Is neuritis nervi optici in children a predictor of multiple sclerosis in adulthood?

Aims:

Optic neuritis [ON] is generally identified as the most frequent potential risk factor associated with future development of multiple sclerosis [MS]. Whereas coherency in case of the adult disease is proven, findings concerning MS after childhood ON could not be demonstrated until now. The aim of this study consists of the identification of risk factors predicting later MS.

Methods:

42 patients [27f, 15m], age 11–50 years [Ø28.1 years], age at onset of ON 2–17years [Ø9.9years], ON bilateral [n=18], ON unilateral [n=24; right 12/left 12], mean follow-up period of 18years, analysis of retrospective data and standardized follow-up with ophthalmological, neurological and electrophysiological investigation and cMRI.

Results:

14.3% [6/42] of the patients show radiological definite lesions of MS, 23.8% [10/42] show suspect signs of MS. 61.9% [26/42] have radiologically no evidence of MS. In subgroup analysis male sex, young age at onset of ON, bilateral ON, mild visual loss, positive lesions in cMRI and additional neurological symptoms especially in coordination increase the risk of later MS [p-value 0.02]. Female sex, unilateral ON, severe visual loss up to transient blindness and pathologic findings in funduscopy cause risk reduction of MS in future. 66.7% of patients treated with cortisone show no typical MS-lesions in cMRI.

Conclusion:

In comparison to adulthood MS after childhood ON is rare [14.3 vs. 40.0%]. Now, for the first time there is a possibility of risk evaluation and risk-adapted follow-up of different subgroups with special risk profile. An initial ophthalmological and neurological investigation is needed, as well as cMRI at onset of ON. Cortisone treatment reduces the probability of later MS; therefore treatment is recommended in case of defined ON.