COVID-19 and MS symptoms
A new study in the U.K. reports that relapses and worsening symptoms are very common in people with MS who contract COVID-19 (Gurjani and colleagues. medRxiv preprint, 10 March 2021).
Researchers obtained abut 400 questionnaires from people with MS who had been infected with COVID-19. Respondents averaged 50 years of age, had been living with MS for about 11 years and had moderate disability. About one-half were taking a disease-modifying therapy. About 2% had been hospitalized due to COVID.
While ill with COVID, 57% said they had an MS relapse, defined as new neurological symptoms or a worsening of pre-existing MS symptoms. In the group suffering a relapse, almost everyone (97%) said they had a fever when their MS got worse. This may indicate that the problem in many cases was a “pseudo-relapse” – a worsening of symptoms that isn’t caused by an inflammatory flare-up in the brain. The researchers were not able to determine if the problem was a relapse or a pseudo-relapse because they could not perform an in-person exam because of the pandemic. But relapse or not, their MS felt worse and the person’s quality of life deteriorated.
The most common MS symptoms during COVID infection were sensory symptoms (e.g. pins and needles, nerve pain, reported by about 11%); muscle weakness (7%); balance or mobility problems (6%); fatigue (5%); and memory problems (4%). About one-third of symptoms were reported to be severe. Having MS symptoms during COVID was about twice as likely if a person was not taking a disease-modifying therapy for their MS.
The survey also found that the relapse rate in people with COVID (63.9%) was not significantly different from the relapse rate in people without COVID (54.4%). So this does suggest that COVID may not actually cause a relapse but can make MS symptoms much worse. It also suggests somewhat different problems caused by the pandemic: relapses and symptoms may have been less controlled because people were not taking their MS medications, could not access their medication (e.g. avoiding going to the pharmacy), or were unable to get the treatment they needed because their MS clinic was closed.
A worrisome finding was that the symptom worsening that occurred during COVID infection seemed to be more severe and persistent – people often reported that their MS symptoms had lingered for several months. Other studies have also shown that relapse symptoms may persist longer if they were triggered by an infection (Buljevac and colleagues. Brain 2002;125:952-960). This underscores the importance of taking precautions to avoid COVID infection, remaining on an MS treatment during the pandemic, and getting vaccinated as soon as possible.
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