New onset or relapsing neuromyelitis optica temporally associated with SARS-CoV-2 infection and COVID-19 vaccination: a systematic review

Abstract

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is a rare chronic neuroinflammatory autoimmune condition. Since the onset of the COVID-19 pandemic, there have been reports of NMOSD clinical manifestations following both SARS-CoV-2 infections and COVID-19 vaccinations.ObjectiveThis study aims to systematically review the published literature of NMOSD clinical manifestations associated with SARS-CoV-2 infections and COVID-19 vaccinations.MethodsA Boolean search of the medical literature was conducted between December 1, 2019 to September 1, 2022, utilizing Medline, Cochrane Library, Embase, Trip Database, Clinicaltrials.gov, Scopus, and Web of Science databases. Articles were collated and managed on Covidence® software. The authors independently appraised the articles for meeting study criteria and followed PRISMA guidelines. The literature search included all case reports and case series that met study criteria and involved NMOSD following either the SARS-CoV-2 infection or the COVID-19 vaccination.ResultsA total of 702 articles were imported for screening. After removing 352 duplicates and 313 articles based on exclusion criteria, 34 articles were analyzed. A total of 41 cases were selected, including 15 patients that developed new onset NMOSD following a SARS-CoV-2 infection, 21 patients that developed de novo NMOSD following COVID-19 vaccination, 3 patients with known NMOSD that experienced a relapse following vaccination, and 2 patients with presumed Multiple Sclerosis (MS) that was unmasked as NMOSD post-vaccination. There was a female preponderance of 76% among all NMOSD cases. The median time interval between the initial SARS-CoV-2 infection symptoms and NMOSD symptom onset was 14 days (range 3–120 days) and the median interval between COVID-19 vaccination and onset of NMO symptoms was 10 days (range 1 to 97 days). Transverse myelitis was the most common neurological manifestation in all patient groups (27/41). Management encompassed acute treatments such as high dose intravenous methylprednisolone, plasmapheresis, and intravenous immunoglobulin (IVIG) and maintenance immunotherapies. The majority of patients experienced a favorable outcome with complete or partial recovery, but 3 patients died.ConclusionThis systematic review suggests that there is an association between NMOSD and SARS-CoV-2 infections and COVID-19 vaccinations. This association requires further study using quantitative epidemiological assessments in a large population to better quantify the risk.

Characteristics of Persistent Symptoms Manifested after SARS-CoV-2 Vaccination: An Observational Retrospective Study in a Specialized Clinic for Vaccination-Related Adverse Events

“…NMOSD is an autoimmune disease that causes demyelination of the central nervous system including the optic nerve and the spinal cord. It was suggested that COVID-19 vaccinations are associated with the development of NMOSD in a systematic review of studies in which 26 patients experienced new demyelinating symptoms related to NMOSD [39]. In those patients, 54% (14/26) of the patients received an mRNA vaccine, 31% (8/26) of the patients received a viral vector vaccine, and 15% (4/26) of the patients received an inactivated COVID-19 vaccine [39].…”

Prevalence of neuromyelitis optica spectrum disorder in the United States

“…Considering evidence supporting a temporal increase in the prevalence of NMOSD, 8 similar to other demyelinating diseases (i.e. MS and Parkinson’s disease), 9 and that SARS-CoV-2 infection may precede NMOSD onset, 10 it is important to describe the recent burden of NMOSD in the United States in the post-pandemic era, including its prevalence by age, sex, and race.…”

A case study: ADEM-like lesions as a first clinical event in highly active multiple sclerosis

“…Conversely, neurological dysfunction associated with autoimmunity was also reported. Cases included ADEM (Nabizadeh et al, 2023), Guillain-Barré syndrome (GBS; Pimentel et al, 2023), MS and NMOSD onset (Harel et al, 2023), encephalitis (Nabizadeh et al, 2022), among others. As COVID-19 became widespread worldwide, those manifestations turned into a public health concern.…”

“…development after COVID-19 in unvaccinated patients(Avila et al, 2023;Pignolo et al, 2021;Palao et al, 2020). A systematic review found 18 cases of MOGAD following infection(Mirmosayyeb et al, 2023), while another one revealed 15 cases of NMOSD(Harel et al, 2023). Another review, which encompassed any case of CNS in ammatory demyelinating disease (IDD), found higher numbers for new onset MOGAD, with 27 cases(Lotan et al, 2022).…”