Annals of clinical and translational neurology · 2026
MOGAD Is the Most Common Cause of Isolated Optic Neuritis in Children.
СтатьяНазвание и аннотация: Перевод в очереди
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Aduru Chaitanya, Chandrasekar Akansha, Blasingame Kyla, Rosen Jonathan, Levine Jesse M, Salazar Karla, Chilakapati Madhuri, Foroozan Rod, Hardwick Victoria, Yarimi Jonathan M, Shukla Nikita, Lotze Timothy E, Fisher Kristen S, Sandweiss Alexander J
Аннотация
OBJECTIVES: The study aimed to characterize the clinical features, etiologies, and outcomes of isolated, first-time pediatric ON in the post-MOG-IgG era.
METHODS: This was a single-center retrospective cohort study at Texas Children's Hospital of patients diagnosed with first-time ON between 2018-2024, with follow-up data collected through 2025. Inclusion criteria required monocular or binocular subacute vision loss with supportive paraclinical signs. Subjects were excluded if they had a prior history of demyelinating disease or extra-orbital demyelinating lesions on initial brain/spine MRI. Primary outcomes were the proportion of MOG-IgG seropositivity, retinal nerve fiber layer thickness, and visual acuity at onset and most recent follow-up.
RESULTS: Of 73 children with ON, 38 met criteria for isolated first-time ON. Etiologies included MOGAD (n = 27, 71.1%) and idiopathic/monophasic (n = 9, 23.7%), while none of the 38 subjects were later diagnosed with multiple sclerosis. MOGAD-ON was associated with less severe vision loss at presentation (p < 0.01) compared to idiopathic cases. At most recent follow-up, both groups achieved excellent functional recovery, yet both demonstrated significant retinal nerve fiber layer thinning from ON presentation. Linear regression revealed worse presenting LogMAR significantly correlated to thinner follow-up RNFL (F(1,18) = 8.467, R2 = 0.32, p < 0.01). One (3.7%) MOGAD-ON patient relapsed during follow-up.
INTERPRETATION: In isolated pediatric ON, no patients were diagnosed with MS, and MOGAD is the predominant etiology. The linear correlation between initial LogMAR and subsequent RNFL atrophy suggests a permanent reduction in neurological reserve dependent on the degree of functional severity at ON onset.
METHODS: This was a single-center retrospective cohort study at Texas Children's Hospital of patients diagnosed with first-time ON between 2018-2024, with follow-up data collected through 2025. Inclusion criteria required monocular or binocular subacute vision loss with supportive paraclinical signs. Subjects were excluded if they had a prior history of demyelinating disease or extra-orbital demyelinating lesions on initial brain/spine MRI. Primary outcomes were the proportion of MOG-IgG seropositivity, retinal nerve fiber layer thickness, and visual acuity at onset and most recent follow-up.
RESULTS: Of 73 children with ON, 38 met criteria for isolated first-time ON. Etiologies included MOGAD (n = 27, 71.1%) and idiopathic/monophasic (n = 9, 23.7%), while none of the 38 subjects were later diagnosed with multiple sclerosis. MOGAD-ON was associated with less severe vision loss at presentation (p < 0.01) compared to idiopathic cases. At most recent follow-up, both groups achieved excellent functional recovery, yet both demonstrated significant retinal nerve fiber layer thinning from ON presentation. Linear regression revealed worse presenting LogMAR significantly correlated to thinner follow-up RNFL (F(1,18) = 8.467, R2 = 0.32, p < 0.01). One (3.7%) MOGAD-ON patient relapsed during follow-up.
INTERPRETATION: In isolated pediatric ON, no patients were diagnosed with MS, and MOGAD is the predominant etiology. The linear correlation between initial LogMAR and subsequent RNFL atrophy suggests a permanent reduction in neurological reserve dependent on the degree of functional severity at ON onset.