Optic neuritis is a common first manifestation of multiple sclerosis (MS) in children, as published in the European Journal of Paediatric Neurology.

The new study analyzed a Serbian population of 52 patients with the disease aged 7 to 17 years. “The present study is the largest series of pediatric multiple sclerosis in [the] Western Balkan region,” the authors said.

Visual evoked potentials (VEPs) can detect both clinical and subclinical lesions in an objective, fast, and low-cost way. It should, therefore, be further tested as a possible tool for the diagnosis of MS in children. 

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Children and adolescents make up around 2.5% to 5% of all patients with MS. The disease is very heterogenous in this population with acute vision loss generally being the most common initial manifestation.

Here, a team of researchers from Serbia evaluated whether VEPs can be used to diagnose optic neuritis and reliably detect clinically silent lesions in children with MS.

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To do so, they conducted VEP tests in all patients (57 in total) after their first MS attack. They compared the test results to those of healthy controls.

With this approach, the researchers identified optic neuritis in 18 of the 52 children after the first attack, corresponding to over 34.6% of them. This ratio went up to 57.7% following the second attack with 30 patients diagnosed with optic neuritis.

Even if they were not all diagnosed with optic neuritis, the majority of patients (76.9%) had pathological VEP. Of those, almost half (42.3%) had clinically silent MS lesions.

The authors suggested that including optic nerve lesions and VEP findings to diagnostic criteria for MS in children and adolescents would increase the sensitivity of the diagnosis.

“We strongly support VEP as an objective, fast, accessible and inexpensive diagnostic method for detecting clinical and subclinical lesions,” they wrote. VEP is a noninvasive method to analyze the function of the visual pathway following light stimulation.


Nikolic B, Zaletel I, Ivancevi N, et al. The usefulness of visual evoked potentials in the assessment of the pediatric multiple sclerosis. Eur J Paediatr Neurol. 2022;36:130-136. doi:10.1016/j.ejpn.2021.12.005