Neuropathic symptoms with SARS-CoV-2 vaccination

Abstract

Background and ObjectivesVarious peripheral neuropathies, particularly those with sensory and autonomic dysfunction may occur during or shortly after acute COVID-19 illnesses. These appear most likely to reflect immune dysregulation. If similar manifestations can occur with the vaccination remains unknown.ResultsIn an observational study, we studied 23 patients (92% female; median age 40years) reporting new neuropathic symptoms beginning within 1 month after SARS-CoV-2 vaccination. 100% reported sensory symptoms comprising severe face and/or limb paresthesias, and 61% had orthostasis, heat intolerance and palpitations. Autonomic testing in 12 identified seven with reduced distal sweat production and six with positional orthostatic tachycardia syndrome. Among 16 with lower-leg skin biopsies, 31% had diagnostic/subthreshold epidermal neurite densities (≤5%), 13% were borderline (5.01-10%) and 19% showed abnormal axonal swelling. Biopsies from randomly selected five patients that were evaluated for immune complexes showed deposition of complement C4d in endothelial cells. Electrodiagnostic test results were normal in 94% (16/17). Together, 52% (12/23) of patients had objective evidence of small-fiber peripheral neuropathy. 58% patients (7/12) treated with oral corticosteroids had complete or near-complete improvement after two weeks as compared to 9% (1/11) of patients who did not receive immunotherapy having full recovery at 12 weeks. At 5-9 months post-symptom onset, 3 non-recovering patients received intravenous immunoglobulin with symptom resolution within two weeks.ConclusionsThis observational study suggests that a variety of neuropathic symptoms may manifest after SARS-CoV-2 vaccinations and in some patients might be an immune-mediated process.

Compression therapy, autonomic nervous system, and heart rate variability: A narrative review and our preliminary personal experience

“…Similarly, it would be interesting to investigate the potential role of CT on the documented dysautonomia (with ANS dysregulation) which is frequently encountered in those patients affected by the so-called "long-COVID," or by the adverse effects of the anti-COVID-19 vaccines. [120][121][122][123][124] The introduction of the so-called "translational medicine," intended as "an interdisciplinary branch of the biomedical field supported by three main pillars: benchside, bedside, and community," 125 gives the opportunity to combine different expertise and disciplines to favor the advancement of biomedical science. The CT interaction with the ANS and PNEI system fits in this opportunity to merge different disciplines finalized at widening biomedical research.…”

Small fiber neuropathies: expanding their etiologies

“…In other patients, treatment with oral corticosteroids seemed to speed up recovery. In nonrecovering patients, IVIG treatment after five to nine months resulted in full recovery within two weeks [25 ▪ ].…”

“…Within one month after administration, both virus vector vaccines and mRNA vaccines resulted in neuropathic and autonomic symptoms. In some cases, spontaneous recovery after weeks was seen [24 ▪ ,25 ▪ ]. In other patients, treatment with oral corticosteroids seemed to speed up recovery.…”

“…In addition, various auto-antibodies have been linked to SFN, in the absence of systemic diseases [15 ▪ ,16 ▪▪ ,17 ▪▪ ]. Besides, postinfectious and postvaccination cases of SFN have been described, in which immune-mediated mechanisms are supposed to be causative [18 ▪ ,19 ▪ ,20 ▪ ,21 ▪ ,22 ▪ ,23 ▪ ,24 ▪ ,25 ▪ ,26 ▪ ].…”

“…Not only COVID-19 itself is associated with the development of SFN, but also post COVID-19 vaccination, sensory and autonomic complaints caused by skin biopsy proven SFN have been described [24 ▪ ,25 ▪ ,26 ▪ ]. Within one month after administration, both virus vector vaccines and mRNA vaccines resulted in neuropathic and autonomic symptoms.…”