Children with abnormal brain MRI at presentation of optic neuritis appear to be at increased risk of MS

This retrospective study is important because pediatric optic neuritis physicians often extrapolate information from adult studies such as the landmark Optic Neuritis Treatment Trial (ONTT). This paper presents pediatric data - some of which is similar to the ONTT, some different - and is more applicable to children with the disorder.

Researchers reviewed the medical records of all children (<18 years) presenting with optic neuritis between 1993 and 2004 at the Children's Hospital of Philadelphia. Excluding children with a history of demyelinating disease or prior optic neuritis, researchers indentified 29 children.

Eighteen of these patients were followed for 24 months or longer and comprised the long-term follow-up cohort for which the conversion rate to multiple sclerosis (MS) was determined.

Every patient who developed MS (17 percent) had an abnormal brain MRI scan at their initial presentation of optic neuritis, while none of the patients with a normal brain MRI scan at presentation developed MS over an average follow-up of 88.5 months. Eleven patients (38 percent) had white matter T2/FLAIR lesions in the brain (not including the optic nerves). Those with one or more white matter lesions on their baseline MRI scans were more likely to develop MS (p = 0.04, Fisher exact test) than patients with a normal MRI at baseline.

The authors conclude that their data demonstrate the utility of brain MRI in predicting development of MS in a cohort of pediatric patients presenting with optic neuritis. They also note that prospective research studies incorporating MRI data and longer follow-up intervals are under way to further explore the risk factors associated with the development of MS after pediatric optic neuritis.

Financial Disclosures
Dr. Vaphiades has no financial interests to disclose.