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1.
Multiple Sclerosis Journal ; 28(3 Supplement):133-134, 2022.
Article in English | EMBASE | ID: covidwho-2138894

ABSTRACT

Neuromyelitis optica spectrum disorders (NMOSD) is an immunemediated inflammatory disorder of the central nervous system. SARS-CoV-2 infections not only affect the lungs but generally all organs including the central nervous system. The underlying pathophysiology for SARS-CoV-2 associated CNS disease is suspected to be immunogenic. Therefore, the question is whether COVID-19 can trigger relapses in NMOSD patients. On the other hand, there have been reports that COVID-19 vaccination may trigger a relapse. The aim of our study was to assess the risk of NMOSD relpase after SARS-CoV-2 infection or after vaccination. Department of Neurology Medical University of Warsaw is a reference center for treatment of NMOSD patients in Poland. Nowadays we are taking care on seventy-five patients meeting NMOSD diagnostic criteria. As of March 31, 2022, we registered 47 SARS-CoV-2 infections. Twenty-two SARS-CoV-2 infections were reported in patients prior to COVID-19 vaccination (19 females, 3 males). Mean age of patients was 49+/-10 years, mean EDSS 4.5+/-1.5. Twenty (90.9%) patients were on immunosuppressive therapy (rituximab -11, steroids-4, inebilizumab -2, azathioprine -1, satralizumab -1, mycophenolate mofetil -1). Twenty-five SARS-CoV-2 infections occurred after the full course of vaccination (23 females, 2 males). Mean age of patients was 50+/-12 years, mean EDSS 3.6+/-1.7. Twenty-three (92%) patients were on immunosuppressive therapy (rituximab - 12, inebilizumab - 1, azathioprine - 3, satralizumab - 3, mycophenolate mofetil - 4). Three patients had a relapse after COVID-19 (within three months). Two of these people were still unvaccinated at the time. These patients were not receiving full immunosuppressive treatment at the time (one patient developed COVID-19 right after the first dose of rituximab, the other patient received the last dose of rituximab 18 months earlier). The third patient was treated with rituximab and was fully vaccinated. NMOSD relapse occurred in 6% of patients confirmed with COVID-19. Thee risk of relapse was even lower (2%) among patients properly treated with immunosuppressants. Of our seventy-five patients, only two were not vaccinated against SARS-CoV-2. All patients receivedmRNA SARS-CoV-2 vaccines. No vaccine-related NMOSD attack has been reported. Conclusion(s): Patients with NMOSD treated with immunosuppressants have a low risk of a relapse due to COVID-19 infection. In our study mRNA COVID-19 vaccines do not increase the risk of a relapse.

2.
Multiple Sclerosis Journal ; 28(3 Supplement):934-935, 2022.
Article in English | EMBASE | ID: covidwho-2138811

ABSTRACT

Background: Viral infections are thought proposed as a possible cause of 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 two years, CNS demyelinating events associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, but causality is unclear. Objective(s): To investigate the relationship between CNS demyelinating disease development with antecedent and/or concurrent COVID-19 infection. Method(s): A systematic literature review of all publications describing either a new disease onset 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. Result(s): Fifty articles were meet inclusion criteria for the study. Most of the reported cases ofNMOSD (n=10., 66.7% of reported cases)and MOGAD (n=12, 92% 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=11, 13% of reported cases), relapses (n=48, 56.5%) and pseudo-relapses (n=26, 30.5%). Median duration between COVID-19 infection and demyelinating event onset was 9 days (range 0-30 days) in NMOSD, 4 days (range-7-+21 days) in MOGAD, and 13.5 days (range-21-+180 days) in MS. Most cases received high-dose corticosteroids with a good clinical outcome. Conclusion(s): Based upon available literature, the rate of CNS demyelinating events occurring in the setting of preceding or concurrent SARS-CoV-2 infection is relatively low given the prevalence of infection. The clinical outcome of new-onset or relapsing MS, NMOSD or MOGAD associated with antecedent or concurrent infection is mostly favorable. Larger prospective epidemiological studies are needed to better delineate the impact of COVID-19 on CNS demyelinating diseases.

