Short report Absoud M, Cummins C, Desai N, et al . Arch Dis Child (2010). doi:10.1136/adc.2009.175422 1 of 3 1 Institute of Child Health, Birmingham Children’s Hospital, Birmingham, UK 2 Paediatric Neurology Department, Great Ormond Street Hospital, London, UK 3 Paediatric Neurology Department, The Evelina Children’s Hospital, London, UK 4 Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, UK 5 Paediatric Neurology Department, Birmingham Children’s Hospital, Birmingham, UK Correspondence to Dr Michael Absoud, Clinical Research Fellow, Third Floor, Institute of Child Health, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH; michaelabsoud@ childdemyelination.org.uk Accepted 22 April 2010 ABSTRACT Aim To describe clinical features and outcome of a series of children with first-episode optic neuritis investigated in three paediatric neurology centres. Methods Databases were searched to identify children (<16 years) with optic neuritis and life table analysis was used. Results 44 children (female/male ratio 1.8) median age 10.9 years were followed up for median 1 year. Optic neuritis was unilateral in 43%. Maximal visual deficit was severe (<6/60) in 77%, with full recovery in 70%. Cumulative probability of developing MS (11/44) or NMO (3/44) at 2 years was 0.45. Relapsing optic neuritis was a strong predictor for development of MS or NMO. A positive MRI (>1 brain T2 hyperintense lesion) was a strong predictor for development of MS. Discussion Childhood optic neuritis is associated with severe visual deficit with good recovery. An initial abnormal MRI brain scan or relapsing optic neuritis should alert the clinician to MS or NMO diagnosis. Childhood optic neuritis due to demyelination is a potentially treatable condition that may lead to visual impairment. A recent Canadian sur- veillance study showed an incidence of 0.2 per 100 000 children. 1 However, incidence rates are likely to be geographically different and more studies are needed. Isolated optic neuritis may also be the fi rst manifestation of multiple scle- rosis or neuromyelitis optica (NMO). The natu- ral history of childhood optic neuritis remains relatively unreported. Case series reported in the literature have tended to be single-centre studies, not including NMO as an outcome, and some have included cases of polysymptomatic clinically isolated syndromes (CIS) at presenta- tion. 2–7 We reviewed isolated fi rst-episode child- hood optic neuritis cases in three tertiary UK centres to evaluate clinical features and outcome. A secondary aim was to inform the design of a prospective national epidemiological surveillance study. METHODS Computerised databases were searched for con- secutive cases to indentify optic neuritis cases between 1 January 2002 and 31 March 2008. The age at presentation was limited from 1 month to less than 16 years of age. A text-based depart- mental database of patients seen in the paediatric neurology and ophthalmology departments was searched using the terms “optic neuritis”. Searches were conducted in three UK Children’s Hospitals. Patients’ notes were retrospectively analysed. We Childhood optic neuritis clinical features and outcome Michael Absoud, 1 Carole Cummins, 1 Nivedita Desai, 2 Artemis Gika, 3 Niamh McSweeney, 2 Pinki Munot, 2 Cheryl Hemingway, 2 Ming Lim, 3 Ken K Nischal, 4 Evangeline Wassmer 5 included cases with acute or subacute visual loss and one or more of the following: relative affer- ent pupillary defect in the affected eye in unilat- eral cases, visual field deficit or scotoma, impaired colour vision, optic disc oedema or abnormal visual evoked potentials. We excluded cases with other neurological fi ndings, concurrent acute dis- seminated encephalomyelitis or other causative aetiology or previous central nervous system (CNS) inflammatory demyelinating episodes. Conditions excluded were anterior ischemic optic neuropathy, neuroretinitis, compressive or infi ltrative optic neuropathies and Leber’s heredi- tary optic neuropathy. Any pre-existing ophthalmic conditions that had affected visual acuity were noted. At least two researchers in each centre carried out the search and decided on inclusion, and in case of disagreement, the fi rst author was consulted. The primary outcome was visual acuity at recovery, and the secondary outcome was multiple scle- rosis or NMO diagnosis on follow-up. A “posi- tive MRI” was defi ned as showing one or more brain T2 hyperintense lesions. International pae- diatric multiple sclerosis study group consensus defi nitions 8 were used for defi ning multiple scle- rosis and other CNS demyelinating conditions. An excel spreadsheet was designed to collect and record anonymised data in the three centres. Descriptive data are presented. Statistical analysis utilised life-table analysis by the Kaplan–Meier method performed using SPSS (version 17.0) software. What is already known on this topic ▶ Optic neuritis may be the first presentation of multiple sclerosis or neuromyelitis optica (NMO). ▶ The natural history is underreported. What this study adds ▶ Childhood isolated optic neuritis is associated with severe visual deficit with generally good recovery. ▶ Our cohort confirms that an initial abnormal MRI brain scan or relapsing optic neuritis should alert the clinician to multiple sclerosis or NMO diagnosis. ADC Online First, published on June 16, 2010 as 10.1136/adc.2009.175422 Copyright Article author (or their employer) 2010. Produced by BMJ Publishing Group Ltd (& RCPCH) under licence. group.bmj.com on April 21, 2011 - Published by adc.bmj.com Downloaded from