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To the Editor: Dr Levin and colleagues¹ found that infection with Epstein-Barr virus (EBV) was a risk factor for later development of multiple sclerosis (MS). Although the authors pointed out that levels of IgG against EBV nuclear antigen 1 (EBNA-1) were correlated with the risk of developing MS, I disagree with their analogy to similar associations between EBV and Burkitt lymphoma and nasopharyngeal carcinoma. In those cases, neoplastic cells reexpress EBV antigens, which leads to an increase in the levels of serologic markers.² Thus, it is uncertain whether EBV has any causal role in the etiology of these cancers. There is no evidence, for instance, of persisting EBNA-1 antigen expression by central nervous system cells in patients with MS. Similarly, there is no evidence that EBV causes the lesions of MS, and the serologic picture of chronic or reactivated EBV infection in otherwise healthy persons is different than that found . . . [Full Text of this Article]

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