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

Abstract

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.

Clinical Research into Central Nervous System Inflammatory Demyelinating Diseases Related to COVID-19 Vaccines

“…ADEM is primarily regarded as a post-infectious disease, whereas vaccine-related ADEM is a rare condition. According to a prior systematic review, determining the incidence of CNS IDDs in confirmed COVID-19 infections posed challenges [ 12 ]. In the Taiwan Centers for Disease Control and Prevention (CDC) reporting system, it is also not possible to obtain the exact incidence of CNS IDD after COVID infection.…”

“…In the Taiwan Centers for Disease Control and Prevention (CDC) reporting system, it is also not possible to obtain the exact incidence of CNS IDD after COVID infection. Furthermore, there is a need for clarification regarding the severity and treatment response of CNS IDDs following COVID-19 infection compared to those without the virus [ 12 ]. It has been published that <5% of ADEM cases are related to vaccination for diseases such as rabies, measles, mumps, smallpox, or Japanese B encephalitis [ 13 ].…”

SARS-CoV-2 pandemic as a model to assess the relationship between intercurrent viral infections and disease activity in Multiple Sclerosis: A propensity score matched case-control study

“…A few previous studies have investigated the relationship between SARS-CoV-2 infection and risk of new demyelinating events, or between SARS-CoV-2 infection and risk of clinical relapses in patients with MS. ( Verstrepen et al, 2020 , Yavari et al, 2020 , Corrêa et al, 2021 , Zhang et al, 2021 , Etemadifar et al, 2021 , Barzegar et al, 2021 , Garjani et al, 2021 , Michelena et al, 2022 , Ismail and Salama, 2022 , Etemadifar et al, 2022 , Bsteh et al, 2022 , Babtain et al, 2022 , Conway et al, 2022 , Kim et al, 2022 , Lotan et al, 2022 ) Many published studies were however limited to small case series, often lacked a matched control group, and did not include MRI data.…”

Different HLA genotype pattern in patients with Multiple Sclerosis onset after COVID-19 vaccine.

“…Few cases of typical onset of MS during or post COVID-19 have been reported as well, even though the evidence is insu cient to establish a causative role of the SARS-CoV-2 virus [10][11][12][13][14].…”