542 Seronegative NMOSD – A post SARS-COV-2 neurological complication associated with Paediatric Multisystem Inflammatory Syndrome (PIMS)?

Shukla, Vanita; Singh, Vindra A; Singh, Virendra Rs; Maharaj, Parmanand; Fernandes, Maritza; Cadan, Sandhya; David, Stephan; Panday, Avidesh; Robertson, Paula; Ramroop, Ronand; Moona, Aruna

doi:10.1136/archdischild-2021-rcpch.59

Cited by 1 publication

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“…In 10 case reports, AQP4-IgG Abs were positive ( 22 – 27 , 29 , 31 , 86 , 87 ). In two case reports the AQP4 abs were negative ( 30 , 32 ) and each fulfilled the diagnostic criteria for seronegative NMOSD. In one report, AQ4 serostatus was not reported ( 28 ).…”

Section: Resultsmentioning

confidence: 98%

“…Sixty-seven articles were included in the final review. Twelve articles describe post-COVID-19 NMOSD (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), 25 describe post-COVID-19 MOGAD , and 29 describe post-COVID-19 MS (57-85). One paper describes three patients with post-COVID-19 demyelinating events, of which one is NMOSD, one-MOGAD, and one-clinically isolated syndrome (CIS) (86).…”

Section: Resultsmentioning

confidence: 99%

“…Ten case reports describe the onset of newly diagnosed NMOSD in people without previous neurological disease ( 22 – 26 , 28 – 30 , 32 , 87 ). Two case reports describe people with previously undiagnosed neurological disease who then presented with a second clinical manifestation in temporal association to COVID-19, leading to an NMOSD diagnosis ( 27 , 86 ).…”

Section: Resultsmentioning

confidence: 99%

“…. (30,32) and each fulfilled the diagnostic criteria for seronegative NMOSD. In one report, AQ4 serostatus was not reported (28).…”

Section: Post-covid-nmosdmentioning

confidence: 99%

“…In the remaining six cases, the treatment regimen was not reported (21,24,27,29,86). A favorable outcome (i.e., improvement of neurological symptoms) was reported in eight patients (21,25,26,30,32,87), while poor neurological outcome (i.e., worsening of neurological disability) was reported in four patients (21)(22)(23). Two patients deceased due to systemic complications (28,29).…”

Section: Post-covid-nmosdmentioning

confidence: 99%

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COVID-19 and the risk of CNS demyelinating diseases: A systematic review

et al. 2022

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BackgroundViral infections are a proposed possible cause of inflammatory central nervous system (CNS) demyelinating diseases, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). During the past 2 years, CNS demyelinating events associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, but causality is unclear.ObjectiveTo investigate the relationship between CNS demyelinating disease development and exacerbation with antecedent and/or concurrent SARS-CoV-2 infection.MethodsA systematic literature review of all publications describing either a new diagnosis or relapse of CNS demyelinating diseases (MS, NMOSD, MOGAD) in association with SARS-CoV-2 infection was performed utilizing PRISMA guidelines. Descriptive statistics were used for data analysis, using a case analysis approach.ResultsSixty-seven articles met the inclusion criteria for the study. Most of the reported cases of NMOSD (n = 13, 72.2% of reported cases) and MOGAD (n = 27, 96.5% of reported cases) were of new disease onset, presenting with typical clinical and radiographic features of these conditions, respectively. In contrast, reported MS cases varied amongst newly diagnosed cases (n = 10, 10.5% of reported cases), relapses (n = 63, 66.4%) and pseudo-relapses (n = 22, 23.2%). The median duration between COVID-19 infection and demyelinating event onset was 11.5 days (range 0–90 days) in NMOSD, 6 days (range−7 to +45 days) in MOGAD, and 13.5 days (range−21 to +180 days) in MS. Most cases received high-dose corticosteroids with a good clinical outcome.ConclusionBased upon available literature, the rate of CNS demyelinating events occurring in the setting of preceding or concurrent SARS-CoV-2 infection is relatively low considering the prevalence of SARS-CoV-2 infection. The clinical outcomes of new onset or relapsing MS, NMOSD, or MOGAD associated with antecedent or concurrent infection were mostly favorable. Larger prospective epidemiological studies are needed to better delineate the impact of COVID-19 on CNS demyelinating diseases.

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