COVID-19 vaccine associated demyelination &amp; its association with MOG antibody

Netravathi, M; Dhamija, Kamakshi; Gupta, Manisha; Tamborska, Arina; Nalini, Atchayaram; Holla, Vikram V.; Nitish, L K; Menon, Deepak; Pal, Pramod; Seena, V; Yadav, Ravi; Ravindranadh, M; Arshad, Faheem; Saini, Jitendra; Mahadevan, Anita; Solomon, Tom; Singh, Bhagteshwar

doi:10.1016/j.msard.2022.103739

Cited by 40 publications

(41 citation statements)

References 29 publications

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“…Including the present case, 20 cases of newly emerging MOG-EM after vaccination against SARS-CoV-2 have been published so far [ 6 – 9 , 30 , 32 , 34 , 36 ] (Table 1 ), with the earliest report dating back to February 2021, i.e., not long after the onset of the vaccination campaign. The median age at onset of MOG-EM was 43.5 years (range 28–68), which is higher than that observed in previous adult cohorts that did not include SARS-CoV-2 vaccination-associated cases (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…The most commonly used therapy for acute attacks was high-dose intravenous methylprednisolone (IVMP) (mostly 1 g/day over 5 days, less often over 3 days), but escalatory treatment with plasma exchange (PLEX) was deemed necessary in nine patients. In some patients, several courses of IVMP were given or IVMP treatment was prolonged (1 × cumulative dose 11 g, followed by PLEX [ 7 ]; 1 × 7 g followed by PLEX [ 36 ]; 1 × 6 g [ 30 ]). Oral steroids (OS) were used at varying dosage in 15/20 (75%) patients (after IVMP in all cases), with dosages usually reduced gradually (depending on tapering strategies, over a period of up to 12 months).…”

Section: Resultsmentioning

confidence: 99%

“…In 11 further ChAdOx1 nCoV-19-vaccinated patients with different manifestations, improvement was considered “significant” (in 10) [ 36 ] or “good” (in one) [ 32 ]. All of these were treated with IVMP, nine in addition with oral corticosteroids, six in addition with PLEX, and one was treated with MMF in addition to IVMP and oral steroids.…”

Section: Resultsmentioning

confidence: 99%

“…However, as mentioned above, clinical and radiological features were compatible with MOG-EM in all cases and MOG-IgG titres were sufficiently high in most cases with available data not to cast substantial doubts on the diagnosis, remained detectable over time in those tested, and were determined by means of CBA in most patients (Table 1 ). If, taking a very strict stance, one excludes those cases in whom titres were not reported (1 × after BNT162b2) or titres were not classified as “strongly elevated” (4 × after ChAdOx1 nCoV-19 [ 36 ]), still 15 unequivocal cases of MOG-EM would remain. AQP4-IgG-positive NMOSD was excluded in 8/20 patients; the AQP4-IgG serostatus was not mentioned in the remainder.…”

Section: Resultsmentioning

confidence: 99%

“…Accordingly, acute disseminated encephalomyelitis (ADEM) is a frequent manifestation of MOG-EM, especially in children. In recent months, almost 20 cases of newly emerging MOG-EM have been reported in which the onset of disease was preceded by vaccination against the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) [ 6 – 9 , 30 , 32 , 34 , 36 ]. Here we report the first case of MOG-EM in a Caucasian patient after vaccination with the Pfizer-BioNTech COVID-19 mRNA vaccine BNT162b2.…”

Section: Introductionmentioning

confidence: 99%

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MOG encephalomyelitis after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2): case report and comprehensive review of the literature

et al. 2022

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Background In around 20% of cases, myelin oligodendrocyte glycoprotein (MOG) immunoglobulin (IgG)-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD) first occurs in a postinfectious or postvaccinal setting. Objective To report a case of MOG-EM with onset after vaccination with the Pfizer BioNTech COVID-19 mRNA vaccine BNT162b2 (Comirnaty®) and to provide a comprehensive review of the epidemiological, clinical, radiological, electrophysiological and laboratory features as well as treatment outcomes of all published patients with SARS-CoV-2 vaccination-associated new-onset MOG-EM. Methods Case report and review of the literature. Results In our patient, MOG-IgG-positive (serum 1:1000, mainly IgG1 and IgG2; CSF 1:2; MOG-specific antibody index < 4) unilateral optic neuritis (ON) occurred 10 days after booster vaccination with BNT162b2, which had been preceded by two immunizations with the vector-based Oxford AstraZeneca vaccine ChAdOx1-S/ChAdOx1-nCoV-19 (AZD1222). High-dose steroid treatment with oral tapering resulted in complete recovery. Overall, 20 cases of SARS-CoV2 vaccination-associated MOG-EM were analysed (median age at onset 43.5 years, range 28–68; female to male ratio = 1:1.2). All cases occurred in adults and almost all after immunization with ChAdOx1-S/ChAdOx1 nCoV-19 (median interval 13 days, range 7–32), mostly after the first dose. In 70% of patients, more than one CNS region (spinal cord, brainstem, supratentorial brain, optic nerve) was affected at onset, in contrast to a much lower rate in conventional MOG-EM in adults, in which isolated ON is predominant at onset and ADEM-like phenotypes are rare. The cerebrospinal fluid white cell count (WCC) exceeded 100 cells/μl in 5/14 (36%) patients with available data (median peak WCC 58 cells/μl in those with pleocytosis; range 6–720). Severe disease with tetraparesis, paraplegia, functional blindness, brainstem involvement and/or bladder/bowel dysfunction and a high lesion load was common, and treatment escalation with plasma exchange (N = 9) and/or prolonged IVMP therapy was required in 50% of cases. Complete or partial recovery was achieved in the majority of patients, but residual symptoms were significant in some. MOG-IgG remained detectable in 7/7 cases after 3 or 6 months. Conclusions MOG-EM with postvaccinal onset was mostly observed after vaccination with ChAdOx1-S/ChAdOx1 nCoV-19. Attack severity was often high at onset. Escalation of immunotherapy was frequently required. MOG-IgG persisted in the long term.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

