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.