Worsening MS post-COVID
So many people with MS who have had COVID-19 have said that COVID-19 has made their MS worse. Do you relate to this?
So many of my patients with MS who have had COVID-19 have said to me that COVID-19 has made their MS worse. Do you relate to this?
My answer to them has been that all infections that cause systemic inflammation can cause transient worsening of existing MS-related symptoms due to reversible conduction block in previously or persistently demyelinated pathways. This is commonly referred to as a pseudorelapse. The majority of people who have a pseudo-relapse get back to their baseline level of functioning within days or weeks of the infection. However, a small minority don’t. This lack of full recovery of function is more often noted in people with more advanced MS who have a lot of disability. However, with COVID-19, I have noted that many of my patients with low levels of disability have been complaining of not getting back to their premorbid or pre-COVID-19 baseline. Why?
A newly released pre-print of a UK study on long COVID-19 investigated 351 patients requiring hospitalisation for COVID-19 and compared them to over 2,900 matched healthy controls. A year after COVID-19, the hospitalised patients showed major cognitive deficits equivalent to the impact of 20 years of ageing. Biomarkers of brain injury indicated that tissue damage was persistent with loss of cortical grey matter. This study tells us that COVID-19 is not behaving like other common viral infections and clearly impacts brain function. Add in a vulnerable MS brain, with reduced brain and cognitive reserve, and the hit from COVID-19 may be much more apparent and may explain my anecdotal clinical observations.
Please note I have not gone into detail about infections triggering relapses. There is a well-studied association, predating the DMT era, where about a third of relapses in pwMS not on a DMT have a relapse in the next 4-6 weeks. This association is not apparent in pwMS on a DMT, presumably because the DMT prevents the relapse.
The observation of infection causing a transient or persistent worsening in neurological function in pwMS on a DMT is unlikely to be driven by relapses but rather by the activation of innate immune mechanisms within the central nervous system (please see ‘Getting Worse’, 2-Jul-2022).
For more information on pseudorelapses, please read ‘Case study: am I having a relapse?’ (5-Jan-2022).
The study results below are very worrying and support COVID-19 vaccination, booster vaccines and antivirals as essential to reduce the chances of getting COVID-19 or at least reducing its severity.
To protect your vulnerable MS brain, please make sure you are vaccinated and are on the NHS vulnerable list so that you can access antivirals if you get COVID-19.
I would like to know how you have dealt with COVID-19 and if any of you have persistent deficits, both cognitive and/or physical. I have prepared a short survey. Please complete the survey so we can see how common this problem is. Please use the ‘leave-a-comment’ function if you have any comments or questions that will help other pwMS. As always, I will try my best to respond.
Thank you.
Paper
The spectrum, pathophysiology, and recovery trajectory of persistent post-COVID-19 cognitive deficits are unknown, limiting our ability to develop prevention and treatment strategies. We report the one-year cognitive, serum biomarker, and neuroimaging findings from a prospective, national longitudinal study of cognition in 351 COVID-19 patients who had required hospitalisation, compared to 2,927 normative matched controls. Cognitive deficits were global and associated with elevated brain injury markers and reduced anterior cingulate cortex volume one year after admission. The severity of the initial infective insult, post-acute psychiatric symptoms, and a history of encephalopathy were associated with the greatest deficits. There was strong concordance between subjective and objective cognitive deficits. Treatment with corticosteroids during the acute phase appeared protective against cognitive deficits. Together, these findings support the hypothesis that brain injury in moderate to severe COVID-19 is immune-mediated and should guide the development of therapeutic strategies.
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General Disclaimer
Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Queen Mary University of London or Barts Health NHS Trust. The advice is intended as general and should not be interpreted as personal clinical advice. If you have problems, please tell your healthcare professional, who will be able to help you.
I have advanced Ms, use a wheelchair but my main issues are with legs and arms. I had seven! Vaccinations and have worn a mask in populated areas since 2020 but did contract COVID once while on holiday despite still wearing a mask and eating outdoors.
COVID worsened my arms and my hands were almost useless. I had antivirals IV on day 3 and my hands are pretty much back to normal 4 months later.
I'm concerned as my neurologist really downplays covid saying that his many patients have very mild symptoms and while he does not say not to have vaccinations, he has said that they are not that important as COVID is very mild and the vaccination is not that efficacious!
He thinks my constant mask wearing is probably over cautious.
What are your thoughts on that?
I've had covid twice and in both cases it was mild, probably because I have had all the vaccinations. I have accessed the antivirals each time, although in the second case (not diagnosed for a good few days) I suspect it was too late to make a difference anyway. In view of your comments, should I get antivirals regardless of whether I feel they are necessary? It's something of a procedure to access them, particularly as I travel frequently.