Abstract: Risk factors for transverse myelitis compared with multiple sclerosis, neuromyelitis optica, and other neurologic disorders in pediatric patients (The 27th Annual Meeting of the CMSC and the 5th Cooperative Meeting of the CMSC-ACTRIMS)

Saturday, June 1, 2013

Kelley M Weinfurtner, B.A. , School of Medicine, University of California-San Francisco, San Francisco, CA

Jennifer Graves, MD, PhD , Neurology, University of California, San Francisco, San Francisco, CA

Ellen M Mowry, MD , Neurology, University of California, San Francisco, San Francisco, CA

Lauren Krupp, MD , Neurology, Stony Brook University Medical Center, East Setauket, NY

Tanuja Chitnis, MD , Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA

E Ann Yeh, MD , Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Moses Rodriguez, MD , Neurology, Mayo Clinic, Rochester, MN

Jayne Ness, MD , Neurology, Children's Hospital Alabama, Birmingham, AL

Anita L Belman, MD , Neurology, Stony Brook University Medical Center, East Setauket, NY

Marc Patterson, MD , Neurology, Mayo Clinic, Rochester, MN

Mark Gorman, MD , Neurology, Boston Children's Hospital, Boston, MA

Bianca Weinstock-Guttman, MD , Department of Neurology, State University of New York at Buffalo, Buffalo, Buffalo, NY

Judith A James, MD , Rheumatology, Oklahoma Medical Research Foundation, University of Oklahoma, Oklahoma City, OK

Emmanuelle Waubant, MD, PhD , Neurology, University of California, San Francisco, San Francisco, CA

Background: Transverse myelitis (TM) has substantial clinical overlap, especially on initial presentation, with other autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica (NMO). Risk factors for TM are not known.

Objectives: We sought to determine if risk factors reported for pediatric 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 TM in pediatric patients.

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 <0.001) and NMO patients (OR 0.154, p=0.054), but had similar frequency as controls (OR 0.62, p=0.573). Vitamin D data are still in progress. No difference was seen in the frequency of DRB1*1501 allele or exposure to CMV in TM patients as compared to neurologic controls, NMO patients, and MS patients.

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.

Acknowledgements: 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 Dean’s Office Medical Student Research Program at UCSF. Dr. Graves is supported by the NMSS (Sylvia Lawry award) and the CMSC.

P11 Risk factors for transverse myelitis compared with multiple sclerosis, neuromyelitis optica, and other neurologic disorders in pediatric patients