COVID-19 and the Risk of Relapse in Multiple Sclerosis Patients: A Fight with No Bystander Effect?

Etemadifar, Masoud; Sedaghat, Nahad; Aghababaee, Ali; Kargaran, Parisa K; Maracy, Mohammad Reza; Ganjalikhani‐Hakemi, Mazdak; Rayani, Milad; Abhari, Amir Parsa; Khorvash, Reza; Salari, Mehri; Nouri, Hosein

doi:10.1016/j.msard.2021.102915

Cited by 47 publications

(39 citation statements)

References 36 publications

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“…A better physician-family relationship may also favour the early initiation of treatment, in order to reduce the relapse rate. Interestingly, the control of relapses may acquire further importance in the COVID-19 pandemic era, in light of the speculation (to date disconfirmed) of a higher risk of exacerbation following contraction [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Paediatric Multiple Sclerosis: A Scoping Review of Patients’ and Parents’ Perspectives

Luca¹,

Ortega-Castro

Patti

2021

Children

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Dealing with paediatric-onset multiple sclerosis is particularly challenging for the young patients and their families, due to its unpredictable symptoms and uncertain outcome. This review aimed at synthesising the qualitative evidence regarding the perspectives about paediatric-onset multiple sclerosis, as expressed by the patients and/or their parents. A literature search was conducted on PubMed and CINAHL. The advanced multi-field search allowed to perform an abstract/title search in both databases, using keywords, combined through Boolean operators. Additional search strategies were adopted: searching the reference list of the selected papers; searching for key authors in the field. All the relevant papers were thoroughly revised using The Joanna Briggs Institute’s data extraction form for qualitative evidence as a guidance. Eight papers were selected. The analysis of these papers allowed to identify some common issues pertaining paediatric-onset multiple sclerosis: (1) onset of symptoms, (2) diagnostic process, (3) reaction to the diagnosis, (4) management and acceptance of multiple sclerosis. The burden of multiple sclerosis was confirmed. However, the young patients and their parents can adjust to the disease. Both the community and the health care professionals must strive to prevent the families dealing with multiple sclerosis from experiencing solitude and rejection.

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Section: Discussionmentioning

confidence: 99%

Paediatric Multiple Sclerosis: A Scoping Review of Patients’ and Parents’ Perspectives

Luca¹,

Ortega-Castro

Patti

2021

Children

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“…Indeed, pwMS receiving DMTs are less likely to develop new MS symptom during COVID-19 compared to untreated patients ( 152 ). On the other hand, a possible “protective” effect of COVID-19 on relapse rate was suggested by Etemadifar and colleagues ( 153 ), who conducted a retrospective study on 125 relapsing-remitting pwMS, 56 of whom had laboratory confirmed SARS-CoV-2 infection. Only 7.14% of pwMS in the COVID-19 group experienced a clinical relapse compared with 26.09% of the non-COVID-19 group.…”

Section: Covid-19 and Sars-cov-2 Vaccines In People With Multiple Sclerosis: What We Knowmentioning

confidence: 99%

Multiple Sclerosis and SARS-CoV-2: Has the Interplay Started?

et al. 2021

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Current knowledge on Multiple Sclerosis (MS) etiopathogenesis encompasses complex interactions between the host’s genetic background and several environmental factors that result in dysimmunity against the central nervous system. An old-aged association exists between MS and viral infections, capable of triggering and sustaining neuroinflammation through direct and indirect mechanisms. The novel Coronavirus, SARS-CoV-2, has a remarkable, and still not fully understood, impact on the immune system: the occurrence and severity of both acute COVID-19 and post-infectious chronic illness (long COVID-19) largely depends on the host’s response to the infection, that echoes several aspects of MS pathobiology. Furthermore, other MS-associated viruses, such as the Epstein-Barr Virus (EBV) and Human Endogenous Retroviruses (HERVs), may enhance a mechanistic interplay with the novel Coronavirus, with the potential to interfere in MS natural history. Studies on COVID-19 in people with MS have helped clinicians in adjusting therapeutic strategies during the pandemic; similar efforts are being made for SARS-CoV-2 vaccination campaigns. In this Review, we look over 18 months of SARS-CoV-2 pandemic from the perspective of MS: we dissect neuroinflammatory and demyelinating mechanisms associated with COVID-19, summarize pathophysiological crossroads between MS and SARS-CoV-2 infection, and discuss present evidence on COVID-19 and its vaccination in people with MS.

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“…Early reports suggested that individuals with multiple sclerosis (MS) had an increased risk for a worse outcome after contracting COVID-19, based on certain disease characteristics and treatments [ 2 – 4 ] while other studies disputed these claims [ 5 – 7 ]. A recent study suggested no significant effects on MS relapse rates after COVID-19 infection [ 8 ]. Nonetheless, it is well recognized that in people without previous neurologic diseases, COVID-19 infection can cause a wide range of neurological complications affecting both the central and peripheral nervous system [ 9 – 17 ], including cases of new onset demyelinating disease or MS following COVID-19 infection [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 mRNA vaccination leading to CNS inflammation: a case series

et al. 2021

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The availability of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), provides hope towards mitigation of the coronavirus disease 2019 (COVID-19) pandemic. Vaccine safety and efficacy has not been established in individuals with chronic autoimmune diseases such as multiple sclerosis (MS). Anecdotal reports suggest that the vaccines may be associated with brain, spinal cord, peripheral nervous system, and cardiac inflammation. Based on the high morbidity and unpredictable course of COVID-19, and the need to achieve herd immunity, vaccination has been recommended for patients with MS. We report clinical and MRI features of seven individuals who received the Moderna ( n = 3) or Pfizer ( n = 4) SARS-CoV-2 mRNA vaccines. Within one to 21 days of either the first ( n = 2) or second ( n = 5) vaccine dose, these patients developed neurologic symptoms and MRI findings consistent with active CNS demyelination of the optic nerve, brain, and/or spinal cord. Symptoms included visual loss, dysmetria, gait instability, paresthesias, sphincter disturbance, and limb weakness. Age ranged from 24 to 64 (mean 39.1) years; five were woman (71.4%). The final diagnosis was exacerbation of known stable MS ( n = 4, two were receiving disease-modifying therapy at the time of vaccination), new onset MS ( n = 2), or new onset neuromyelitis optica ( n = 1). All responded to corticosteroid ( n = 7) or plasma exchange ( n = 1) therapy, with five returning to baseline and two approaching baseline. Large prospective studies are required to further investigate any possible relationship between COVID-19 vaccines and acute CNS demyelination.

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COVID-19 and the Risk of Relapse in Multiple Sclerosis Patients: A Fight with No Bystander Effect?

Cited by 47 publications

References 36 publications

Paediatric Multiple Sclerosis: A Scoping Review of Patients’ and Parents’ Perspectives

Paediatric Multiple Sclerosis: A Scoping Review of Patients’ and Parents’ Perspectives

Multiple Sclerosis and SARS-CoV-2: Has the Interplay Started?

COVID-19 mRNA vaccination leading to CNS inflammation: a case series

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