Citations 1
Adenotonsillectomy is associated with increased risk and disease activity in pediatric-onset multiple sclerosis
Chang, Gina , Nasr, Z., Schoeps, Vinícius Andreoli , Virupakshaiah, Akash , Zamvil, Scott S, Moseley, Carson E. , Chong, Janet, Graves, Jennifer , Waltz, Michael , Tillema, Jan-Mendelt, Abrams, Aaron , Mar, Soe, Schreiner, Teri , Rose, John W. , Casper, T Charles, Nasr, Zahra , Graves, Jennifer , Rodriguez, Moses , Chitnis, Tanuja , Rensel, Mary R. , Abrams, Aaron , Krupp, Lauren , Schreiner, Teri , Rose, John W , Waubant, Emmanuelle L. , Virupakshaiah, Akash , Zamvil, Scott S. , Sabatino, Joseph J. , Chong, Janet, Rodriguez, Moses , Tillema, Jan‐Mendelt , Krupp, Lauren , Waldman, Amy , Mar, Soe , Casper, T. Charles
Multiple Sclerosis Journal | May 29, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Background: Epstein–Barr virus (EBV) is a key environmental risk factor for multiple sclerosis (MS), and tonsils and adenoids serve as a primary viral reservoir. This study investigates the potential role of adenotonsillectomy in pediatric-onset multiple sclerosis (POMS) risk and relapse rate. Objectives: POMS participants and controls were recruited from 16 pediatric MS clinics between 1 November 2011 and 1 July 2017. Clinical and demographic information, including history of adenotonsillectomy, EBV serostatus, and HLA-DRB1*15:01:01 status, were collected. Multivariable logistic regression assessed the association between adenotonsillectomy and MS risk. In addition, negative binomial regression offset by follow-up time was used to assess the relationship between adenotonsillectomy and relapse rate in POMS participants with available follow-up data. Results: The case-control analysis included 359 POMS participants and 560 pediatric controls. Individuals with a history of adenotonsillectomy had a 63% increased odds of MS (adjusted odds ratio (OR) = 1.63, 95% confidence interval (CI) = 1.01–2.64, p = 0.046). Among the 239 POMS participants with available follow-up data, adenotonsillectomy was associated with a twofold increase in annualized relapse rate (adjusted incidence rate ratio (IRR) = 2.00, 95% CI = 1.15–3.48, p = 0.013). Conclusions: Prior adenotonsillectomy was associated with increased risk of MS and greater relapse rate in pediatric patients, suggesting a potential interplay between EBV, immune regulation, and MS pathogenesis.