COVID-19 and the risk of CNS demyelinating diseases: a systematic review

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.