Recurrent optic neuritis after acute disseminated encephalomyelitis in pediatrics. A case report
Keywords:
Optic neuritis (ON), multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), right eye (RE), visual acuity (VA), optic neuromyelitis (ONM)Abstract
Optic Neuritis (ON) is a condition caused by the inflammation of the optic nerve, causing diminished visual acuity and ocular pain. It is tightly related to Multiple Sclerosis (MS), often being the first demyelinating event. There is a 31% risk of recurrence during the first 10 years after the diagnosis, and 48% of the patients end up being diagnosed with Multiple Sclerosis1. Imaging studies like brain MRI (Magnetic Resonance Imaging) have a critical role in the diagnosis and prognosis of ON, as well as in the recognition of MS.2
The patient is a 11-year-old girl with recurrent ON and past medical history of Acute Disseminated Encephalomyelitis (ADEM) when she was 5 years old. ON diagnosis was based on clinical findings as well as on ophtalmologic, electrophysiologic and imaging studies. The recurrent episodes of ON improved after the use of high dose steroids. Recurrences were observed after titration of the dose, but remission was achieved after adjustment of treatment. During one of the recurrent episodes, blood work was performed to evaluate possible underlying infectious, demyelinating or autoinmmune process. Anti-MOG antibodies were found positive. The patient at the moment is not presenting with any other criteria suggesting MS or Optic Neuromyelitis, but long term follow up is adviced.
Downloads
References
Balcer LJ: Optic Neuritis. The New England Journal of Medicine 2006;354:1273-1280.
Ayuso T, Aliseda D, Ajuria I, Zandio B, Mayor S, Navarro M. Neuritis óptica inflamatoria. An Sist Sanit Navar 2009;32(2).
Monge Galindo L, et al. Neuritis óptica en pediatría: experiencia en 27 años y protocolo de actuación. Neurología. 2017. https://doi.org/10.1016/j.nrl.2018.01.008
Bandwell B, Kennedy J, Sandovick D, Arnold DL, Magalhaes S, Wambera K, et al. Incidence of acquired demyelination of the CNS in Canadian children. Neurology 2009;72(3)232-239.
Melinda Y. Chang and Stacy L. Pineles. Pediatric Optic Neuritis, Seminars in Pediatric Neurology. http://dx.doi.org/10.1016/j.spen.2017.04.004
Optic Neuritis Study Group. The 5-year risk of MS after optic neuritis: experience of the optic neuritis treatment trial. Neurology 1997;49:1404-1413.
Borchert M, Liu G, Pineles S, Waldman A. Pediatric optic neuritis: What is new. J Neuroophtalmol 2017;37(1):S14-S22.
Yeh E, Graves J, Benson L, Wassmer E, Waldman A. Pediatric optic neuritis. American Academy of Neurology 2016;S53-S58.
Licea-Blanco J, Paypa-Jabre E, Cantú-Salinas A, Muñiz-Landeros C, Villareal-Velásquez H. Características clínicas de la neuritis óptica en niños en un hospital de tercer nivel en México. Medicina Universitaria 2013;15(58):15-20.
Peragallo J. How to manage pediatric optic neuritis. Review of Ophthalmology. [Published online April 10, 2018]. E n : URL: https://www.reviewofophthalmology.com/article/how-tomanage-pediatric-optic-neuritis
Pérez-Cambrodí RJ, Gómez-Hurtado Cubillana A, Merino-Suárez ML, Pinero-Llorens DP, Laria-Ochaita C. Optic neuritis in pediatric population: A review in current tendencies of diagnosis and management. J Optom 2014;7:125-130.
Söderström M, Link H, XuZ, Fredriksson S. Optic neuritis and multiple sclerosis: Anti-MBP and anti-MBP peptide antibodysecreting cells are accumulated in CSF. Neurology 1993;43(6).
Waldman AT, Liu GT, Lavery AM, Liu G, Gaetz W, Aleman TS, et al. Optical coherence tomography and visual evoked Potentials in pediatric MS. Neurol Neuroimmunol Neuroinflamm 2017;354:6.
Khadse R, Ravindran M, Pawar N, Maharajan P, Rengappa R. Clinical profile and neuroimaging in pediatric optic neuritis in Indian population: A case series. Indian J Ophthalmol 2017;65:242-245.
Waldman AT, Stull LB, Galetta SL, Balcer LJ, Liu GT. Pediatric optic neuritis and risk of multiple sclerosis: Meta-analysis of observational studies. J AAPOS 2011;15:441-446.
Duignan S, Wright S, Rossor T, Cazabon J, Gilmour K, Ciccarelli O, Hacohen Y. Myelin oligodendrocyte glycoprotein and aquaporin-4
antibodies are highly specific in children with acquired demyelinating syndromes. Developmental Medicine and Child Neurology 60(9),958-962. https://doi.org/10.1111/dmcn.13703
Oubiña M. Pichon-Riviere A, Augustovski F, Martí S, Alcaraz A, Bardach A, Ciapponi A, López A, Rey-Ares L. Anti-MOG (myelin oligodendrocyte glycoprotein) antibodies for the diagnosis of optic neuromyelitis and other demyelinating diseases. Buenos Aires. IECS; abril 2016.
Kim YM, Kim HY, Cho MJ, Kwak Mj, Park KH, Yeon GM, et al. Optic neuritis In Korean children: Low risk of subsequent multiple sclerosis. Pediatr Neurol 2015;53(3):221-225.
Ramanathan S, Reddel S, Henderson A, et al. Antibodies to myelin oligodendrocyte glycoprotein in bilateral and recurrent optic neuritis. American Academy of Neurology, Neurol Neuroimmunol Neuroinflamm 2014;1.
Downloads
Published
Issue
Section
License
Copyright (c) 2019 Nora Pinargote, Paulina Segovia, Marcelo Román, Ana María Román, Mónica Vargas
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
