No Increase in MS Disease Activity Due to COVID-19

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Despite COVID-19 triggering autoimmune conditions in healthy individuals, it does not appear to increase the risk for clinical and MRI disease activity or motor and cognitive worsening in people with multiple sclerosis (MS), a new study shows.


  • The analysis included 136 people with MS who had a history of COVID-19 (median age 41 years; MS-COVID group), and 186 people with MS with no history of COVID-19 who were matched for age, sex, Expanded Disability Status Scale (EDSS), disease duration, and treatment type (MS-NCOVID group).

  • Patients underwent regular neurologic follow-up, brain MRI, neuropsychological evaluations, and assessments of fatigue using the Modified Fatigue Impact Scale (MFIS), depression and anxiety using the Hospital Anxiety and Depression Scale (HADS), sleep using the Pittsburgh Sleep Quality Index (PSQI), and psychological and posttraumatic effects related to COVID using the Impact of Event Scale-Revised (IES- R).

  • Researchers also measured immune response to SARS-CoV-2 in the two groups.


  • During the 18-24 months following COVID infection, there was no significant difference between groups in EDSS worsening, percentages of patients with relapses, need for change in disease-modifying therapy, new/enlarging brain T2-hyperintense lesions, and gadolinium-enhancing lesions.

  • At follow-up, 28 (22%) MS-COVID and 40 (23%) MS-NCOVID patients were cognitively impaired, with no significant between-group difference, which was also the case for global cognitive functions, verbal and visual memory, information processing speed, attention, and verbal fluency.

  • There were no significant differences in MFIS, HADS anxiety, HADS depression, PSQI, and IES-R scores.

  • There was also no significant difference in tests for cellular immune response to SARS-CoV-2.


“Based on these findings, it may be appropriate to suggest that people with MS can begin to return to their normal lives,” the authors write. However, they stress that good hygiene should continue to be encouraged as the virus can still pose a risk and future variants may have a different spectrum of neurologic symptoms.


The study was carried out by Federico Montini, San Raffaele Hospital, Milan, Italy, and colleagues. It was published online October 19 in the Journal of Neurology, Neurosurgery & Psychiatry.


Most patients from both groups were vaccinated 18-24 months after the baseline evaluation, significantly reducing the likelihood of detecting a difference in T-cell response. As COVID-19 severity was generally mild, the study does not shed light on the presence of sequelae among people with MS with severe COVID-19 infection. The follow-up period was relatively short and the sample size relatively small.


The study received support from Fondazione Italiana Sclerosi Multipla. Montini has no relevant conflicts of interest. See the original article for disclosures of other authors.

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