Does COVID19 affect your brain?

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COVID-19 is pretty much a gift that keeps on giving.

Couple of facts about COVID19 – immune response, particularly antibody response is not sustained (out goes the idea of establishing herd immunity), the brain is involved (headache and lack of smell being the commonest presentations), and long COVID exists.

We’ve faffed about whether it affects MS adversely or not, an increase in relapse activity is known but we have not had much in the way of objective scientific information to support this. That was probably until now.

In a moderately large study from Iran, they looked at the brain imaging appearances over a 12 month period during the first wave of the pandemic. They divided the group up into those that were PCR positive (n=71) vs those who were negative (n=496), with some drop outs over the course of the monitoring period and therefore not included in the final analysis.

In those who were PCR positive there were more new active lesions vs. those who were negative, but the overall number is small (4 in each group; see Table below). The MRI activity didn’t necessarily lead to clinical activity in the form of relapses. On the other hand, there was an increase in EDSS scores (disability measure) by 0.55 in the COVID19 group vs 0.17 in the negative group.

Figure: COVID19 positive cases versus controls for active lesions (new enhancement) and clinical activity

The main issue with this study is that the sample size which isn’t large enough to make it generalisable. Moreover, as with similar studies of this ilk they are dependent on who gets in (i.e. selection bias) and relied here on self-reporting of symptoms. Nonetheless, since COVID seems to be here with us for a while a much larger study to look at this closely can be conducted.

Abstract

Med Clin (Barc). 2022 Aug 10;S0025-7753(22)00410-9.

COVID-19 and its implications on the clinico-radiological course of multiple sclerosis: A case-control study

Mohammad RahmaniAbdorreza Naser Moghadasi Shayan Shahi Sharareh Eskandarieh Hossein Azizi Alireza HasanzadehAli Ahmadzade Ali Zare Dehnavi Ramin Hamidi Farahani  Mohammad Aminianfar Alireza Ranjbar Naeini 

Background: Multiple sclerosis (MS) is an immune-mediated disease that has been related to several risk factors such as various viral infections. We carried out this study in order to establish a relationship between COVID-19 infection and MS severity.

Methods: In a case-control study, we recruited patients with relapsing-remitting multiple sclerosis (RRMS). Patients were divided into two groups based on positive COVID-19 PCR at the end of the enrollment phase. Each patient was prospectively followed for 12 months. Demographical, clinical, and past medical history were collected during routine clinical practice. Assessments were performed every six months; MRI was performed at enrollment and 12 months later.

Results: Three hundred and sixty-two patients participated in this study. MS patients with COVID-19 infection had significantly higher increases in the number of MRI lesions (p: 0.019, OR(CI): 6.37(1.54-26.34)) and EDSS scores (p: 0.017), but no difference was found in total annual relapses or relapse rates. COVID-19 infections were positively correlated with EDSS progression (p: 0.02) and the number of new MRI lesions (p: 0.004) and predicted the likelihood of the number of new MRI lesions by an odds of 5.92 (p: 0.018).

Conclusion: COVID-19 may lead to higher disability scores in the RRMS population and is associated with developing new Gd-enhancing lesions in MRI imaging. However, no difference was observed between the groups regarding the number of relapses during follow-up.

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Neuro Doc Gnanapavan

3 comments

  • Feeling the rest of the world has moved on, they dont care about long covid, they dont care about catching covid once twice or kept getting it.

    While we learned all these potential issues, also being relatively young, we cant just have a fearless spirit coz it matters few decades later.

    I feel socially isolated at work coz I want to keep a distance from ppl, I get uncomforable when aircon is on and no ventilation, and other companies never understand why I don’t want to meet up in person.

    Ignorance is bliss? Should I just move on and live like everyone else? The social burden is too much and affecting my job.

    • You’re well within your right to prioritise your safety, what others do is their prerogative. Be true to yourself 🙂

  • i had covid 19 in march 2020 (positive test in hospital) and was in hospital with oxygen support for three weeks. i left hospital mid april after suffering not a single health issue in 28 years of life. following this my feet went numb in april followed by everything else from the neck down my vision started to blurr and i lost power in both arms and both legs. by the time i was back on the same ward being invesigated for all sorts of post viral syndromes i couldnt walk talk move hold bladder or bowel had no thought proccess and was diagnosed within a week with ms. i had steroid treatment and initially improved but 4 weeks later had a further relapse with enhancing lesions. i cannot believe the link between covid 19 and the issues it is causing with ai diseases is not being further investigated in any real depth. to be clear how extreme the relapse was before it i worked as an engineer 80-90 hours a week all over the country and had not had a sick day in 5 years. i have never been able to return to my role and continued to relapse untill i was treated at barts this year with hsct. for some reason that neither hematology nor neurology can explain even a small amount of methylprednisolone can mean the difference for me between walking and not being able to move when i say small i mean 85mg which is a relative dose but should have no real effect on ms. am i suffering long covid along side ms ? am i misdiagnosed ? we will never know i dont suppopse

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