It is known that viral infections can both cause relapses and worsen existing MS symptoms – why should COVID-19 be any different?
This study used the UK MS Register COVID-19 study, where people with MS can self-report both COVID infection and MS related information. By asking people with symptoms suggestive of COVID-19 about their MS symptoms, we were able to try to estimate the impact of infection on MS.
Of the 978 people who had reported COVID-19 symptoms, 404 provided information about their MS. These people had had MS for an average of 11 years, and most of them had some MS-related disability prior to getting COVID-19. About half were taking a DMT – and the DMTs taken were spread across the full range. 8 people were hospitalised as a result of their COVID-19 symptoms.
Over half of the people taking part in this study – 230/404 reported new and/or worsening MS symptoms during their infection. 82/404 people with COVID-19 developed new symptoms, and 207/404 had worsening of existing symptoms. This means that 59/404 (or 15%) had both new symptoms and worsening of existing symptoms. Almost everyone with worsening of their MS had a fever during their COVID-19 infection, compared to ⅔ of those with COVID-19 but no change in MS. 77/196 (39%) of those with an MS exacerbation required additional support during their infection, as opposed to 7/114 without an MS exacerbation.
The most common new symptoms were weakness and sensory problems. People taking a DMT were less likely to get new symptoms. Pre-existing symptoms were more likely to worsen in those with higher EDSS and longer MS duration.
There has been a lot of concern around DMT use in the current pandemic. However, this study shows that people taking DMT are substantially less likely to develop new MS-related symptoms if they are unlucky enough to get COVID-19. When this is taken alongside the wealth of studies that show that most DMT are not associated with more severe COVID-19, the message seems clear, if you are eligible for DMT then don’t delay because of the current pandemic.
The apparent association between fever and worsening of MS symptoms is not surprising, we know that this happens in other viral illnesses, and that fever (or anything else that raises core temperature) can slow nerve conduction, particularly in demyelinated axons. However, this is temporary, and should not lead to lasting worsening of MS symptoms.
Of course – prevention is better than cure and if you are offered vaccination then please take it up.
Most people do not get significant fever or worsening of symptoms from the vaccine and if you do this is likely to be temporary, and lead to less long-term problems than a significant relapse resulting from COVID infection. We are currently trying to look at vaccine responses, so if you are under the care of BartsMS and want to take part in our study (which doesn’t require any hospital visits, but does require fingerprick blood samples), please let us know by email – firstname.lastname@example.org
COI: I am an author of this Preprint
COVID-19 is associated with multiple sclerosis exacerbations that are prevented by disease modifying therapiesAfagh Garjani, Rodden M Middleton, Rachael Hunter, Katherine A Tuite-Dalton, Alasdair Coles, Ruth Dobson, Martin Duddy, Stella Hughes, Owen R Pearson, David Rog, Emma C Tallantyre, Roshan das Nair, Richard Nicholas, Nikos Evangelou medRxiv 2021.03.08.21253141; doi: https://doi.org/10.1101/2021.03.08.21253141
Background: Infections can trigger exacerbations of multiple sclerosis (MS). The effects of the coronavirus disease 2019 (COVID-19) on MS are not known. The aim of this study was to understand the impact of COVID-19 on new and pre-existing symptoms of MS.
Methods: The COVID-19 and MS study is an ongoing community-based, prospective cohort study conducted as part of the United Kingdom MS Register. People with MS and COVID-19 were invited by email to complete a questionnaire about their MS symptoms during the infection. An MS exacerbation was defined as developing new MS symptoms and/or worsening of pre-existing MS symptoms.
Results: Fifty-seven percent (230/404) of participants had an MS exacerbation during their infection; 82 developed new MS symptoms, 207 experienced worsened pre-existing MS symptoms, and 59 reported both. Disease modifying therapies (DMTs) reduced the likelihood of developing new MS symptoms during the infection (OR 0.556, 95%CI 0.316-0.978). Participants with a higher pre-COVID-19 webEDSS (web-based Expanded Disability Status Scale) score (OR 1.251, 95%CI 1.060-1.478) and longer MS duration (OR 1.042, 95%CI 1.009-1.076) were more likely to experience worsening of their pre-existing MS symptoms during the infection.
Conclusion: COVID-19 infection was associated with exacerbation of MS. DMTs reduced the chance of developing new MS symptoms during the infection.