3.
NeuroQuantology ; 20(10):2908-2915, 2022.
Article in English | EMBASE | ID: covidwho-2033475

ABSTRACT

Background: A severe antibody-mediated inflammatory demyelinating disease of the central nervous system is neuromyelitis optica spectrum disorder (NMOSD). Azathioprine (AZA) and Rituximab (RTX) were used to treat NMO-SD patients though not FDA approved yet. Aim of the study: To compare the effectiveness and safety of rituximab treatment versus azathioprine in treating individuals with NMOSDs. Methods: Seventy four Egyptian individuals with NMOSDs in this retrospective observational study and collecting their medical records from multiple sclerosis (MS) clinics, Neurology Departments, El-Maadi Military Hospital, and Cairo University hospitals. Fourty four patients received either treatment over two year duration, Group 1 (rituximab group) consisted of 19 patients, while group 2 (azathioprine group) consisted of 25 patients. Their full medical history, general and neurological examination, MRI brain and spinal cord results, and laboratory investigation were collected including immune assays and AQP-4 antibody. Results: There was no statistically significant difference between the groups in terms of brain MRI data at the baseline and outcomes. Between the two groups, there were statistically significant differences in last observer spinal MRI (p=0.025), annual relapse rate before treatment with RTX group (P=0.021), EDSS pretreatment (p=0.005), annual relapse rate post-treatment. When it came to the number of relapses after treatment, there was a high statistically significant difference between the two groups (p=0.016), with group 1 (RTX group) having zero relapses. There was a statistically significant decrease comparing EDDS scores pre-and post-treatment regarding the RTX group (p=0.003). Adverse events were Infusion rate reaction (5.3%) and pneumonic COVID (9.5%) of patients. Conclusion: RTX is more helpful and less harmful for NMO-SD patients than AZA.

4.
Journal of the Formosan Medical Association ; 121(9):1617-1621, 2022.
Article in English | Scopus | ID: covidwho-2015654
5.
Multiple Sclerosis and Related Disorders ; 59, 2022.
Article in English | EMBASE | ID: covidwho-2004362

ABSTRACT

Background: Coronavirus 2019 (COVID19) is a new coronavirus which has created a pandemic since early 2020. Neuromyelitis Optica Spectrum Disorder (NMOSD) patients are more affected by psychological effects of COVID19 pandemic such as anxiety and fear because they may be worried about being infected by COVID19 (due to the nature of disease and treatment by immunosuppressant drugs) and also they are concerned about their treatment protocol and disease relapses during the pandemic. Material(s) and Method(s): The aim of study was to evaluate the anxiety due to COVID19 infection, 3 and 12 months after beginning of epidemic in Iran.The study was performed in patients of NMOSD Cohort Clinic of Kashani hospital, Isfahan. We first asked individuals if they were anxious or afraid of the pandemic subjectively. To investigate the objective level of anxiety, Hospital Anxiety and Depression Scale (HADS-A) questionnaire was filled. Moreover, we asked them about respecting general cautions and sanitary protocols to prevent COVID19 infection. Result(s): Study included 120 patients (96 female) with mean age of 36.37±9.69 and mean duration of disease about 8.49±5.35 years. A total of 96 cases (80%) experienced anxiety during the first 3 months of pandemic. The point is that their level of anxiety decreased significantly with the prolongation of pandemic after 9 months and just 66 patients (55%) showed anxiety subjectively on the second survey. Based on HADS-A score, 92 patients (76.66%) were anxious on the third month while after one year of epidemic 70 cases (58.33%) showed anxiety. Respecting preventive measures increased in the same period. Conclusion(s): Along with the COVID19 pandemic prolongation, the level of anxiety had decreased gradually while the level of alertness and attention was almost high. It should be considered that this awareness must be preserved till the end of pandemic.

6.
Clinical and Experimental Neuroimmunology ; 2022.
Article in English | EMBASE | ID: covidwho-1968077

ABSTRACT

Various effective monoclonal antibodies (mAbs) have been approved for both multiple sclerosis (MS) and anti-aquaporin-4-seropositive neuromyelitis optica spectrum disorders worldwide, including in Japan. As these newer mAbs have distinct modes of action that effectively suppress the recurrence of inflammation and slow disability progression, they can modulate and interfere with the protective immune response against pathogens, resulting in various infectious complications. Among various mAbs, natalizumab (NTZ) has the highest risk of causing progressive multifocal leukoencephalopathy (PML), a rare but fatal opportunistic brain infection caused by John Cunningham polyomavirus. Switching from NTZ to B-cell-depleting mAbs, such as ocrelizumab, is also a possible risk factor for PML development. Alemtuzumab carries the risk of reactivation of varicella-zoster virus (VZV);therefore, prophylactic acyclovir treatment is required. NTZ has also been associated with VZV reactivation. Eculizumab can cause severe meningococcal infection due to Neisseria meningitis, and vaccination prior to treatment induction is required. Attention to the reactivation of hepatitis B or Mycobacterium tuberculosis is also needed during mAb therapy. Additionally, in the era of severe acute respiratory syndrome coronavirus 2 infection (COVID-19), the risk for of developing severe COVID-19 may be associated with some mAbs, such as B-cell-depleting agents. Thorough understanding and mitigation strategies for infectious risks are essential.

