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Adenotonsillectomy is associated with increased risk and disease activity in pediatric-onset multiple sclerosis
Gina Chang1, Zahra Nasr1, Vinicius Andreoli Schoeps2
1UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
Insights
A history of adenotonsillectomy was linked to a higher risk of developing pediatric-onset multiple sclerosis (MS). This procedure also correlated with an increased relapse rate in children already diagnosed with MS.
Area of Science:
- Neurology
- Immunology
- Virology
Background:
- Epstein-Barr virus (EBV) is a known risk factor for multiple sclerosis (MS).
- Tonsils and adenoids are identified as primary reservoirs for EBV.
- The study explores the impact of adenotonsillectomy on pediatric MS risk and disease activity.
Purpose of the Study:
- To investigate the association between adenotonsillectomy and the risk of pediatric-onset multiple sclerosis (POMS).
- To evaluate the effect of adenotonsillectomy on the relapse rate in pediatric MS patients.
Main Methods:
- A case-control study involving POMS participants and pediatric controls.
- Data collection included history of adenotonsillectomy, EBV serostatus, and HLA status.
- Statistical analyses utilized multivariable logistic and negative binomial regression models.
Main Results:
- Adenotonsillectomy was associated with a 63% increased odds of developing MS (OR=1.63, p=0.046).
- Among POMS patients, adenotonsillectomy correlated with a twofold increase in annualized relapse rate (IRR=2.00, p=0.013).
Conclusions:
- Prior adenotonsillectomy is linked to elevated MS risk and higher relapse rates in pediatric patients.
- Findings suggest a potential interaction between EBV, immune responses, and MS development.
Background:
Epstein-Barr virus (EBV) is a key environmental risk factor for multiple sclerosis (MS), and tonsils and adenoids serve as a primary viral reservoir. This study investigates the potential role of adenotonsillectomy in pediatric-onset multiple sclerosis (POMS) risk and relapse rate.
Objectives:
POMS participants and controls were recruited from 16 pediatric MS clinics between 1 November 2011 and 1 July 2017. Clinical and demographic information, including history of adenotonsillectomy, EBV serostatus, and HLA-DRB1*15:01:01 status, were collected. Multivariable logistic regression assessed the association between adenotonsillectomy and MS risk. In addition, negative binomial regression offset by follow-up time was used to assess the relationship between adenotonsillectomy and relapse rate in POMS participants with available follow-up data.
Results:
The case-control analysis included 359 POMS participants and 560 pediatric controls. Individuals with a history of adenotonsillectomy had a 63% increased odds of MS (adjusted odds ratio (OR) = 1.63, 95% confidence interval (CI) = 1.01-2.64, p = 0.046). Among the 239 POMS participants with available follow-up data, adenotonsillectomy was associated with a twofold increase in annualized relapse rate (adjusted incidence rate ratio (IRR) = 2.00, 95% CI = 1.15-3.48, p = 0.013).
Conclusions:
Prior adenotonsillectomy was associated with increased risk of MS and greater relapse rate in pediatric patients, suggesting a potential interplay between EBV, immune regulation, and MS pathogenesis.
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