Researchers at Birmingham Children’s Hospital, and Great Ormond Street and Evelina Children’s Hospitals, London, UK followed 44 children (female/male ratio 1.8; median age 10.9 years) with a first-episode optic neuritis for a median of 1 year (mean, 1 year 10 months). Maximal visual deficit was severe (<6/60) in 77%. Recovery was complete in 70%. At follow-up, 32% were diagnosed with MS (11/44) or neuromyelitis optica (NMO) (3/44). Cumulative probability of developing MS or NMO by 2 years after optic neuritis onset was 0.45. Gender, age, unilateral/bilateral optic neuritis, visual acuity severity, and CSF oligoclonal bands were non-predictive. Strong predictors of MS or NMO were relapsing optic neuritis (p<0.001) and an initial abnormal MRI (>1 brain T2 hyperintense lesion)(p<0.001). [1]

COMMENT. Pediatric acute onset optic neuritis has a good initial prognosis. An abnormal initial MRI or relapsing optic neuritis is predictive of MS or NMO.