Italian study confirms association between multiple sclerosis and mononucleosis in children and adolescents.

Even in children and adolescents, the kissing disease, infectious mononucleosis caused by the Epstein-Barr virus (EBV), represents a direct risk factor for multiple sclerosis (MS). This is supported by an Italian study conducted by the Bambino Gesù Children's Hospital and recently published in the Journal of Neurology .

Multiple sclerosis in children

Multiple sclerosis is an autoimmune disease of the central nervous system: the immune system attacks myelin, the sheath that covers nerve fibers and ensures the proper passage of electrical signals. Ninety percent of cases occur in adults, and only 10% manifest before age 18 (1% before age 10). These cases, explain experts at the Roman hospital, a national reference point for the disease, present unique clinical characteristics that require specific protocols and targeted studies.

The link between MS and the kissing disease

We are talking about a complex and multifactorial disease, the causes of which are still partly unknown. Both genetic and environmental factors appear to contribute to its development. Among the latter are viral infections, and the association between the Epstein-Barr virus and multiple sclerosis is well documented in adults. However, this correlation has so far been less clear in pediatric cases.

EPV, on the other hand, is a very widespread virus, infecting nearly the entire population without any significant consequences. Obviously, not everyone who contracts the infection is at risk of developing MS, and part of the research is aimed at understanding the biological mechanism linking it to MS.

For example, another recent Italian study —coordinated by the Sapienza Multiple Sclerosis Center, Sant'Andrea University Hospital, and San Raffaele Telematic University, funded by the Italian Multiple Sclerosis Association with the FISM Foundation, and published in the Proceedings of the National Academy of Sciences (PNAS)—shows that some variants of the virus "communicate" with genes that predispose to MS.

The study that confirms the association

To test the correlation in the pediatric population as well, researchers and doctors from the Developmental Neurology Unit at Bambino Gesù Hospital, in collaboration with the Department of Neuroscience at Sapienza University of Rome, analyzed blood samples from 219 children and adolescents between the ages of 6 and 17, 57 of whom had multiple sclerosis. All MS patients were positive for EBV, which is often contracted asymptomatically.

To further test the link, the researchers conducted the same studies on pediatric patients with non-neurological autoimmune diseases or primary headaches who were considered immunologically healthy. Of the latter, only 59% showed signs of a previous EBV infection. This statistically significant difference strengthened the hypothesis of a direct connection between the two diseases.

"Our results confirm that EBV infection is a key risk factor in children and adolescents," comments Gabriele Monte , lead author of the study. "Understanding the causes of multiple sclerosis is important for developing targeted treatments and effective prevention strategies," concludes Massimiliano Valeriani , head of Developmental Neurology at Bambino Gesù Hospital and coordinator of the research. "Our study supports the possibility that a vaccine against the virus that triggers mononucleosis could have a significant impact on reducing the incidence of multiple sclerosis in young people."