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Introduction: Since the declaration of COVID-19 pandemic, several cases of demyelination of both peripheral and central nervous systems have been reported. The association of viral infection and the development of CNS demyelination has long been studied, and this link has recently been reported following SARS-CoV-2 infection as well. Case report: We report a case of a 36-year-old male who developed CNS demyelinating disease, that fulfilled the diagnostic criteria of multiple sclerosis (MS), 2 months after laboratory-confirmed infection with SARS-CoV-2. Conclusion(s): To our knowledge, this is the second published case report of MS in association with COVID-19 infection, and the first case from Middle East and North Africa (MENA) region, adding to the growing literature of a probable causal relationship between SARS-CoV-2 infection and the development of MS.Copyright © 2021 The Author(s)
ABSTRACT
Introduction: Since the declaration of COVID-19 pandemic, several cases of demyelination of both peripheral and central nervous systems have been reported. The association of viral infection and the development of CNS demyelination has long been studied, and this link has recently been reported following SARS-CoV-2 infection as well. Material(s) and Method(s): We report a case of a 36-year-old male who developed CNS demyelinating disease, that fulfilled the diagnostic criteria of multiple sclerosis (MS), 2 months after laboratory-confirmed infection with SARS-CoV-2. Result(s): A 36-year-old male developed CNS demyelination, 2-months following a laboratory-confirmed SARS-CoV-2 infection, that fulfilled the revised 2017 McDonald diagnostic criteria for MS. He presented with ataxia, and MRI showed multiple demyelinating lesions in the brain, and positive oligoclonal bands in CSF. Conclusion(s): To our knowledge, this is the second case report of MS in association with COVID-19 infection, and the first case from Middle East and North Africa (MENA) region. This case report adds to the growing body of evidence of a probable causal relationship between SARS‐CoV‐2 infection and the development of MS. SARS-CoV-2 could potentially trigger a demyelinating process, through an acute or delayed immune-mediated CNS inflammatory response.
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Background: Two vaccine (BNT162b2 and ChAdOx1 nCoV-19) have been approved to be used in Kuwait since December 2021 Objective: To assess the safety of the vaccination in MS patients and to determine the occurrence of relapses following COVID-19 vaccination in MS patients. Material(s) and Method(s): MS patients were contacted by phone, WhatsApp, or through face-to-face interview and were invited to complete a web-based questionnaire. Demographic, clinical, medications, administration of first and second vaccine doses, symptoms following vaccine, worsening of preexisting MS symptoms and occurrence of relapse were recorded. Result(s): 482 MS patients answered the web-based questionnaire. Between January 2021 and 20 May 2021, 240 (49.8%) MS patients received at least one dose of the approved vaccination. Their mean age was 37.27 +8.95 and most of them 146 (60.8%) were females. 159 received first dose and 81 received the second dose. 126 revived BNT162b2 vaccine and 114 received ChAdOx1 nCoV-19. There was one case of COVID-19 infection encountered after the first dose of BNT162b2 vaccine. Nine cases reported worsening of preexisting MS symptoms after vaccine. One patient reported relapse after first BNT162b2 vaccine dose. The most common adverse events of COVID-19 vaccine were pain at the injection site, fatigue, low grade fever and body ache. 28 Patients on anti CD20 needed to postpone vaccine or reschedule their medications. Conclusion(s): Both BNT162b2 and ChAdOx1 nCoV-19 are safe for MS patients. There is no increased risk of relapse activity or worsening of preexisting MS symptoms were recorded.
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Objective(s): To evaluate the incidence, severity, and outcomes of coronavirus disease (COVID-19) and to identify demographic and clinical risk factors in patients with multiple sclerosis (MS). Material(s) and Method(s): A cross-sectional hospital records-based study was conducted on MS patients from clinics in Oman, Kuwait, and the United Arab Emirates (UAE) between March 2020 and February 2021. Patients diagnosed with MS using the 2010 McDonald criteria or previously accepted diagnostic criteria and with a positive diagnosis of COVID-19 were included in the study. Association between patient demographics, disease characteristics, use of disease-modifying therapies, and outcome of COVID-19 illness was evaluated statistically using an odds ratio estimation. Result(s): A total of 134 MS patients with COVID-19 (overall incidence rate of 3.7%) were analyzed in the study (116 with relapsing-remitting MS [RRMS], 11 with progressive MS;and 7 with clinically isolated MS). The median age of patients was 35.5 years. Of the total cohort, 127 (94.8%) patients were on disease-modifying therapy (DMT). A majority of the patients (126 [94.0%]) had mild COVID 19 illness and 122 (91.0%) made a full recovery while 1 (0.7%) patient died. A total of 8 patients (6.0%) were hospitalized;3 (2.2%) required intensive care, while 2 (1.5%) reported ventilator requirement. The mean EDSS scores reported in the study were low (1.74) with 127 (94.8%) reporting a score between 0 – 4.5. Univariate logistic regression analysis identified a high EDSS score and progressive MS disease as a risk factor for moderate to severe COVID-19 requiring hospitalization. Rituximab use and anti CD20 therapy were also associated with a statistically significant higher risk of developing moderate/severe COVID-19. The presence of comorbidities was associated with a higher risk of non-recovery from the viral infection in both univariate and multivariate analyses. Conclusion(s): COVID-19 showed an incidence rate of 3.7% in the studied cohort of MS patients. The disease course and outcomes were mostly favorable with most patients not requiring hospitalization. A higher EDSS score, progressive disease, use of rituximab, and use of antiCD20 therapy were associated with statistically significant increased risk of developing moderate/severe COVID-19, while the presence of comorbidities was associated with a higher risk of non-recovery from COVID-19. Age, sex, smoking history, and duration of MS were not independent risk factors for increased severity or adverse COVID-19 disease outcomes.
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Objective: Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy that is often related to a previous infectious exposure. GBS emerged as a potentially serious complication of coronavirus disease 2019 (COVID-19) since its declaration as a global pandemic. We report the first case from Kuwait, to the best of our knowledge. Clinical Presentation: A 72-year-old male presented with 3 weeks history of acute progressive and ascending lower limbs weakness. He developed these symptoms 3 weeks after testing positive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electrophysiological studies showed acute demyelinating polyradiculoneuropathy and cerebrospinal fluid showed protein-cell dissociation. He was successfully treated with intravenous immunoglobulins (IVIGs). Conclusion: Neurologists should be aware of GBS as a potentially serious complication associated with CO-VID-19. Our patient had a favorable outcome with IVIG with no autonomic or respiratory affection.