• Michael Absoud, Ming J Lim, Richard Appleton, Anu Jacob, Joanna Kitley, M Isabel Leite, Michael G Pike, Angela Vincent, Evangeline Wassmer, Patrick Waters, Mark Woodhall, Cheryl Hemingway, and Jacqueline Palace.
• Department of Children's Neurosciences, Evelina Children's Hospital at Guy's & St Thomas' NHS Foundation Trust, Kings Health Partners Academic Health Science Centre, London, UK.
• J. Neurol. Neurosurg. Psychiatr. 2015 Apr 1; 86 (4): 470-2.

BackgroundNeuromyelitis Optica (NMO) is a severe and rare inflammatory condition, where relapses are predictive of disability.MethodsWe describe a national paediatric NMO cohort's clinical, MRI, outcome, and prognostic features in relation to Aquaporin-4 antibody (AQP4-Ab) status, and compared to a non NMO control cohort.ObservationsTwenty NMO cases (females = 90%; AQP4-Ab positive = 60%; median age = 10.5 yrs) with median follow-up = 6.1 yrs were compared to a national cohort sample of known sequential AQP4-Ab negative first episode CNS acquired demyelination cases (n = 29; females = 55%; all AQP4-Ab negative; median age = 13.6 yrs). At presentation, 40% NMO cases had unilateral optic neuritis (ON); 20% bilateral ON; 15% transverse myelitis (TM); 15% simultaneous TM&ON; 10% Acute disseminated encephalomyelitis. At follow up, 55% had a clinical demyelinating episode involving the brain; 30% of cases had abnormal brain MRI at onset and 75% by follow up. NMO brain scan lesions compared to controls were large (> 2 cm), acute lesions largely resolved on repeat imaging, and often showed T1 hypointense lesions. Mean time to relapse = 0.76 yrs (95% CI 0.43-1.1 yrs) for AQP4-Ab positive vs 2.4 yrs in AQP4-Ab negative cases (95% CI 1.1-3.6 yrs). In AQP4-Ab positive cases, 10/12 had visual acuity < 6/60 Snellen in ≥ 1 eye (0/8 AQP4-Ab negative), and 3 AQP4-Ab negative cases were wheelchair-dependent.ConclusionsIn children, NMO is associated with early recurrence and visual impairment in AQP4-Ab positivity and physical disability in AP4-Ab negative relapsing cases. Distinct MRI changes appear more commonly and earlier compared to adult NMO. Early AQP4-Ab testing may allow prompt immunomodulatory treatment to minimise disability.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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