7.
Chinese Journal of Neurology ; 55(4):289-299, 2022.
Article in Chinese | EMBASE | ID: covidwho-1939082

ABSTRACT

Coronavirus disease 2019 (COVID‑19) caused by 2019 novel coronavirus (2019‑nCoV), has constituted a major worldwide public health event. At present, vaccination against COVID‑19 is being actively promoted in order to establish a population immune barrier. Here consensus guidance is given on the safety and efficacy of COVID‑19 vaccination in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Overall, the risk of 2019‑nCoV infection in MS or NMOSD patients is not increased than that in the general population. The existing vaccines against COVID‑19 do not cause vaccine‑derived infection in patients receiving any immune interventions, although the effectiveness of vaccine may be reduced in some cases (such as the use of sphingosine‑1‑phosphate receptor modulator or B‑cell depletion agent). There is no sufficient evidence that vaccination will aggravate MS or NMOSD, or directly lead to disease recurrence. Therefore, after fully informed consent and pre‑assessment of vaccination‑related risk, it should be recommended that MS and NMOSD patients with stable disease control be vaccinated against COVID‑19.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925542

ABSTRACT

Objective: To determine the optimal time for SARS-CoV-2 mRNA vaccination, after infusion with anti-CD20 therapy, in patients with multiple sclerosis and neuromyelitis optica spectrum disorder (MS/NMOSD) as there are currently no guidelines. Background: To achieve adequate immunity against SARS-CoV-2, mRNA vaccines (BNT162b2 or mRNA-1273) stimulate B and T cells. Therefore, it is imperative to ensure MS/NMOSD patients on anti-CD20 therapy have enough B cells to produce antibodies at the time of vaccination. Design/Methods: This was a retrospective study at Rutgers New Jersey Medical School, Newark. We identified all MS/NMOSD patients on anti-CD20 therapy (Ocrelizumab or Rituximab) who received a SARS-CoV-2 mRNA vaccine. Some of these patients were not on the standard, biannual dosing schedule due to treatment guideline modifications made during the pandemic. Antibody response to the SARS-CoV-2 spike protein was checked at least 4 weeks after the second dose of the vaccine. Results: We analyzed 23 vaccinated MS/NMOSD patients on anti-CD20 therapy (87% on Ocrelizumab and 13% on Rituximab). Patients were divided into two groups: those who developed antibodies after vaccination (52%) and those who did not (48%). There was no significant difference between the two groups in age, gender, MS type, expanded disability status scale, type of anti-CD20 therapy, and brand of vaccine. However, there was statistical significance in the interval between infusion and vaccination between the groups (p-value -0.03;9.2±3.9 vs 6.2±3.1months). Additionally, none of these patients had a relapse. Conclusions: The mean interval between infusion and vaccination was 9.2 months in those that developed antibodies and 6.2 months in those that did not. Patients on anti-CD20 therapy may mount an immune response when vaccinated if the time between infusion and vaccination is extended beyond 6 months. The main limitation of this study was the variable timing in the collection of CD19 counts.

9.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925535

ABSTRACT

Objective: To assess symptoms, severity, outcome of Covid 9 in Multiple sclerosis patients ( including NeuroMyelitis Optica )and to assess the prognostic factors for severe Covid19 Background: Covid 19 pandemic came with its own challenges of novelty, lack of information uncertainty of treatment and its effect on chronic autoimmune diseases like Multiple sclerosis. The outcome of covid 19 with immunosuppressive and immunomodulatory treatment in multiple sclerosis was not known till this year. We share our observation of multiple sclerosis patients including neuromyelitis optics who contracted Covid 19 in Dubai UAE, during April 2020 to Sep 2021 in 2 major hospitals treating multiple sclerosis. Design/Methods: All Multiple sclerosis Patients following in Rashid hospital and Alzahra Hospital Neurology apartment who had Covid 19 were included in this observational study. Results: 55 MS patient with Covid 19 ( including 2 NMO) were studied. Age of the patients ranged from 19 to 58years. There were 39 females and 16 males. 43 were RRMS, 6 -SPMS,4- CIS, 1- PPMS and 2 NMOSD. 6 were on interferons, 2 on teriflunamide, 8 on dimethylfumarate, 12 on fingolimod, 3 on natalizumab, 1 on alemtuzumab, 1 on rituximab, 9 on cladribine, 12 on ocrelizumab and 1 on azathioprine. 47 had fever, 30 anosmia, 28 had fatigue and 42 had sorethroat and cough, 5/55 had pneumonia.39/55 had mild covid, 13/55 had moderate and 3 had severe covid 19. 3/55 needed ICU. There were 2 deaths, first with MS, EDSS 6.5 on ocrelizumab and second with NMO (EDSS 7.0)on rituximab Conclusions: The disease course and outcomes were mostly favorable with most patients not requiring hospitalization. A higher EDSS score, progressive disease, use of rituximab, and ocrelizumab(antiCD20 therapy) were associated with the mortality encountered. Age, sex, smoking history, and duration of MS were not independent risk factors for increased severity or adverse COVID-19 disease outcomes.

