Clinical characteristics and clinical course of myelin oligodendrocyte glycoprotein antibody-seropositive pediatric optic neuritis

Purpose: To investigate the ophthalmic and neurological features of myelin oligodendrocyte glycoprotein antibody seropositive optic neuritis (MOG-ON) in pediatric patients. Methods: We analyzed the clinical data and orbital magnetic resonance images of patients aged below 15 years, diagnosed with MOG-ON at our institution (n = 40). Results: The mean age at first ON onset was 7.7 +/- 3.1 years, and 26 (65.0%) patients were girls. Twenty-three patients (57.5%) experienced bilateral ON, and ten (25.0%) had recurrent ON. Pain on eye movement was present in 30.6% of the eyes. In the acute stage, optic disk swelling and peripapillary hemorrhage was found in 82.6% and 15.2% of the eyes, respectively. In the chronic stage, optic atrophy was noted in 91.5% of the eyes. Although mean visual acuity (VA) at nadir was 1.72 +/- 0.66 logMAR, all patients experienced visual improvement of >= 0.3 logMAR, and the mean final VA was 0.05 +/- 0.14 logMAR. Twenty-one patients (52.5%) had other demyelinating diseases during the disease course (ON plus group), while 18 patients (45.0%) had experienced ON without other demyelinating disease (isolated ON group). Pain (19.4% vs. 38.5%, p = 0.098) and perineural enhancement (3.3% vs. 21.7%, p = 0.036) were less frequently observed in ON plus group. Conclusions: Pediatric MOG-ON has distinct clinical features, such as infrequent pain and perineural enhancement. Although optic atrophy is commonly observed, visual function is retained in most patients. A multidisciplinary approach and long-term follow-up are required for pediatric MOG-ON, since CNS involvement is more common than ON recurrence.

Automated summary

The purpose of this study was to investigate the ophthalmic and neurological features of myelin oligodendrocyte glycoprotein antibody seropositive optic neuritis (MOG-ON) in pediatric patients. The results showed that pediatric MOG-ON has distinct clinical features, such as infrequent pain and perineural enhancement. Although optic atrophy is commonly observed, visual function is retained in most patients. Therefore, a multidisciplinary approach and long-term follow-up are required for pediatric MOG-ON, as CNS involvement is more common than ON recurrence.