1. Epstein-Barr virus may cause Multiple Sclerosis through involvement of the venous system.

    Dear Editor,

    I read the article by Zivadinov (1) with reference to the association of Epstein-Barr virus (EBV) to gray matter atrophy in multiple sclerosis (MS) patients.

    Accumulation of EBV infected B cells in meninges and perivascular regions of MS lesions in 21 or 22 patients with MS (2) was noted as well, indicating direct involvement of the brain and perivascular spaces by EBV in MS patients..

    A recent study has indicated chronic cerebrospinal venous insufficiency with multiple extracranial venous strictures in MS patients (3).

    EBV appears to infect endothelial cells (4), and may be important in the pathology of EBV virus.

    EBV virus has been found to cause deep venous thrombosis in a patient with hereditary thrombophilia (5).

    EBV may infect the venous endothelium causing venous thromboses and strictures in the cranial and spinal venous drainage system and perivascular regions of MS lesions in patients with MS.

    Such venous involvement may be implicated in MS disease involvement.

    Chronic EBV infection may involve the venous system with secondary effects on the brain and spinal cord in MS.


    1.Zivadinov R, Zorzon M, Weinstock-Guttman B, Serafin M, Bosco A, Bratina A, et al.
    Epstein-Barr virus is associated with grey matter atrophy in multiple sclerosis
    J Neurol Neurosurg Psychiatry 2009; 80: 620 -625.

    2.Serafani B, Rosicarelli B, Franciotta D, et al.
    Dysregulated Epstein-Barr virus infection in the multiple sclerosis brain.
    J Exp Med 2007; 204:2899-2912.

    3. Zamboni P, Galeotti P, Menegatti E, Malagoni AM, Tacconi G, et al.
    Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis.
    J Neurol Neurosurg Psychiatry 2009: 80: 392-398.

    4. Jones K, Rivera C, Sgadari C, Franklin J, Max EE, et al.
    Infection of human endothelial cells with Epstein-Barr virus.
    J Exp Med. 1995; 182: 1213-1221.

    5. Mashav N, Saar N, Chundadze T, Steinvil.
    Epstein-Barr virus associated thromboembolism: A case report and review of the literature.
    Thromb Res. 2008; 122: 570-571.

    No conflict of interest.

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