The Significance of COVID-19 Immunological Status in Severe Neurological Complications and Multiple Sclerosis—A Literature Review

Abstract

SARS-CoV-2/Coronavirus 2019 (COVID-19) is responsible for the pandemic, which started in December 2019. In addition to the typical respiratory symptoms, this virus also causes other severe complications, including neurological ones. In diagnostics, serological and polymerase chain reaction tests are useful not only in detecting past infections but can also predict the response to vaccination. It is now believed that an immune mechanism rather than direct viral neuroinvasion is responsible for neurological symptoms. For this reason, it is important to assess the presence of antibodies not only in the serum but also in the cerebrospinal fluid (CSF), especially in the case of neuro-COVID. A particular group of patients are people with multiple sclerosis (MS) whose disease-modifying drugs weaken the immune system and lead to an unpredictable serological response to SARS-CoV-2 infection. Based on available data, the article summarizes the current serological information concerning COVID-19 in CSF in patients with severe neurological complications and in those with MS.

Multiple Sclerosis Patients and Disease Modifying Therapies: Impact on Immune Responses against COVID-19 and SARS-CoV-2 Vaccination

“…It is demonstrated that some DMTs can affect production of anti-SARS-CoV-2 antibodies upon infection in MS patients. According to some studies, MS patients who received anti-CD20 therapy (like ocrelizumab) showed reduction in the immunoglobulin production resulting in low or zero IgG antibody titers, but patients treated with teriflunomide, glatiramer acetate, dimethyl fumarate, and natalizumab showed IgG seroconversion [21,47,61]. Regarding ocrelizumab, there is a contradictory study indicating that patients suffering from COVID-19 and under ocrelizumab therapy had an IgG level within the normal range [57].…”

SARS-CoV-2 infection in multiple sclerosis patients: interaction with treatments, adjuvant therapies, and vaccines against COVID-19

“…After recovery from SARS-CoV-2 infection, the next question posed about pwMS is whether they will be able to generate a detectable neutralizing antibody titer, which can prevent reinfection [ 106 ]. There are already some reports, although limited, on certain DMTs affecting seroconversion after SARS-CoV-2 infection, in pwMS [ 106 , 107 ]. In general, the administration of IFN-β has been significantly associated with the presence of antibodies against SARS-CoV-2, after infection with the virus [ 108 ].…”

“…Another possibility is that SARS-CoV-2 can cross the BBB through vascular endothelial cells and directly access the brain [ 198 , 203 ]. However, other authors state that the mechanism responsible for the development of NEURO-COVID is an immunological mechanism rather than a direct neuroinvasion [ 107 , 204 ]. We have already described that SARS-CoV-2 can interfere with the clinical course of MS, also exhibiting a long-term latency potential [ 96 , 205 ], which could trigger disease exacerbations in pwMS that have recovered from COVID-19 [ 96 ].…”

Analysis of the correlation between Guillain-Barré and post-COVID-19 syndromes

“…The review by Kulikowska et al (2021), brings a comparison between the presentations of GBS before and after the beginning of the pandemic, elucidating the point of a difference observed in this aspect: before antiganglioside antibodies were present in a varied way in about 88% of the forms of the syndrome, with highlighting anti-GM1 in typical GBS and anti-GQ1b for the Miller-Fisher variant. However, studies of GBS…”