years 13% 20 years 19% 30 years 22% 40 years 26%
- 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.
Patient Education
- 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, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education article, Multiple Sclerosis.
Miscellaneous
Medicolegal Pitfalls
- Children with optic neuritis need to be evaluated by both an ophthalmologist and a neurologist. Failure to diagnose and treat patients with optic neuritis who have additional CNS involvement could be a potential source of liability. Efforts to identify those patients who are at high risk of developing future episodes of demyelination and MS are motivated by the belief that early treatment with immunomodulator therapy is important. Although currently less of an issue with children, such decisions are in the purview of the pediatric neurologist who will be aware of the latest literature and treatment practices.
More on Optic Neuritis, Childhood |
| Overview: Optic Neuritis, Childhood |
| Differential Diagnoses & Workup: Optic Neuritis, Childhood |
| Treatment & Medication: Optic Neuritis, Childhood |
Follow-up: Optic Neuritis, Childhood |
| Multimedia: Optic Neuritis, Childhood |
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References
Wilejto M, Shroff M, Buncic JR, et al. The clinical features, MRI findings, and outcome of optic neuritis in children. Neurology. Jul 25 2006;67(2):258-62. [Medline].
Lucchinetti CF, Kiers L, O'Duffy A, et al. Risk factors for developing multiple sclerosis after childhood optic neuritis. Neurology. Nov 1997;49(5):1413-8. [Medline].
Banwell B, Tremlett H. Coming of age: the use of immunomodulatory therapy in children with multiple sclerosis. Neurology. Mar 8 2005;64(5):778-9. [Medline].
Beck RW. Optic neuritis. In: Miller NR, Newman NJ, ed. Walsh and Hoyt's Clinical Neuro-ophthalmology. 5th ed. Baltimore: Lippincott Williams & Wilkins; 1998.
Beck RW, Trobe JD. What we have learned from the Optic Neuritis Treatment Trial. Ophthalmology. Oct 1995;102(10):1504-8. [Medline].
Bonhomme GR, Liu GT, Balcer LJ. Isolated pediatric optic neuritis. Brain MRI abnormalities and risk of multiple sclerosis. Paper presented at: Annual Meeting of the North American Neuro-ophthalmology Society; 2005.
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Nakao Y, Omoto T, Shimomura Y. Optic neuritis in children. Folia Ophthalmol Jpn. 1983;34:496-498.
Neetens A, Smets RM. Leber's neurogenic stellate maculopathy. Neuro Ophthalmol. 1987;7:315-328.
Pohl D, Rostasy K, Gartner J, et al. Treatment of early onset multiple sclerosis with subcutaneous interferon beta-1a. Neurology. Mar 8 2005;64(5):888-90. [Medline].
Riikonen R, Donner M, Erkkilä H. Optic neuritis in children and its relationship to multiple sclerosis: a clinical study of 21 children. Dev Med Child Neurol. Jun 1988;30(3):349-59. [Medline].
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Further Reading
Keywords
childhood optic neuritis, optic neuritis, optic nerve inflammation, optic nerve, acute vision loss, papillitis, retrobulbar optic neuritis, bilateral simultaneous optic neuritis, bilateral sequential optic neuritis, neuroretinitis, multiple sclerosis, MS, acute disseminated encephalomyelitis, neuromyelitis optica, Devic disease
Follow-up: Optic Neuritis, Childhood