Acute central nervous system inflammation following COVID-19 vaccination: An observational cohort study

• Published in: Multiple sclerosis Vol. 29; no. 4-5; pp. 595 - 605
• Main Authors: Lee, Sydney, Muccilli, Alexandra, Schneider, Raphael, Selchen, Daniel, Krysko, Kristen M
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-04-2023; Sage Publications Ltd
• Subjects: Central Nervous System; Cerebellar ataxia; Cerebellum; Cohort analysis; Cohort Studies; Coronaviruses; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - adverse effects; Demyelination; Female; Humans; Inflammation; Inflammation - etiology; Male; Multiple sclerosis; Myelin; Myelin-Oligodendrocyte Glycoprotein; Myelitis; Neoplasm Recurrence, Local; Nervous system; Neuromyelitis; Neuromyelitis Optica; Observational studies; Oligodendrocyte-myelin glycoprotein; Original Research Paper; Retrospective Studies; Steroid hormones; Vaccination - adverse effects; COVID-19; neuroinflammatory diseases; demyelinating diseases; multiple sclerosis; vaccination; central nervous system
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/13524585231154780

Background:
Reports suggest a potential association between coronavirus disease 2019 (COVID-19) vaccines and acute central nervous system (CNS) inflammation.
Objective:
The main objective of this study is to describe features of acute CNS inflammation following COVID-19 vaccination.
Methods:
A retrospective observational cohort study was performed at the BARLO MS Centre in Toronto, Canada. Clinicians reported acute CNS inflammatory events within 60 days after a COVID-19 vaccine from March 2021 to August 2022. Clinical characteristics were evaluated.
Results:
Thirty-eight patients (median age 39 (range: 20–82) years; 60.5% female) presented within 0–55 (median 15) days of a receiving a COVID-19 vaccine and were diagnosed with relapsing remitting multiple sclerosis (MS) (n = 16), post-vaccine transverse myelitis (n = 7), clinically isolated syndrome (n = 5), MS relapse (n = 4), tumefactive demyelination (n = 2), myelin oligodendrocyte glycoprotein antibody disease (n = 1), neuromyelitis optica spectrum disorder (n = 1), chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (n = 1) and primary autoimmune cerebellar ataxia (n = 1). Twenty-two received acute treatment and 21 started disease-modifying therapy. Sixteen received subsequent COVID-19 vaccination, of which 87.5% had no new or worsening neurological symptoms.
Conclusion:
To our knowledge, this is the largest study describing acute CNS inflammation after COVID-19 vaccination. We could not determine whether the number of inflammatory events was higher than expected.