The whole pandemic is like watching a slow-mo rendition of the ‘The Good, The Bad, and The Ugly’, where Eastwood keeps repeating the same lines over and over. Then enter those who are actually slow on the uptake, the wannabe anti-vaxxers who may use this article as evidence for their ideals. So, how can I portray the findings of this case series as no more than a rare occurrence and definitely one that has happened before? It seems reasonable also to remind doubters how unreasonable COVID-19 actually is.
So what do we have?
Khayat-Khoei and colleagues report on 7 cases detailed below from different centres in the USA with either de novo demyelinating disease post-vaccination or worsening of pre-existing MS (3 Moderna, 4 Pfizer). They occured 1-21 days (on average 13.7 days) after either the 1st or 2nd dose of the vaccine. Those with pre-existing MS were disease activity free for 2.2-14 years (on average 7.5 years).
The authors add that their case series add to previous reports already in the literature. I can add two cases to this from my experience.
Our case series adds to other recently published reports of the first manifestation of MS after the Pfizer COVID-19 vaccine , MS relapse 3 days after the Sputnik V COVID-19 vaccine, MS relapse after the Pfizer COVID-19 vaccine, and four cases of acute myelitis after the AstraZeneca COVID-19 vaccine.
But, post-vaccination related demyelinating disease isn’t anything new, and is in fact a rare occurrence. Guillian-Barre syndrome with flu-vaccines occur annually for instance. Moreover, active COVID infection itself also causes brain inflammation and has caused sadly deaths in MS patients on immunosuppressants and in the vulnerable.
COVID-19 mRNA vaccination leading to CNS inflammation: a case series
The availability of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), provides hope towards mitigation of the coronavirus disease 2019 (COVID-19) pandemic. Vaccine safety and efficacy has not been established in individuals with chronic autoimmune diseases such as multiple sclerosis (MS). Anecdotal reports suggest that the vaccines may be associated with brain, spinal cord, peripheral nervous system, and cardiac inflammation. Based on the high morbidity and unpredictable course of COVID-19, and the need to achieve herd immunity, vaccination has been recommended for patients with MS. We report clinical and MRI features of seven individuals who received the Moderna (n = 3) or Pfizer (n = 4) SARS-CoV-2 mRNA vaccines. Within one to 21 days of either the first (n = 2) or second (n = 5) vaccine dose, these patients developed neurologic symptoms and MRI findings consistent with active CNS demyelination of the optic nerve, brain, and/or spinal cord. Symptoms included visual loss, dysmetria, gait instability, paresthesias, sphincter disturbance, and limb weakness. Age ranged from 24 to 64 (mean 39.1) years; five were woman (71.4%). The final diagnosis was exacerbation of known stable MS (n = 4, two were receiving disease-modifying therapy at the time of vaccination), new onset MS (n = 2), or new onset neuromyelitis optica (n = 1). All responded to corticosteroid (n = 7) or plasma exchange (n = 1) therapy, with five returning to baseline and two approaching baseline. Large prospective studies are required to further investigate any possible relationship between COVID-19 vaccines and acute CNS demyelination.