Risk Factors for Transverse Myelitis Compared with Multiple Sclerosis, Neuromyelitis Optica, and Other Neurologic Disorders in Pediatric Patients (P02.121)

OBJECTIVE: We sought to determine if risk factors reported for pediatric multiple sclerosis (MS) patients, such as HLA-DRB1*1501 allele, past infections with common herpes viruses, including Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV), and level of 25-hydroxy-vitamin D, were also associated with transverse myelitis (TM) in pediatric patients. BACKGROUND: TM has substantial clinical overlap, especially on initial presentation, with other autoimmune disorders, including MS and neuromyelitis optica (NMO). Risk factors for TM are not known. DESIGN/METHODS: Sera were collected from pediatric TM patients and neurologic controls, and from pediatric MS and NMO patients early in disease course through Stony Brook Pediatric MS Centers and the Accelerated Cure/Guthy Jackson Biobank. Serum 25-hydroxy-vitamin D levels were measured by chemoluminescent immunoassay. Antibodies against EBV (EBNA-1), HSV, and CMV were measured by ELISA. HLA-DRB1 allele status was measured by PCR. Logistic regression models, adjusting for age at draw, were used to compare risk factors between TM and the other groups. RESULTS: Blood samples were collected for patients with TM (n=16), NMO (n=34), MS (n=184), and neurologic controls (n=31). Median ages at disease onset were 12.3 years (0.4-17.0 years), 11.0 years (1.9-17.3 years), and 14.3 years (1.4-19.2 years) for TM, NMO, and MS, respectively. TM patients were less likely to have been exposed to EBV as compared to MS patients (OR 0.021, p CONCLUSIONS: Unlike pediatric and adult MS, EBV exposure does not appear to be associated with TM in pediatric patients. Larger studies are needed to confirm this association. Supported by: TM and some NMO sera were provided by the Accelerated Cure/Guthy Jackson Foundation. The Pediatric MS Centers are supported by the NMSS. KW is supported by a grant from the Dean9s Office Medical Student Research Program at UCSF. Dr. Graves is supported by the NMSS (Sylvia Lawry award) and the CMSC. Disclosure: Dr. Weinfurtner has nothing to disclose. Dr. Graves has nothing to disclose. Dr. Mowry has received research support from Teva Neuroscience. Dr. Krupp has received personal compensation for activities with Teva Neuroscience, Biogen Idec, EMD Serono, MEDA Corp, Acorda Therapeutics, Betaseron/Bayer Healthcare, Gerson Lehrman Group, Guidepoint Global, Adler, Cohen, Harvey and Wakeman. Dr. Krupp has received royalty payments from Genzyme, Zymogenetics, Ortho-McNeil, and ER Squibb & Sons. Dr. Krupp has received research support from Genentech, Biogen Idec, Teva Neuroscience, Celgene Corporation, Garnett McKeen Laboratory Incorporated, the National Institutes of Health, Slomo and Cindy Silvian Foundation, MS Foundation and the Lourie Foundation. Dr. Belman has nothing to disclose. Dr. Milazzo has nothing to disclose. Dr. James has received personal compensation for activities with Pfizer Inc, and Novartis as a speaker. Dr. Waubant has received personal compensation for activities with Actelion, Roche Diagnostics Corporation, Sanofi-Aventis and Teva Neuroscience as a consultant, advisory board member and/or speaker. Dr. Waubant has received research support from Roche Diagnostics Corporation, Biogen Idec and Sanofi-Aventis.