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Strong association with remote EBV infection in children with MS as opposed to other acquired demyelinating disorders

Sandy Molenaar1,2, Sandra Scherbeijn3, Arlette Bruijstens4

  • 1Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands s.molenaar@erasmusmc.nl.

Journal of Neurology, Neurosurgery, and Psychiatry
|March 18, 2025
PubMed
Abstract

Insights

Epstein-Barr virus (EBV) is linked to pediatric multiple sclerosis (MS), with high EBV antibody levels in MS patients. Cytomegalovirus (CMV) was more common in myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

Area of Science:

  • Pediatric neurology
  • Infectious diseases
  • Immunology

Background:

  • The association between Epstein-Barr virus (EBV) and multiple sclerosis (MS) is established in adults but less understood in children.
  • The role of viral infections, including EBV, in pediatric acquired demyelinating syndromes (ADS), such as pediatric MS and MOG antibody-associated disease (MOGAD), requires further investigation.

Purpose of the Study:

  • To investigate the prevalence of viral infections, specifically EBV, cytomegalovirus (CMV), and human herpesvirus 6 (HHV-6), in children diagnosed with MS, MOGAD, and other ADS.
  • To explore potential correlations between viral seroprevalence and clinical characteristics in these pediatric patient groups.

Main Methods:

  • Serum samples were collected from a Dutch multicenter cohort of pediatric patients diagnosed with ADS.
  • Immunoassays were utilized to determine the seroprevalence of EBV, CMV, and HHV-6 in the patient cohort.

Main Results:

  • All children with MS exhibited evidence of prior EBV exposure, with significantly higher EBV nuclear antigen 1 (EBNA-1) and viral capsid antigen antibody levels compared to MOGAD and other ADS groups.
  • Nearly all patients across all groups had evidence of prior HHV-6 infection.
  • Cytomegalovirus (CMV) seroprevalence was higher in MOGAD (58%) than in MS (35%), despite a younger age of onset in MOGAD patients.

Conclusions:

  • Children with pediatric MS show a strong association with remote EBV infection, characterized by elevated EBNA-1 levels, distinguishing them from MOGAD and other ADS.
  • Remote CMV infection appears more prevalent in pediatric MOGAD cases.
  • No significant associations were found between viral serology markers and clinical parameters such as relapse rates or MRI findings in children with MS.
Keywords:
MULTIPLE SCLEROSISMYELINPAEDIATRIC NEUROLOGYVIROLOGY

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