10.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925398

ABSTRACT

Objective: To describe, to the best of our knowledge, the first case of myelin oligodendrocyte glycoprotein (MOG) antibody syndrome associated with the Moderna COVID-19 mRNA vaccine, and a case of acute transverse myelitis (ATM) associated with the Pfizer COVID-19 mRNA vaccine. Background: Post-vaccination CNS demyelinating syndromes have been reported with different vaccines, most notably the influenza and human papilloma vaccines. Two cases of new-onset multiple sclerosis (MS) and a case of new-onset neuromyelitis optica (NMO) associated with the Pfizer vaccine have been reported. One case of new-onset relapsing-remitting MS was reported after the Moderna vaccine. Design/Methods: NA Results: A 38-year-old man developed left blurry vision, lower extremity weakness/paresthesia and bowel/bladder dysfunction three days after receiving the Moderna vaccine. He was diagnosed with left optic neuritis and longitudinally extensive transverse myelitis;he tested positive for MOG antibody. A 39-year-old woman presented with progressive lower extremity weakness/numbness seven days after receiving the Pfizer vaccine. She was diagnosed with ATM. Both patients improved with intravenous corticosteroids. Conclusions: The association between CNS demyelinating syndromes and vaccination has been reported for many years. The proposed pathogenesis of CNS demyelinating syndromes after vaccines includes molecular mimicry, epitope spreading, bystander activation, polyclonal activation, effects of adjuvants, and depends on vaccine-related factors like type, dose, and route of administration. The adjuvanticity of COVID-19 vaccines is novel in that it involves Toll-like Receptor (TLR) 7 and 9 agonism, and several immune-mediated disorders have been linked to altered nucleic acid metabolism and processing that have stimulated TLR-7 and TLR-9 experimentally. While the risk of CNS demyelinating events is non-negligible, the incidence is very low. The rate of demyelinating events after the COVID-19 infection is higher. Therefore, we feel that the overall benefits of vaccination outweigh the marginal risk. However, providers should be aware of this potential neurological complication of the COVID-19 mRNA vaccines.

11.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925300

ABSTRACT

Objective: To report a case of antibody-positive neuromyelitis optica (NMO) after COVID-19 vaccination. Background: Neuromyelitis optica spectrum disorder is a rare demyelinating disorder of the central nervous system characterized by longitudinally extensive transverse myelitis (LETM) and severe, sometimes bilateral optic neuritis. The majority of cases have serologic or CSF antibody for aquaporin-4 (AQP4). Design/Methods: Case report Results: A 19 year old woman with no prior medical history presented with two days of progressive, severe weakness and sensory changes first in the arms, then legs. On the morning of presentation, she woke with urinary incontinence. She had received COVID-19 vaccination (Moderna) fifteen days preceding her onset of symptoms. Examination revealed sinus tachycardia, MRC grade 3-4/5 power in the arms, 0/5 in the legs with approximately T4 sensory level. Cervical spine MRI revealed T2 prolongation in the spinal cord extending from the cervicomedullary junction to the conus medullaris. CSF revealed neutrophilic pleocytosis with increased IgG synthesis rate and positive CSF AQP4 antibody;serum AQP4 and MOG antibodies were negative. Bilateral, saddle pulmonary emboli were discovered shortly after admission. Her NMO was treated with high-dose intravenous methylprednisolone, plasmapheresis, and rituximab. Conclusions: This case describes a severe, new presentation of antibody-positive neuromyelitis optica following vaccination against COVID-19.