MOG encephalomyelitis after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2): case report and comprehensive review of the literature

et al. 2022

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Evaluation of the safety profile of COVID-19 vaccines in patients with MS, NMOSD, and MOGAD

Kim

Seok

2023

Neurol Sci

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Introduction Vaccination against the coronavirus disease 2019 (COVID-19) is recommended for patients with multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). However, vaccine safety in these patients taking immunotherapeutic agents is unclear as they were not included in the vaccine trials. Objectives To evaluate the safety of COVID-19 vaccines in patients with MS, NMOSD, and MOGAD. Methods We reviewed the medical records of MS, NMOSD, and MOGAD patients at the Keimyung University Dongsan Hospital. Information regarding vaccination schedules and adverse events was collected. Results A total of 56 patients (19, 22, and 15 patients with MS, NMOSD, and MOGAD, respectively) with a median age of 48.18 ± 15.72 years (range, 16–81 years) were included. Of them, 42 (75.0%) were female. In total, 76.8% (43/56) of all patients were vaccinated, and the vaccination rate was the highest for NMOSD patients (81.8%) and the lowest for MS patients (68.4%). All vaccinated patients were administered mRNA vaccines at least once in single or multiple vaccination doses. Only 3 of 43 (7.0%) vaccinated patients experienced clinical relapse following vaccination. Facial sensory changes with a brainstem lesion developed in an MS patient taking dimethyl fumarate, while myelitis occurred in a MOGAD patient receiving azathioprine maintenance therapy. The first episode of optic neuritis occurred in a patient who was later diagnosed with MOGAD. Conclusions Our study demonstrated a favorable safety profile with no serious adverse events associated with COVID-19 vaccines in patients with MS, NMOSD, and MOGAD.

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Risk and characteristics of Bell’s palsy in adults as an adverse event following COVID-19 vaccination: a retrospective study

et al. 2023

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Background Although an association between COVID-19 vaccination and Bell’s palsy (BP) has been reported, a clear causal relationship has not been elucidated. We investigated the risk and clinical characteristics of BP after COVID-19 vaccination. Methods This retrospective chart review evaluated the association between COVID-19 vaccination and BP by comparing the number of patients diagnosed with BP during the pre-COVID-19 vaccination period (March 2018–February 2021) and the COVID-19 mass vaccination period (March 2021–February 2022). We then compared vaccine-related (time between vaccination and BP onset < 42 days) and -unrelated (time interval ≥ 42 days or non-vaccination) clinical characteristics in newly diagnosed patients with BP. Results BP occurred more during the COVID-19 vaccination period than in the previous three pre-vaccination years. Thirteen patients developed BP within 42 days of vaccination. All patients, except one, developed BP after mRNA-based vaccination, with most cases (9/13, 69.2%) occurring after the second or third dose. Thirteen patients with vaccine-related BP were younger (age 43.92 ± 13.14 vs. 54.32 ± 16.01 years; p = 0.033) and more frequently experienced taste changes (58.8% vs. 10.9%; p = 0.002) than 52 patients with vaccine-unrelated BP. Patients with vaccine-related BP had a greater likelihood of good and faster ( p = 0.042) facial nerve function recovery than those with vaccine-unrelated BP (100% vs. 78%). Conclusion COVID-19 vaccines, especially mRNA-based vaccines, may be associated with BP cases with distinctive clinical characteristics, which occur more frequently in young individuals, are frequently accompanied by taste changes, and have fast and good recovery.

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COVID-19 vaccine associated demyelination & its association with MOG antibody

Cited by 40 publications

References 29 publications

MOG encephalomyelitis after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2): case report and comprehensive review of the literature

MOG encephalomyelitis after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2): case report and comprehensive review of the literature

Evaluation of the safety profile of COVID-19 vaccines in patients with MS, NMOSD, and MOGAD

Risk and characteristics of Bell’s palsy in adults as an adverse event following COVID-19 vaccination: a retrospective study

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