Management and outcomes of pediatric optic neuritis in a tertiary hospital in Riyadh, Saudi Arabia: a retrospective study.

BACKGROUND

Although pediatric optic neuritis (PON) is a rare condition, current advancements in its diagnosis, investigation, and treatment suggest that a more precise risk assessment is necessary given the history of irreversible damage and functional degeneration of the optic nerve. Additionally, after further investigations and/or new neurological events, the initial diagnosis is revised.

AIM: To report clinical profile, management and outcome of different demyelinating disease phenotypes of pediatric optic neuritis (PON) in individuals under the age of 18 years in a tertiary center in the Kingdom of Saudi Arabia (KSA).

STUDY METHOD: We analyzed the electronic medical records of pediatric patients under the age of 18 years who first experienced different phenotypes of demyelinating PON between January 2000 and December 2020 as part of this retrospective case series. We studied the clinical characteristics, serology, imaging data, treatment regimens, and follow-up of the patients. Descriptive statistics were calculated.

RESULTS

The majority of patients were less than 10 years old (63.6%), males (63.6%) and had bilateral involvement (72.7%). Among the 11 patients diagnosed with PON, 5(45.5%) had isolated pediatric optic neuritis, 1 (9.1%) had multiple sclerosis (MS), 1(9.1%) had neuromyelitis optica spectrum disorder (NMOSD), 1 (9.1%) had acute disseminated encephalomyelitis (ADEM) and 3 (27.2%) had myelin oligodendrocyte glycoprotein (MOG) antibody associated disease (MOGAD). Despite poor vision at presentation, most of the patients improved, 81.1% achieved a BCVA of ≥ 20/40, and 36.6% attained 20/20 visual acuity. Four patients experienced recurrence.

CONCLUSIONS

The overlapping features of disease phenotypes in PON make it difficult to identify the underlying cause. The findings of this retrospective case series suggest the need for a future prospective multicenter study for a better understanding of the different phenotypes.