12.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925272

ABSTRACT

Objective: To describe cases of transverse myelitis (TM) associated with mild COVID-19 in adults. Background: Post-infectious TM is described after various infections but is not as well-known after COVID-19. Design/Methods: We present a series of 2 cases who developed TM after infection with SARS-CoV-2. Case 1: 55-year-old male with coronary artery disease presented with worsening paraparesis over 4 months, T4 sensory level and urinary retention, starting two weeks after mild COVID-19 illness. MRI showed T2 hyperintensity extending from the lower medulla to T3 spinal cord. CSF analysis revealed elevated protein and pleocytosis. His functional status improved after plasma exchange. Subsequently, his symptoms worsened and was treated with multiple courses of glucocorticoids. He recently started Rituximab and continues to have leg weakness with urinary retention. Case 2: 66-year-old male with diabetes mellitus presented in a wheelchair with rapidly progressive paraparesis over 10 days, starting six weeks after mild COVID-19 illness. He was initially diagnosed with GBS and received IVIG with no improvement. MRI revealed T2 hyperintensity in the lateral corticospinal tracts of cervical and thoracic spinal cord. Somatosensory evoked potential testing showed mild bilateral demyelinating lesions involving the dorsal columns between the C6-parietal cortex. CSF analysis was normal. Plasma exchange therapy provided minimal improvement. He remains wheelchair bound with urinary urgency. In both cases, other causes of TM including neuromyelitis optica, myelin oligodendrocyte associated disease, neurosarcoidosis and paraneoplastic myelopathy were ruled out. Conclusions: SARS-CoV2 may cause a post-infectious TM. While causation remains difficult to prove, our cases suggest TM was precipitated by COVID-19 given the temporal association and no other identified etiology. Our cases continued to have significant neurologic deficits likely due to delayed diagnosis. These cases add to the growing body of evidence of neurologic complications associated with COVID-19. Further studies are needed to establish the incidence and outcomes of post-infectious TM after COVID-19.

13.
Prescrire International ; 31(236):100-102, 2022.
Article in English | EMBASE | ID: covidwho-1912842

ABSTRACT

Three new drugs, all based on messenger RNA or small interfering RNA technology, represented a major therapeutic advance in 2021. But the bigger picture is that most of the new authorisations that advanced patient care were adaptations of existing drugs. And that more than half of this year's new authorisations were not advances, and in fact about one-tenth represented a step backwards compared to existing options.

14.
Developmental Medicine and Child Neurology ; 64(SUPPL 1):22, 2022.
Article in English | EMBASE | ID: covidwho-1723132

ABSTRACT

Objective: Paediatric neurologists are concerned about the risk of COVID-19 in children with demyelinating disorders receiving immunomodulatory treatment. To investigate this, we collected data via the UK Childhood Neuro-Inflammatory Disorders (UK-CNID) network of the British Paediatric Neurology Association (BPNA). Methods: Survey of paediatric neurologists managing unvaccinated UK children (<18 years) with a demyelinating disorder (multiple sclerosis [MS];neuromyelitis optica spectrum disorder [NMOSD] and myelin oligodendrocyte glycoprotein antibody disease [MOGAD]) on immunomodulatory therapy with SARS-CoV-2 infection confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) of nasopharyngeal swabs between March and December 2020. Results: Of 151 UK children (MS 98, MOGAD 37, NMOSD 16) with a median age of 9 years (range 6-18y), with a demyelinating disorder, nine (6.0%) had a positive PCR for SARS-CoV-2. Five had MS and four MOGAD. Four were from south Asian or south-east Asian, four were White and one was mixed White and south Asian. Seven children had COVID-19 symptoms;two were asymptomatic. Two required a brief hospital admission for typical COVID-19 respiratory symptoms and the remaining five had mild symptoms including fever, rash, cough and headache. One with MOGAD, treated with azathioprine, developed transverse myelitis 12 days after COVID-19 onset. She recovered fully with a course of corticosteroids. MS patients were on following disease modifying therapies;dimethylfumarate (n=2), fingolimod (n=1);natalizumab (n=1) and ocrelizumab (n=1). MOGAD cases were on the following immune therapy: combination of oral prednisolone and intravenous immunoglobulin (n=2), prednisolone steroids (n=1) and azathioprine (n=1). Conclusions: In contrast to adult patients, who often have underlying co-morbidities and advanced neurological disabilities, we have identified that children treated for demyelinating disorders appear to have a milder COVID-19 course. Whilst the number of children treated for demyelinating disorders that developed COVID-19 is low, the overall mild course described may provide reassurance to neurologists, patients and family members.

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