Pediatric Myelin-oligodendrocyte Glycoprotein Associated Demyelinating Optic Neuritis: Clinical Characteristics and Outcomes
Naga Pradyumna Kothapalli1, Ketaki Milind Panse2, Akash Virupakshaiah3, Shannon Beres4, Yin Allison Liu2
1Stanford University, 2ophthalmology, University of California Davis, 3neurology, University of California, Sanfrancisco, 4Stanford Children's Health/Lucille Packard Children's Hospital
Objective:
to assess the clinical characteristics, outcomes and utility of Ocular coherence tomography to predict outcomes in pediatric Myelin oligodendrocyte glycoprotein associated optic neuritis patients.
Background:
Myelin oligodendrocyte glycoprotein associated diseases (MOGAD) commonly presents with optic neuritis (ON), transverse myelitis (TM), isolated cerebellar involvement, isolated cortical encephalitis, ADEM (acute disseminated encephalomyelitis). The clinical and visual outcomes in patients with childhood MOGAD presenting with ON have not been well studied
Design/Methods:

We conducted a multicenter retrospective study in a cohort of pediatric patients (age <18) with seropositive MOGAD. Patient’s demographics and clinical management information were extracted from electronic medical record system. Retinal nerve fiber layer (RNFL) thickness and median deviation (MD) were collected via neuro-ophthalmic testing. 

Results:

Eighteen patients were included in the study with a median age of onset 10 years (6-14), 12/18 were female, 6/18 were male, 13/18 (72%) presented with isolated ON as the first event, remaining five patients had ON as a part of combined demyelinating phenotype at the first event. Median follow-up was 31 months (5-41). 3/18 (17%) had recurrent ON alone, 3/18 (17%) relapsed with other phenotypes (TM, cerebellar attack, encephalitis, ADEM); six patients (28%) had bilateral optic nerve involvement during initial attack. Mean LogMAR visual acuity was 1.7 at onset in 24 affected eyes. Maximum visual recovery to LogMAR 0 is attained in 1 month (1-1.5) in 16 eyes. Median RNFL thickness within two weeks of ON onset is 180 microns (IQR: 146-250) in seven eyes without correlation to log MAR outcomes at two weeks with median 0.6 (IQR:0.2 to 2, P=0.16) or at two months with median 0 (IQR: 0-0.1, P=0.2)

Conclusions:

Pediatric patients with MOGAD related optic neuritis often return to baseline visual acuity. 

10.1212/WNL.0000000000204848