Multiple sclerosis has a common viral culprit, opening doors to new approaches

I'm on Ocrelizumab for MS, which wipes out memory B Cells. EBV lives in these cells. Ironically I'm sitting here at the cancer center now getting my semiannual infusion. Anecdotally this drug has made my day-to-day much easier.

Fluoroquinolone antibiotics, like ciprofloxacin, are well documented to cause permanent nerve damage (and chronic fatigue). One of the symptoms/causes is demyelination of the nerves. Similarly in MS, as the article states:

> Myelin is the very thing that is destroyed in MS

While it seems unlikely that FQ nerve damage is caused by the immune system attacking its own nerve cells, the mechanism by which these antibiotics cause nerve damage is unknown. This makes them higher risk to take, because your doctor has no idea what to look for to make sure you don't get nerve damage. Most doctors aren't even aware of the link, the FDA forced manufacturers to add permanent neuropathy as a black box warning to the drugs, long after most doctors learned about them in medical school.

If two conditions lead to the same outcome, I wonder if there's any utility in looking for links, either in treatment or prevention, between them.

It's Epstein-Barr virus. In case you don't want to start reading and then be interrupted with a modal popup like I was.

and yeah, more and more studies[0][1][2][3] are indicating the link between EBV and MS:

[0] https://journals.lww.com/epidem/fulltext/2000/03000/epstein_...

[1] https://www.hsph.harvard.edu/news/press-releases/epstein-bar... / https://www.science.org/doi/10.1126/science.abj8222

[2] https://pubmed.ncbi.nlm.nih.gov/31862243/

[3] https://link.springer.com/article/10.1007/s11481-010-9201-3

This is such a fascinating area of research. I think it's increasingly clear that there is a common thread tying together conditions like long-COVID, MS and chronic fatigue syndrome - a long-running and persistent viral infection leading to a chronic immuno-inflammatory response. Other seemingly unlikely diseases such as Alzheimers, depression and even schizophrenia may may have neuro-inflammatory origins too.

This article hints that the persistence of the Epstein-Barr virus might be causing the chronic inflammation. But I wonder if it could instead be due to some sort of non-linear process in the immune-response that causes our immune system to enter a positive feedback loop when it's activated for too long or in a certain way. And perhaps the therapy for this would be to suppress the immune system for some period of time to allow it to abort this feedback loop, perhaps something like this: https://www.healthline.com/health-news/patients-resorting-to...

I know that Tanina Agosto‘s story is not the main content of the article, but it makes me incredibly angry.

The idea that someone lives in a supposedly developed country , has very worrying neurological symptomps and is not seen by a doctor for months is barbaric. The fact that she literally works in a hospital is an extra layer of insult on top of this.

How are people okay with this system?

> Agosto spoke with a doctor at the New York City hospital where she works as a medical secretary. He told her that she probably had a pinched nerve and to see a chiropractor.

Amazing. Do New York City hospital doctors refer people to witch doctors and prescribe powdered tiger penis too?

There are two lines of evidence for EBV and MS, but both are uncertain:

1) Given ~1M vets, ~800 diagnosed with MS after having 2-3 blood samples taken. Of those, most without EBV exposure didn't get MS until they were exposed. MS is rare (<1%), and EBV is ubiquitous (>95%?), so getting large numbers of unexposed people who get MS would be hard in any case. It's unclear if they corrected e.g., for expected age of onset (~30) since I expect they started sampling blood in ~20 y.o.'s.

2) Some researchers claim molecular mimicry, where an EBV protein looks very close to a protein on the foot of myelin (near the edge)

But in MS it's not clear if the inflammation causes the myelin loss or some nerve pathology causes the loss (which causes the inflammation). There's a line of evidence that the axons are disrupted well before the myelin loss.

Also, MS is a clinical disease: it's just "multiple" "sclerosis" in the CNS -- without other more specific causes like MOG/NMO. There could be many causes that end up creating multiple demyelinating plaques, so EBV, even if it is a cause, might not be a principle one.

Finally, the problematic form of MS is the (typically later) progressive phase, with increasing disability even without immune flairs. While some immune suppressants can limit the (earlier) flairs, drugs approved for progressive are barely better than nothing.

Also, the incidence of MS seems to be increasing overall. sigh.

I was diagnosed with PPMS in January 2018 and my neurologist put me on OCREVUS. At the time of diagnosis to MS I just had a little numbness in left hand and a little weakness in right leg but now after two years and three times OCREVUS Infusion which was supposed to help me and slow down the disease progression but on the contrary I am using walker for little walking at home with lack of balance and too much spasticity, weakness, numbness, bladder issue, low back and neck pains!!! I think this drug destroyed my life and I think if I hadn't used this drug my MS disease wouldn’t progressed at this level but I had no other choice because my neurologist said this is the only medication for PPMS!!! There has been little if any progress in finding a reliable treatment. Acupuncture eased my anxiety a bit. I was introduced to Health Herbs Clinic and their effective Multiple Sclerosis treatment. When I started the MS treatment I felt like a miracle has happened. Feel as good as I can feel. Started driving including on a freeway.! The herbal treatment is a sensation.. “Just google openpaymentsdata and see how much your doctor is getting paid ! AWESOME!!! They make money while we suffer.” I Just wanted to share for people suffering from this disease to visit healthherbsclinic. com it’s a 10 out of 10 from me! I Adhere anyone reading this to try natural approach, I’m 55 and never been this healthier.

Moderna is already working on a vaccine. This disease has ruined my life in more ways than one and I hope the vaccine eliminates the disease. Nobody should have to live like this.

I think the vaccine will reduce incidence drastically, but it will not make MS a historical disease. MS is not caused by EBV in ~20% of the patients.

It's like T1D, Alzheimer's, etc. There is a major environmental cause, in this case EBV, but also lots of different patient clusters with more complex etiology.

One of the most inspiring people I ever met was a college friend's mom who was years into MS but had steeled herself to stay active and strong and so into her 50s ran marathons. In her 60s she was confined to a wheelchair but nevertheless became one of the top hand-cyclist marathoners. Incredible palpable energy and positivity in her presence.

I have no doubt had a vaccine existed she would have taken it and spared herself the suffering.

But absent suitable treatment she made herself a hero.

Seems clear now that EBV causes enough trouble that we should think about trying to eradicate it if we can get a good vaccine. This will be horrendously expensive and difficult. But eradicating a disease has such unbounded benefits for humanity that we should try. By far the greatest thing medicine did last century, and possibly will ever do, was eradicate small pox.

> Vaccines might one day “make multiple sclerosis become a historical disease like polio,”

You'd think so yes.