Mono and MS

Is there a connection between mononucleosis and multiple sclerosis? Studies conducted over many years have brought proof to the table of the connection between these two diseases and the common link of the Epstein-Barr virus.

The EBV/Mono Link to Multiple Sclerosis

Researchers from the Harvard School of Public Health, Kaiser Permanente, and a team of collaborators have discovered factors which implicate the Epstein-Barr virus as a possible contributor to MS.

Blood samples collected over a nine year period, from 1965 to 1974, were the base source for the study which looked for possible MS diagnosis between 1995 and 1999.

Forty-two individuals diagnosed with MS who had serum collected before the diagnosis date were chosen for the two control groups. The study's main finding was that the antibodies to the Epstein-Barr nuclear antigen complex and its component were elevated for as many as 20 years before symptoms of MS even began to show in these individuals.

"Collectively, the results of this and the previous studies provide compelling evidence that infection with EBV is a risk factor in the development of MS," said Alberto Ascherio, senior author of the study and Associate Professor of Nutrition and Epidemiology at Harvard School of Public Health.

Incurable Disease

Multiple sclerosis is an incurable autoimmune disease that often causes severe disability. Researchers from the University of Buffalo and the University of Trieste, in Italy published important findings linking mono to MS in the Journal of Neurology, Neurosurgery and Psychiatry.

Robert Zivadinov, M.D., Ph.D., an associate professor of neurology in the University of Buffalo's Jacobs Neurological Institute (JNI), and lead author of this study tells us that the study is the first of its kind.

Zivadinov says the study proves that a viral agent may be responsible for the severity of how a specific case of MS presents and that this can be measured by magnetic resonance imaging (MRI). 

"A growing body of experimental evidence indicates that past infection with EBV may play a role in MS, but the relationship of EBV and the brain damage that can be seen on MRI scans had not been explored," says Zivadinov.

The University of Trieste's Multiple Sclerosis Center recruited 135 MS patients. Researchers at both the University of Trieste and at the JNI's Buffalo Neuroimaging Analysis Center (BNAC) evaluated the participants' MRI scans. BNAC is directed by Zivadinov.

Gray Matter

The researchers in Buffalo recorded the total volume of the brain as well as measuring the decrease in the gray matter, both at the onset of the study and three years later.

It was demonstrated that those patients with higher levels of anti-EBV antibody at the inception of the study were found to have a greater loss of gray matter and total brain volume at the three-year evaluation.

At present, the research team is studying patients who experienced the condition known as "clinically isolated syndrome," which is the first neurological episode in an MS patient that lasts at least a day and is found to be caused by either inflammation or demylenation in at least one site within the central nervous system.

When a second episode occurs, patients are diagnosed with MS. This part of the investigation focuses on the connection between anti-EBV antibody levels with the atrophying of gray matter, neurocognitive functioning, and the progression of disability as time goes on.

Other Manifestations of EBV

The EBV is also implicated in other diseases. In temperate climates, such as the US, Canada and Europe, it is seldom fatal, but in tropical climates, EBV is associated with two different types of cancer, Burkitt's lymphoma and nasopharyngeal carcinoma.

Now, research is confirming the connection between mono and MS since people with MS have higher than expected levels of antibodies to the Epstein-Barr virus.

Several studies have cited the onset of MS often follows infectious mononucleosis. It appears that few people develop MS during or immediately after their first EBV infection, however, the vast majority of people with MS have been previously infected by EBV.

Hope For Prevention

There is mounting evidence that shows the relationship of EBV infection to other autoimmune diseases, especially lupus, as well as MS. "Discovering strong risk factors is the task of epidemoiologists and an important initial step in finding ways to diagnose, treat, and prevent MS," said Ascherio.

"A focused multidisciplinary effort is now needed to complete the puzzle and thus open the door to new therapeutic approaches."

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