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Title: | Optic neuritis in Turkish children and adolescents: A multicenter retrospective study | Authors: | Direk, M.Ç. Besen, Ş. Öncel, İ. Günbey, C. Özdoğan, O. Orgun, L.T. Sahin, S. Cansu, Ali Yıldız, Nihal Kanmaz, Seda Yılmaz, Sanem Tekgül, Hasan Türkdoğan, Dilşad Ünver, Olcay Thomas, Gülten Öztürk Başıbüyük, Salih Yılmaz, Deniz Kurt, Ayşegül Neşe Gültutan, Pembe Özsoy, Özlem Yiş, Uluç Kurul, Semra Hız Güngör, Serdal Özgör, Bilge Karadağ, Meral Dündar, Nihal Olgaç Gençpınar, Pınar Bildik, Olgay Orak, Sibğatullah Ali Kabur, Çişil Çerçi Kara, Bülent Karaca, Ömer Canpolat, Mehmet Gümüş, Hakan Per, Hüseyin Yılmaz, Ünsal Karaoğlu, Pakize Ersoy, Özlem Tosun, Ayşe Öztürk, Semra Büyükkorkmaz Yüksel, Deniz Atasoy, Ergin Gücüyener, Kıvılcım Yıldırım, Miraç Bektaş, Ömer Çavuşoğlu, Dilek Yarar, Çoşkun Güngör, Olcay Mert, Gülen Gül Sarıgeçili, Esra Edizer, Selvinaz Çetin, İpek Dokurel Aydın, Seren Diler, Betül Özdemir, Asena Ayça Erol, İlknur Okuyaz, Çetin Anlar, Banu |
Keywords: | Multiple sclerosis Myelin oligodendrocyte glycoprotein antibody Neuromyelitis optica Pediatric optic neuritis Treatment methylprednisolone myelin oligodendrocyte glycoprotein protein antibody adolescent adolescent health Article child child health clinical evaluation clinical feature convalescence demography disease association disease predisposition drug effect drug pulse therapy female follow up human major clinical study male multicenter study (topic) multiple sclerosis nuclear magnetic resonance imaging onset age optic neuritis prognosis recurrent disease retrospective study risk assessment sex ratio trend study Turk (people) |
Publisher: | Elsevier B.V. | Abstract: | Background: Various etiologies may underlie optic neuritis, including autoantibody-mediated disorders described in the last decade. We re-examined demographic, clinical, laboratory features and prognostic factors in pediatric patients with autoimmune optic neuritis according to current knowledge. Methods: Cases of pediatric ON from 27 centers in Türkiye diagnosed between 2009 and 2022 were included for retrospective evaluation. Results: The study included 279 patients, 174 females and 105 males, with a female-to-male ratio of 1.65. The average age at onset was 12.8 ± 3.4 years, and mean follow-up, 2.1 years (range: 1–12.1 years). Patients <10 years old were grouped as "prepubertal" and those ≥10 years old as "others”. The diagnoses made at the end of follow-up were multiple sclerosis associated optic neuritis (n = 90, 32.3 %), single isolated optic neuritis (n = 86, 31 %), clinically isolated syndrome (n = 41, 14.7 %), myelin oligodendrocyte glycoprotein antibody associated optic neuritis (n = 22, 7.9 %), and relapsing isolated optic neuritis (n = 18, 6.5 %). Predominant diagnoses were myelin oligodendrocyte glycoprotein antibody associated optic neuritis and acute disseminated encephalomyelitis associated optic neuritis in the prepubertal group and multiple sclerosis associated optic neuritis in the older group. Recurrences were observed in 67 (24 %) patients, including 28 with multiple sclerosis associated optic neuritis, 18 with relapsing isolated optic neuritis, 11 with myelin oligodendrocyte glycoprotein antibody associated optic neuritis, 8 with aquaporin-4 antibody related optic neuritis, and 2 with chronic relapsing inflammatory optic neuropathy. Recurrences were more common among female patients. Findings supporting the diagnosis of multiple sclerosis included age of onset ≥ 10 years (OR=1.24, p = 0.027), the presence of cranial MRI lesions (OR=26.92, p<0.001), and oligoclonal bands (OR=9.7, p = 0.001). Treatment in the acute phase consisted of intravenous pulse methylprednisolone (n = 46, 16.5 %), pulse methylprednisolone with an oral taper (n = 212, 76 %), and combinations of pulse methylprednisolone, plasmapheresis, or intravenous immunoglobulin (n = 21, 7.5 %). Outcome at 12 months was satisfactory, with 247 out of 279 patients (88.5 %) demonstrating complete recovery. Thirty-two patients exhibited incomplete recovery and further combination treatments were applied. Specifically, patients with relapsing isolated optic neuritis and aquaporin-4 antibody related optic neuritis displayed a less favorable prognosis. Conclusion: Our results suggest optic neuritis is frequently bilateral in prepubertal and unilateral in peri‑ or postpubertal patients. Age of onset 10 or older, presence of oligoclonal bands, and brain MRI findings reliably predict the development of multiple sclerosis. The risk of developing multiple sclerosis increases mostly during the second and third years of follow-up. Relapsing isolated optic neuritis remains a separate group where the pathogenesis and outcome remain unclear. Investigation of predisposing and diagnostic biomarkers and long follow-up could help to define this group. © 2023 Elsevier B.V. | URI: | https://doi.org/10.1016/j.msard.2023.105149 https://hdl.handle.net/11499/56549 |
ISSN: | 2211-0348 |
Appears in Collections: | PubMed İndeksli Yayınlar Koleksiyonu / PubMed Indexed Publications Collection Scopus İndeksli Yayınlar Koleksiyonu / Scopus Indexed Publications Collection Tıp Fakültesi Koleksiyonu WoS İndeksli Yayınlar Koleksiyonu / WoS Indexed Publications Collection |
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