COVID-19 vaccination and brain inflammation, fodder for anti-vaxxers?

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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.

Figure: Patient characteristics

Abstract

J Neurol. 2021 Sep 4. doi: 10.1007/s00415-021-10780-7. Online ahead of print.

COVID-19 mRNA vaccination leading to CNS inflammation: a case series

Mahsa Khayat-Khoei  , Shamik BhattacharyyaJoshua KatzDaniel HarrisonShahamat TauhidPenny BrusoMaria K HoutchensKeith R EdwardsRohit Bakshi

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.

About the author

Neuro Doc Gnanapavan

29 comments

  • There have been 221 million cases of Covid-19 infection worldwide (reported – so probably 1 billion+ realistically).
    We know the vaccines can cause MS exacerbation – rarely.
    We know infections cause MS exacerbation – very frequently.
    We…. do we have any number on Covid-19 triggering MS relapses / episodes / flare-ups / deterioration? There ought to be a signal. And I’d have thought it would be pretty significant.

    Covid-19 is going to go endemic at least in the short-to-medium term. So we have to assume we will all encounter it in the wild. This shifts the risk balance – simplifies it massively in fact.

    If the probability of contracting Covid-19 is 1, therefore the risk associated of MS exacerbation with Covid-19 (which I don’t know if we know) : risk of MS exacerbation with the vaccine (v small) is the relative risk of the vaccine. Pretty low – probably somewhere between 1:20,000 and 1:60,000 vs that MS disease exacerbation rate which I don’t know yet…

    TLDR have the jab

    • How is this established to be down to the vaccine & not something that would have happened anyway?
      Am asking as I suffered a pretty major brainstem relapse 4 weeks after the second dose, after being stable for 10 years. I lost use of legs, numbness down body, problems with vision & speech, am still trying to recover.
      I also have an ex-colleage who lost use of legs also following second dose. I believe she has had every test & doctors can’t put it down to anything else apart from vaccine.

      • In those with a pre-existing autoimmune disorder this isn’t a straight forward diagnosis to make. It’s easier in those that don’t have anything wrong with them, for example most vaccine studies are done in healthy subjects who shouldn’t really experience these side effects had they not received the agent.

        In those with drug-related side effects an arbitrary temporal association is given. This is normally 2 weeks, this would apply for vaccines as well, with 4 weeks becoming less likely, but not completely impossible. Anything after 4 weeks is unlikely.

        • Apologies for delay in replying, just seen your question. Yes, had alemtuzumab 9 & 10 years ago followed by copaxone as belt & braces since.

  • Why is everyone who has a concern about their health an anti vaxxer?

    It’s shocking, that you think people can’t have an opinion.

    I’m not an anti Vaxxer but I’m not having a second shot due to the first causing a relapse, am I an anti vaxxer? No.

    It is right that I won’t be able to go certain places due concerns for my health and not having a covid passport, no?

    When do the vaccines complete the phase 3 clinical trials anyway?

    • Vaccines completed long ago, they are perhaps the most tested agents in history.

      The question one asks is it cause or chance

    • Hi Anon, that statement is not targeted at you but specifically at anti-vaxxers, who will use publications such as above to block vaccination programmes.

      A doctor will be able to judge risk of vaccination based on previous side effects and judge whether it is safe to re-vaccinate. I’ve had patients that worsened after the 1st vaccine but the second was fine; a decision based on where the peak of the pandemic was. There are some that I’ve said no to the second vaccine, it’s a risk-benefit balance. This by the way was not MS alone but also other neurological disorders that I’ve looked after.

      • I wish my consultant was as informed and open-minded as you.
        I suggested the vaccine to 2 neurologists at my local hospital. They both laughed.

        • I have just had a telephone conversation with my haematologist, have had problems with itp all year (have had alemtuzumab) only to have this ms relapse in May.
          I wasn’t going to ask, but at the end of the conversation he enquired how the ms was. I told him of this article & he told me they have had lots of people in haemotology with all kinds of blood problems, all following covid vaccine. In his opinion, as a haematologist, he would make an educated guess that this relapse was brought on by vaccine, following so many stable years.
          I am not an anti-vaxxer, but interesting conversation. As I said previously, it’s extremely disappointing that my neurology team doesn’t have an open mind on this subject.

      • Great that you would take it into account on your clinical practice, yet experience from patients points that it is mostly labeled as an irrelevant coincidence. And without such studies patients (and especially women) are for them just “ignorant loonies”.

        And if an exacerbation could be a manageable issue for other autoimmune diseases, when it comes to MS or NMO relapses do matter, and this “AnTI VaXxERS” humor in your title really does not help to get doctors take all parameters into account, like you say you do.

  • How is this established to be down to the vaccine & not something that would have happened anyway?
    Am asking as I suffered a pretty major brainstem relapse 4 weeks after the second dose, after being stable for 10 years. I lost use of legs, numbness down body, problems with vision & speech, am still trying to recover.
    I also have an ex-colleage who lost use of legs also following second dose. I believe she has had every test & doctors can’t put it down to anything else apart from vaccine.

