¿ Can COVID-19 exacerbate multiple sclerosis symptoms? A case series analysis

Michelena, Gloria; Casas, Magdalena; Eizaguirre, María Bárbara; Pita, María Cecilia; Cohen, Leila; Alonso, Ricardo; Garcea, Orlando; Silva, Berenice A

doi:10.1016/j.msard.2021.103368

Cited by 26 publications

(15 citation statements)

References 29 publications

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“…However, the role played by vaccination could be double-edged. Vaccine antigen may provoke an exaggerated autoimmune reaction ( Chen et al, 2001 , Kivity et al, 2009 ) and trigger clinical relapses in patients with NMOSD ( Apostolos-Pereira et al, 2021 ) and MS ( Michelena et al, 2022 ). Recently, several cases of acute demyelinating disease of the CNS (optic nerve, brain, and/or spinal cord) following SARS-CoV-2 vaccination have been reported ( Pagenkopf & Südmeyer, 2021 , Khayat-Khoei et al, 2021 , Kaulen et al, 2021 , Ismail & Salama, 2021 , Chen et al, 2021 , Netravathi et al, 2022 , Badrawi et al, 2021 , Abboud et al, 2020 , Fragoso et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, the role played by vaccination could be double-edged. Vaccine antigen may provoke an exaggerated autoimmune reaction [14,15] and trigger clinical relapses in patients with NMOSD [16] and MS [17]. Recently, several cases of acute demyelinating disease of the CNS (optic nerve, brain, and/or spinal cord) following SARS-CoV-2 vaccination have been reported [18][19][20][21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Relapses after SARS-CoV-2 vaccination in patients with neuromyelitis optica spectrum disorder and multiple sclerosis

Kong

Wang

Chen

et al. 2022

Multiple Sclerosis and Related Disorders

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relapses after SARS-CoV-2 vaccination in patients with neuromyelitis optica spectrum disorder and multiple sclerosis

Kong

Wang

Chen

et al. 2022

Multiple Sclerosis and Related Disorders

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“…Fifteen case reports and case series reported the occurrence of MS relapse/pseudo-relapse or the onset of a first demyelinating event consistent with MS or CIS in 19 patients ( 57 , 63 , 65 – 69 , 76 – 79 , 81 , 82 , 84 , 86 ). Twelve observational case series and cohort studies documented the occurrence of relapses or pseudo-relapses among patients with a known diagnosis of MS and confirmed diagnosis of COVID-19 ( 58 – 61 , 64 , 71 – 75 , 83 , 85 ). Collectively, 54 relapses and 20 pseudo-relapses were reported in 804 patients (6.7 and 2.5%, respectively).…”

Section: Resultsmentioning

confidence: 94%

“…The remaining 455 MS patients treated with DMTs (73%) were reported in larger cohorts in which some people were not treated. The information regarding relapses in these cohorts was not stratified between treated and untreated patients ( 61 , 75 ).…”

Section: Resultsmentioning

confidence: 99%

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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“…Another study revealed an upregulation in HERVs in children with mild or moderate COVID-19 but a decrease in those with a severe disease ( Tovo et al, 2021 ). However, literature data highlight a possible exacerbation of neurological conditions in cases with COVID-19, and particularly, a recent case series analysis concluded that SARS-CoV-2 infection may affect the MS or even cause a relapse ( Finsterer, 2022 , Michelena et al, 2022 ).…”

mentioning

confidence: 99%