Is the clinical onset of demyelinating CNS disease after COVID-19 vaccination a denovo disease or the clinical manifestation of a preexisting condition?

ABSTRACT

Introduction: Within the last year, cases with multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) associated with SARS-CoV-2-vaccination have been published worldwide. It remains unclear, whether the clinical onset in these patients is either causal and denovo or, alternatively, the initial manifestation of a preexisting demyelinating disease and thus a coincidence in time. Objective(s) We therefore compared clinical, laboratory and neuroimaging data of MS patients with clinical onset after SARSCoV- 2-vaccination (MSpostvacc) with a MS cohort without association to the vaccination (MSreference), respectively, with a single case of MOGAD following SARS-CoV-2-vaccination (MOGADpostvacc). Aim(s) To determine whether there is evidence of a preexisting, chronic inflammatory disease at clinical onset in MSpostvacc and MOGADpostvacc patients. Method(s) We included patients with clinical manifestation of MS or MOGAD <=30 days following SARS-CoV-2-vaccination and analysed clinical, cerebrospinal fluid (CSF), magnetic resonance imaging (MRI) and optical coherence tomography (OCT) data. The MSpostvacc characteristics were compared to an age- and gender- matched MS cohort recruited at our neuroimmunological outpatient clinic. Result(s) In 5 patients (3 female) the initial diagnosis of MS was made in association to SARS-CoV-2-vaccination (4 after BNT162b2 vaccine;mean clinical onset after 8 days). CSFspecific oligoclonal bands and indications of a preexisting inflammatory process were detectable on MRI and OCT in all MSpostvacc patients. Their analysed parameters (clinical, CSF, MRI, OCT) were assimilable to those of the MSreference cohort. One woman with onset of MOGAD after ChAdOx1 nCoV-19 vaccination was identified. Here, CSF analysis revealed an acute inflammatory profile (106 cells per mul;no CSF-specific OCB). After treatment with high-dose corticosteroids, the initial cerebral and cerebellar lesions resolved on follow-up MRI. Conclusion(s) Since we found CSF-specific oligoclonal bands, chronic inflammatory lesions on MRI and retinal neuroaxonal damage on OCT a denovo disease seems unlikely for the MSpostvacc cohort. Our data point to the hypothesis that the MSpostvacc patients described had a subclinical disease that first manifested coincidentally with the SARS-CoV-2-vaccination. However, this cannot be assumed for the MOGADpostvacc patient.