  • I thought about this paper and decided not to comment as it simply raises questions that need not be questions.

    but likewise should I have talked about Uhthoffs phenomenon (heat induced nerve failure) knowing that the vaccines cause fever, which would trigger transient events in pre-exisiting demyelinated nerves. Preparing some of the brave for a temporary bad times, whilst frightening off the Shy.

    I wonder what roll the media has in all this a BBC reporter dies after the vaccine and it is front line news, I wonder how many reporters die in a car accident but this does not get reported. We never hear of knofe attacks where it was frontline news. The problem is shock sells and we can ask questions of MSers dying from COVID verses vaccine. I am sure the risks of COVID-19 are far greater.

    However, when you are the rare result, I appreciate it is devastating.
    Astrazeneca vaccine is essentially dead in the Western World due to polictical spite and the media. Have a nosebleed on AZ and it was all splashed over the front page, but I don’t remember hearing about the numerous deaths in the first week of using Pfizer in Norway. Our media did not seem to carry the story, but I got it from New York Times. It seems that elderly people in care homes were being pushed over the edge.

    Had it been on the news would both vaccines have been tainted?

  • I seem to remember a when France halted use of a HeP B vaccine due to reports of increased Incidence of MS. After further investigation the vaccine was found not to be causing MS. Vaccines do cause adverse effects in a percentage of the population but this is nothing new.

  • I have had three “rounds” of Lemtrada, the most recent February of 2020. I had Covid-19 in November 2020. I Had a mild case, the old “thought it was a cold/flu” storyline…until I lost ALL sense of smell. Ten-ish months later still no smell, with the exception of nail polish remover. I did both courses of Pfizer vaccine in March/April and a booster last week. Considering I did a third round of Lemtrada, my MS had flared, but both having COVID-19 and now receiving three doses of Pfizer, I have not had a resurgence of multiple sclerosis symptoms.
    The loss of smell is concerning though. Is my olfactory area of the brain still inflamed? Would course of steroids help? Not asking for advice, just opinions/research/articles. Thank you in advance!

  • Case Report…….I received my COVID-19 vaccine four weeks prior to initiating CLAD. Took ANTI SARS COVID-19 SPIKE test six weeks later and results showed >2,500.

    Was previously on OCR; however, allowed CD19 B cells to fully reconstitute prior to initiating CLAD.

      • “What was the number for the B cells that met the fully reconstituted level for you?”……..Please remember each individual is different. I tested my CD19+ CD3- levels twice before initiating OCR and my bottom baseline was determined to range between 90-110/ul. So that was the level I was trying to achieve, at a minimum. Once they started to repopulate they increased at a very fast pace.

        • 80cells/microlitre is the classic lower limit of normal for CD19 B cells. Typically once you get to 1% B cells they repopulate up quite quickly. B cells propliferate quickly which is why they are more susceptible to MS drugs

    • Is this good…the problem is that without knowing the test the numbers it produces are difficult to understand, but happy you made a response and add further weight that cladribine is a good option vaccine wise…we were taking amongst ourselves today about explaining the biology

      • “The problem is that without knowing the test the numbers it produces are difficult to understand”…..agreed.

        It was a semi-quantitative detection of total IgM/IgA/IgG antibodies. The reference range was 0.80U/ml up to a maximum of 250 (or said another way 80 to 2,500). Less than 0.80 is negative and anything greater is positive. The test has a maximum range of 250, so a result >250 is a strong response, so I am told. It was ordered by my oncologist.

        P.S. “cladribine is a good option vaccine wise”….just as you predicted several month ago. I am going to start calling you Nostradamouse 😉

          • Getting more data is always beneficial, I hope the manufacturers do share what they know.

            For me, the cladribine had the desired effect, at least from a immunology standpoint. Not pleased with the minor heart damage it caused, but I guess all the DMTs come with some type of secondary issues.

            One week after ending the first year cycle and my total lymphocytes dropped from 2,000 down to 900, with the most pronounced effect on my CD19 B cells, as expected. CD19 are almost back down to zero.

            I tried to access a lab test of memory B cells; however, I found the test only to be available in a research setting, even if I wanted to pay out of pocket. So I am stuck with the basic lymphocyte subtype panel….only CD4, CD8, CD19, and NK.

            Thank you for the insights on the SARS Covid antibody tests. Just happy I made a response and CLAD did not wipe it out.

        • The problem with some IgM/IgA/IgG assays is that they have two molecule in the assay a capture and a detect so you need the different molecules to to bind to each arm of the antibody of IgG and so two captures is not detected and two detects are no monitored. However the data is complicated when measuring IgG, IgA and IgA. IgG has 2 sites, IgA has 4 and IgM has ten site. So the detect in the test may bind to just one or nine of the antigen binding sites making it difficult to quantitate

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