"Over 80% of the children with MS, irrespective of
geographical residence, were seropositive for remote EBV
infection. Seropositivity for EBV was associated with an
almost three times increased likelihood of MS compared
with age-matched and region-matched controls. Children
with MS also had signifi cantly higher EBV-EBNA1 titres,
and were more likely to have EBV titres in the highest
tertile, than controls. The higher EBV titres could represent
heightened immunological responses to EBV, as has been
suggested in a similar analysis comparing EBNA1 titres in
EBV-positive adult MS patients and controls.35 Studies of
T-cell proliferation to HLA-restricted EBV antigens in EBVpositive
children with MS compared with EBV-positive
healthy children are now underway. Increased EBV titres
might be due to episodic viral reactivation, a process that
has been postulated to occur with greater frequency in MS
patients than in individuals without MS, especially in
association with MS relapses.51 PCR analysis of EBV DNA
in saliva or plasma is required to ascertain lytic cycle
occurrence, and to correlate this with clinical disease
activity. Of note, to minimise potential cross-reactivity with
self-antigens, we specifi cally selected an EBNA-1 EIA assay
that relies on synthetic peptides, and excluded the Gly-Ala
repetitive sequence known to cross-react with self epitopes
from collagen, keratin, and actin.