New or Worsening Neurologic Symptoms Post-COVID in Patients With Multiple Sclerosis

In a retrospective review, researchers sought to investigate the neurologic outcomes in patients with MS and related disorders following COVID-19 infection.

More severe COVID-19 and sequelae were associated with new or worsening neurologic symptoms among over a third of patients with multiple sclerosis (MS). These findings, from a retrospective review, were published in Multiple Sclerosis and Related Disorders.

COVID-19 has been associated with various neurologic symptoms including headache, anosmia, and ageusia. Previous studies have found new or worsening MS symptoms after infections with SARS-CoV-2. In order to better understand the long-term neurologic effects of COVID-19 in MS, this study retrospectively reviewed patient data from individuals (N=111) with MS and related disorders who had confirmed COVID-19 cared for at the Brigham MS center between March 2020 and April 2021. COVID-19 severity and outcomes were related with post-infection MS progression.

Patients were aged mean 49.3 (standard deviation [SD], 12.2) years, 76.6% were women, 72.1% were White, 64.9% had relapsing-remitting MS, 18.9% secondary progressive MS, 7.2% related disorders, and 1.8% clinically isolated syndrome.

Most patients (72%) had asymptomatic or mild COVID-19 and 76.5% recovered completely. The patients who did not recover fully had mild sequelae (n=16), significant sequelae (n=2), and COVID-19 mortality (n=6).

Among patients with symptoms, the most common presentation symptoms were fever (33.3%), cough (27%), and shortness of breath (24.3%). A quarter (25.2%) received COVID-19 treatment.

Following COVID-19 infection, 36.9% reported neurologic worsening or exacerbations of preexisting symptoms (46.3%), pseudorelapses (46.3%), long-term neurologic symptoms not meeting the definition of relapse (17.1%), and relapse requiring high-dose intravenous solumedrol (4.8%).

A subset of patients (n=55) underwent magnetic resonance imaging post-COVID at a mean of 144.6 days after infection. Two events of new T2 lesions without enhancement, 2 events of asymptomatic gadolinium (Gd+) enhancing lesions, 1 event of a new T2 and Gd+ enhancing lesion, and 1 occipital lobe stroke were observed.

Stratified by new or worsening symptoms, more patients with disease progression had moderate or severe COVID-19 (43.9% vs 11.7%; P =.001) and received treatment for COVID-19 (45.0% vs 15.5%; P =.006) and fewer fully recovered (71.1% vs 90.3%; P =.027).

The major limitation of this study was the small sample size and therefore limited power to detect significant trends.

The researchers concluded that “COVID-19 severity and lack of complete systemic recovery were associated with new or worsening neurologic symptoms in 36.9% of MSRD patients.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Conway SE, Healy BC, Zurawski J, et al. COVID-19 severity is associated with worsened neurological outcomes in Multiple Sclerosis and Related Disorders. Mult Scler Relat Disord. Published online June 5, 2022. doi:10.1016/j.msard.2022.103946

This article originally appeared on Neurology Advisor