title: Pediatric optic neuritis: does a prolonged course of steroids reduce relapses? A preliminary study.
abstract: BACKGROUND
  Optic neuritis is an important pediatric disorder causing visual impairment. Because of the absence of pediatric-specific studies, data extrapolated from the adult-based optic neuritis treatment trial are used to guide management of pediatric patients. Recent literature promotes a prolonged course of oral steroids to prevent relapses. However, there are no published data to support this view. Patients who were recently treated in our hospital received a longer course of steroids, relative to those treated several years ago. We hypothesized that a longer course of steroids results in fewer relapses and better final visual acuity.
  
  
  METHODS
  A retrospective analysis of 26 consecutive patients (age 4.5-19 years) treated for optic neuritis within the past 10 years was conducted. Patients received either a short course (2 weeks) or a prolonged course (more than 2 weeks) of steroids. Some patients were not treated. Mean follow-up was 70 weeks (3 weeks-10 years). Comparisons were made among the groups receiving 2 weeks of steroid treatment (16 of 26 patients) and greater than 2 weeks of steroid treatment (seven of 26 patients) to evaluate relapse rate, eventual visual acuity, and reported side effects.
  
  
  RESULTS
  There were no significant differences in the relapse rates, reported side effects, and final visual acuity in the two treatment groups.
  
  
  CONCLUSIONS
  In this cohort, a prolonged course of steroids was not associated with reduced relapse rate, increased side effects, or improved visual outcome. This cohort was small, but the results do not identify any reason to deviate from the common approach of optic neuritis treatment, which is 2 weeks of steroids.
authors.affiliation: Division of Child Neurology, Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa. Electronic address: Himalij@gmail.com.
authors.forename: Himali
authors.initials: H
authors.lastname: Jayakody
authors.affiliation: Division of Child Neurology, Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bonthius
authors.affiliation: Division of Neuro-Ophthalmology, Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Reid
authors.initials: R
authors.lastname: Longmuir
authors.affiliation: Division of Child Neurology, Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa.
authors.forename: Charuta
authors.initials: C
authors.lastname: Joshi
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009902:Optic Neuritis / Q000517:prevention & control*; D012008:Recurrence; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013256:Steroids
keywords: optic neuritis; pediatrics; steroid treatment; visual acuity; visual impairment; visual outcome