Despite the Covid-19 Pandemic, People With Chronic Neurological Disease (Multiple Sclerosis) are Trying to Maintain Physical Activity

Multiple sclerosis (MS) is a chronic autoimmune neurodegenerative disease. This disease can manifest itself in many different neurological symptoms such as (gait and balance impairment, sensory deficits, muscle weakness, spasticity, bladder impairment, fatigue, cognitive impairment etc.). For successful disease management not only pharmacological treatment is important, but also a healthy lifestyle including regular physical activity. However, pandemic restrictions limited access to sport facilities and together with home-office regimen, increased the sedentary behaviour in all population. The pandemic level of physical activity in people with MS in the Czech Republic remains unclear. Therefore, using an online cross-sectional survey we aimed to evaluate physical activity (PA) level in people with MS during Covid-19 pandemic. Two hundred ninety-seven persons with MS filled out online survey, 83 % women, with a mean age 43.7 years (SD 11.3). Most respondents had mild to moderate disability (74 %). During pandemic year 2020, 23 % persons with MS ceased their PA, 18 % reduced their PA, 25 % continued their PA as before, 11 % increased their PA, and 20 % did not perform any PA in the past and did not do so during the pandemic. Aerobic activity was the main type of performed PA, followed by health exercise and yoga. Total of 37 % people reported that their fitness level had decreased during the pandemic. © Masaryk University. All Rights Reserved.

Immunity following SARS-CoV-2 vaccination in autoimmune neurological disorders treated with rituximab or ocrelizumab

Introduction: B cell-depleting therapy targeting CD20 molecule with rituximab (RTX) or ocrelizumab (OCR) affects humoral immune response after vaccination. It remains unclear whether these therapies influence T-cell-mediated immune response against SARS-CoV-2 after immunization. Aim(s): We aimed to evaluate the humoral and cellular immune response to the COVID-19 vaccine in a cohort of patients with multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myasthenia gravis (MG). Method(s): Patients with MS (83), NMOSD (19), MG (7) under RTX (n=47) or OCR treatment (n=62) were vaccinated twice with mRNA BNT162b2 vaccine. Antibodies were quantified using the SARS-CoV-2- IgG chemiluminescence immunoassay targeting the spike protein. SARS-CoV-2-specific T-cell responses were quantified by interferon gamma release assays (IGRA). Immunocompetent vaccinated individuals (n=41) were included as controls. Result(s): Almost all immunocompetent controls developed antibodies against the SARS-CoV-2 trimeric spike protein, but only 42.05% of the patients under anti-CD20 (RTX or OCR) treatment seroconverted. There was no correlation between circulating B cells and the levels of antibodies. Even patients with a low proportion of circulating CD19+ B cells (<1%, 71 patients) had detectable SARS-CoV-2 specific antibody responses. This response was even higher in patients with longer than 3 weeks intervals of vaccination. SARS-CoV-2 specific T cell response measured by released interferon gamma was detected in 94.39% of the patients, independently of a humoral immune response. Conclusion(s): The majority of MS and NMOSD patients developed SARS-CoV-2-specific T cell response. The data suggest that vaccination can induce SARS-CoV-2-specific antibodies in a part of anti-CD20 treated patients. The response represented by levels of antibodies was better in individuals, who completed vaccination within more than 3 weeks.

Older patients with multiple sclerosis have greater enlargement of the brain ventricles following COVID-19

Introduction: The effect of COVID-19 on brain pathology in multiple sclerosis patients is currently unknown. Objective(s):To describe changes in brain lesion activity as well as brain and spinal cord volumes following COVID-19. Method(s): We included 181 MS patients (McDonald 2017 criteria) with available MRI scans (N=650) before (#scans>=2) and after (>=1) COVID-19. All patients were clinically stable (no relapsing activity or disability progression), did not received highdose steroids, and did not change treatment status. All patients were scanned on a single 3T scanner (MAGNETOM Skyra, Siemens Healthcare, Erlangen, Germany). Brain MRI activity was assessed manually by neuroradiologist using automatic subtraction. Global and regional brain volumes were evaluated using the MorphoBox prototype software, and the mean upper cervical cord area (MUCCA) was assessed using ScanView software. Linear mixed models (with random intercept for patient) adjusted for sex age, disease duration, Expanded Disability Status Scale (EDSS), treatment status at infection, severity of COVID-19, and use of anti-covid treatment were used to analyze the difference in MRI measures before and after COVID-19. Result(s): The sample consisted of 75.7% of women, the mean duration of the age was 45.5 years, the mean disease was 15.1 years, and median EDSS was 2.0 (range 0-6.5). A total of 7.2% patients had not immunomodulatory treatment, 39.8% were on platform, 37.0% were on oral, and 16.0% were on high-efficiency monoclonal antibody immunomodulatory therapy. Together, 3.3% of the patients were asymptomatic, 82.3% had a mild infection, 14.4% had suspected or confirmed pneumonia. Patients with a higher age had a greater enlargement of the total ventricle volume (interaction age vs. COVID-19: b=0.0029;p=0.0027), right and left lateral ventricles (b=0.0012-0.0013;p=0.0069-0.0015), third ventricle (b=0.0002;p=0.027) and a greater reduction of mesencephalon volume (b=-0.0004;p=0.013) following the infection. In eleven patients on anti-CD20 treatment we found reduction of normalized white matter (b=-0.58;p=0.044) and hippocampal white matter volume (b=-1.73;p=0.0063). The brain lesion activity (occurrence of new and enlarging T2 lesions) was not influenced by the infection. Conclusion(s): Older MS patients had greater enlargement of brain ventricles after COVID-19. We did not find clear changes in lesion activity or brain tissue volumes following the infection.

COVID-19 in multiple sclerosis and neuromyelitis optica spectrum disorder-The Czech experience

Background and aims: 1 of the countries with the highest number of COVID-19 infected people per capita is the Czech Republic. The aim of this study is to evaluate the incidence, severity and outcome of SARS-CoV-2 infected multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients. Methods: From March 2020, Czech MS Centres were requested to report COVID-19 laboratory-confirmed MS/ NMOSD patients. Data on demographics, MS type, history and severity, disease-modifying treatment (DMT), comorbidities and COVID-19 severity were obtained. Results: We identified 428 (422 MS,six NMOSD;mean age 43.5;mean EDSS 2.8, median EDSS 2) laboratoryconfirmed patients (PCR 92.5%;Antigen Rapid Test 0.9%, serology 7.5 %) with COVID-19 onset between March 16 and December 31. Mild COVID-19 course (no pneumonia) had 392 patients, more severe course 30 patients (5 deaths),six unknown course. Patients with more severe COVID-19 infection relative to patients with mild COVID © 19 course were older (mean 53.8 years vs 42.7 years), had higher EDSS (mean 4.3, median 4 vs mean 2.6, median 2) and had more frequent at least one comorbidity (50.3% vs 19.4 %). There was also a higher proportion of patients without DMT (40% vs 13.8%) and on anti-CD20 therapies (23.3% vs 8.2%) in more severe vs mild COVID-19 infection patients. Conclusion: Majority of patients with MS had mild COVID-19 course. In the patients with more severe COVID-19 course, there was a higher proportion of patients without DMD, on anti-CD20 therapy, with higher degree of disability, with presence of comorbidities and in older age.