Neuropediatrics 2015; 46 - PS02-01
DOI: 10.1055/s-0035-1550715

Oligoclonal Bands Predict Multiple Sclerosis in Children with Isolated Optic Neuritis: A Retrospective Multicenter Cohort Study

N. Heußinger 1, E. Kontopantelis 2, J. Gburek-Augustat 3, A. Jenke 4, G. Vollrath 5, R. Korinthenberg 6, P. Hofstetter 7, S. Meyer 8, I. Brecht 9, B. Bajer-Kornek 10, P. Herkenrath 11, M. Schimmel 12, K. Wenner 13, M. Häusler 14, S. Lutz 15, A. Blaschek 16, M. Smitka 17, S. Karch 18, M. Piepkorn 19, K. Rostasy 20, P. Weber 21, R. Trollmann 22, J. Klepper 1, M. Häußler 23, R. Hofmann 24, R. Weissert 25, A. Merkenschlager 26, M. Buttmann 9
  • 1Kinderklinik Aschaffenburg, Aschaffenburg, Germany
  • 2Institute of Population Health, University of Manchester, Manchester, United Kingdom
  • 3Universitätskinderklinik Tübingen, Tübingen, Germany
  • 4Helios Kinderklinik Wuppertal, Wuppertal, Germany
  • 5Universitätskinderklinik Rostock, Rostock, Germany
  • 6Universitätskinderklinik Freiburg, Freiburg, Germany
  • 7Universitätskinderklinik Frankfurt, Frankfurt a.M., Germany
  • 8Universitätskinderklinik Homburg, Homburg/Saar, Germany
  • 9Neurologische Klinik der Universität Würzburg, Würzburg, Germany
  • 10Universitätsklinik für Neurologie, Wien, Austria
  • 11Universitätskinderklinik Köln, Köln, Germany
  • 12Klinikum Augsburg, Klinik für Kinder- und Jugendliche, Augsburg, Germany
  • 13Universtitätskinderklinik Hamburg, Hamburg, Germany
  • 14Universitätskinderklinik Aachen, Aachen, Germany
  • 15Universitätskinderklinik Essen, Essen, Germany
  • 16Dr. von Haunersches Kinderspital, LMU, München, Germany
  • 17Universitätskinderklinik Dresden, Dresden, Germany
  • 18Neuropädiatrie, Zentrum für Kinder- und Jugendmedizin, Uniklinikum Heidelberg, Heidelberg, Germany
  • 19Neuropädiatrie, Kinderkrankenhaus Auf der Bult, Hannover, Germany
  • 20Neuropädiatrie, Department für Kinder- und Jugendheilkunde, Universitätsklinik für Pädiatrie I, Innsbruck, Germany
  • 21Universitäts-Kinderspital beider Basel, Basel, Germany
  • 22Klinik für Kinder- und Jugendheilkunde, Universität Erlangen, Erlangen, Germany
  • 23Kinderklinik der Universität Würzburg, Würzburg, Germany
  • 24Abteilung Neuropädiatrie, Sozialpädiatrie und Epileptologie, Klinik für Kinderheilkunde und Jugendmedizin, Gießen, Germany
  • 25Klinik für Neurologie der Universität Regensburg, Regensburg, Germany
  • 26Neuropädiatrie, Universitätskinderklinik Leipzig, Leipzig, Germany

Aims: Isolated optic neuritis (ON) in childhood may remain a singular event or indicate the beginning of multiple sclerosis (MS). Higher age and pathological cranial MRI at presentation were previously demonstrated as independent risk factors of conversion to MS.

To further evaluate potential risk factors for MS, including cerebrospinal fluid (CSF) findings in children with isolated ON as a first demyelinating event.

Methods: Only children with isolated unilateral or bilateral ON as a first demyelinating event younger than 18 years of age were included in this retrospective multicenter cohort study. The minimal follow-up (FU) for those not converting to MS according to McDonald 2010 was 2 years. Age (< 10 vs. = 10 years), sex, FU, laterality of ON, cranial MRI (none vs. = MS-compatible lesion outside the optic nerves) and intrathecal oligoclonal bands (OCB) were assessed as risk factors using simple and multiple logistic regressions.

Results: Of 338 included children, 268 had unilateral and 70 bilateral-isolated ON. Median FU of patients not developing MS was 5.1 years (range, 2.0–22.0 years). Univariate analyses revealed age (OR, 1.21; 95% CI, 1.21–1.30; p < 0.001), MRI positivity (OR, 34.75; 95% CI, 18.19–66.39; p < 0.001) as well as presence of OCB (OR, 18.22; 95% CI, 10.53–31.51; p < 0.001) as predictive factors, while the three other tested parameters were not significantly associated with conversion to MS. Multivariate analysis of all six factors confirmed MRI positivity (cMRI; OR, 18.62; 95% CI, 8.53–40.64; p < 0.001) and OCB (OCB; OR, 8.62; 95% CI, 3.98–18.65; p < 0.001) as significant predictors of conversion, but not age, sex, FU time or laterality (unilateral vs. bilateral). cMRI and OCB positivity indicated a 161.9-fold higher odds of developing MS compared with double negativity (95% CI, 47.27–554.53; p < 0.001). Only one of 35 children with recurrent isolated ON or neuromyelitis optica had OCB at onset.

Conclusion: This is the first study showing that CSF examination in children with isolated ON as a first demyelinating event may help to determine the risk of conversion to MS.

Keywords: optic neuritis, risk factors, multiple sclerosis, oligoclonal bands.