Multiple Sclerosis Is Rare in Epstein-Barr Virus-Seronegative Children with Central Nervous System Inflammatory...

Area of Science:

• Neurology
• Immunology
• Virology

Background:

• Epstein-Barr virus (EBV) is considered a prerequisite for multiple sclerosis (MS).
• However, a notable percentage of pediatric MS cases present as EBV-seronegative, challenging this hypothesis.
• This highlights a potential gap in understanding MS etiology in children.

Purpose of the Study:

• To investigate the significance of EBV seronegativity in pediatric patients diagnosed with clinically isolated syndrome or MS.
• To identify alternative diagnoses in EBV-seronegative children presenting with MS-like symptoms.
• To assess the prevalence of anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in this cohort.

Main Methods:

• Retrospective analysis of 189 pediatric patients with clinically isolated syndrome/MS.
• Evaluation of EBV serostatus in all patients.
• Testing for anti-MOG antibodies in EBV-seronegative patients and a subset of EBV-seropositive patients.
• Clinical review to confirm MS diagnosis.

Main Results:

• Among 25 EBV-seronegative children, 11 (44%) tested positive for anti-MOG antibodies.
• In contrast, only 9 of 164 (5.5%) EBV-seropositive patients had anti-MOG antibodies (p < 0.001).
• Of the EBV-seronegative/MOG antibody-negative patients, only 4 met the criteria for an MS diagnosis after review.

Conclusions:

• EBV seronegativity in children with an MS-like presentation warrants consideration of alternative diagnoses, particularly MOG-antibody disease.
• This finding underscores the importance of MOG antibody testing in EBV-seronegative pediatric neurological cases.
• Rethinking the EBV prerequisite for MS is necessary, especially in pediatric populations.