Treatments for Optic Neuritis (ON) in Children

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How is ON treated?

Medications are used to reduce the inflammation (swelling) in the optic nerve in ON. The main medication that is used is called methylprednisolone (Solu-medrol™), which is a corticosteroid given by IV once a day for three to five days. This medication is completely different from the illegal steroids that some athletes use. Most children with ON improve with high doses of methylprednisolone.

What are the side effects of treatment?

Most children tolerate medication very well, although some children can develop temporary moodiness or other behavioral changes.

Steroids can also cause increases in blood pressure and blood sugar, which your doctors and nurses will check for and treat if necessary. In addition, steroids can irritate the stomach lining. In such cases, medication such as ranitidine (Zantac™) is usually given to prevent stomach irritation.

Will my child leave the hospital on medications?

Some children will be placed on a steroid medication for a short time. While on prednisone, a medication to prevent your child from having stomach irritation may also be prescribed.

What is the prognosis of ON?

Steroid treatment can reduce some visual symptoms and stop new symptoms from developing. Although the long-term prognosis for children with ON varies, most children make a complete or nearly complete recovery, including those children with initially severe symptoms. For most children, recovery begins within days and continues for up to one year. Some patients can have residual symptoms such as blurred vision or decreased color vision.

Will ON affect my child's school performance?

Most children return to their baseline school performance, but some children may have new difficulty with their school work. This may be due to several factors, including missed school days during the illness, as well as changes in vision. If you notice changes in your child's school performance, it's important to let your medical providers know so that they can work with the school to develop an educational plan.

Will my child get ON every time he/she has an infection?

No. In most patients, ON occurs only once; in some patients, however, it can re-occur. When it re-occurs, the symptoms can be identical to the initial episode but can also be different. It is not known why patients develop ON with certain infections at certain times.

If you notice symptoms during an infection that you think are unusual — such as confusion, changes in vision, weakness, numbness or imbalance — it is important to notify your doctor immediately.

How is ON similar to multiple sclerosis (MS)?

Both ON and MS involve autoimmune responses to myelin; they are both "demyelinating" disorders. Symptoms common to both disorders include loss of vision. Corticosteroids are used to treat attacks of both ON and MS.

How is ON different from MS?

Although children can develop MS, it is much more common in adults. Common symptoms of MS, such as weakness, numbness or loss of balance do not occur in ON.

There are also clues on brain MRI to distinguish ON from MS. Most importantly, ON typically occurs only once, while patients with MS have further, repeated attacks of inflammation in the brain and spinal cord. Most patients with MS are treated with ongoing medication to prevent such attacks. Patients with ON don't need such medication.

Can a child with ON ever develop MS in the future?

Although most children do not, some children who initially have ON can develop MS if they have new attacks affecting other parts of the brain or spinal cord. For this reason, it is important to have ongoing follow-up with your doctor. If you notice new symptoms, such as visual loss, weakness, numbness or loss of balance, it is important to let your doctor know immediately.

What will the follow-up be after my child is discharged from the hospital?

After you leave the hospital, it's important to follow up with your neurologist and ophthalmologist in the outpatient clinic. We will perform a neurological and eye examination on your child. A follow-up brain and/or spinal cord MRI and visual field testing may also be done.

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