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. 2022 Apr:60:103739.
doi: 10.1016/j.msard.2022.103739. Epub 2022 Mar 13.

COVID-19 vaccine associated demyelination & its association with MOG antibody

M Netravathi  1 , Kamakshi Dhamija  2 , Manisha Gupta  2 , Arina Tamborska  3 , A Nalini  2 , V V Holla  2 , L K Nitish  2 , Deepak Menon  2 , P K Pal  2 , V Seena  2 , Ravi Yadav  2 , M Ravindranadh  2 , Arshad Faheem  2 , J Saini  4 , Anita Mahadevan  5 , Tom Solomon  3 , Bhagteshwar Singh  6
Affiliations

COVID-19 vaccine associated demyelination & its association with MOG antibody

M Netravathi et al. Mult Scler Relat Disord. 2022 Apr.

Abstract

Background: ChAdOx1-S (Covishield™/Vaxzervria, AstraZeneca) and BBV152 (Covaxin) SARS-CoV-2 vaccines are proven to be safe and effective, but rare complications have been reported.

Objective: To describe reports of central nervous system (CNS) demyelination following ChAdOx1-S and BBV152 vaccinations.

Methods & results: We report 29 (17 female; mean 38 years) cases of CNS demyelination; twenty-seven occurred in temporal association with ChAdOx1-S vaccine; two in association with BBV152 vaccine. Eleven patients had presentation with myelitis, six patients developed optic neuritis, five had acute demyelinating encephalomyelitis, three presented with brainstem demyelination, and four had multiaxial involvement. Myelin oligodendrocyte glycoprotein (MOG) antibodies were positive in ten patients. One patient with ADEM and tumefactive demyelinating lesions died after a prolonged intensive care unit stay and superimposed infection. As compared to the control group (87); the postvaccinial cases were found to have a significantly higher mean age, presence of encephalopathy (p value:0.0007), CSF pleocytosis (p value: 0.0094) and raised CSF protein (p value: 0.0062).

Conclusions: It is difficult to establish a causal relationship between vaccination and neurological adverse events such as demyelination. The temporal association with the vaccination and the presence of MOG antibodies raises the possibility of an immunogenic process triggered by the vaccine in susceptible individuals.

Keywords: CNS DEMYELINATION; COVID-19; MOG; SARS-CoV-VACCINE.

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Conflict of interest statement

None

None of the authors have any financial disclosure or Conflicts of interest.

Figures

Fig 1
Fig 1
A-E: MRI brain axial images of patient 3: shows T1 hypo to isointense (A), T2/FLAIR (B,C) hyperintensity lesion in bilateral frontoparietal parasagittal region. Diffusion images (D) shows restriction at periphery, same region showing T1 post contrast (E) patchy as well as open ring enhancement suggestive of tumefactive demyelination. F,G,H: MRI Brain axial images of patient 1: T2 FLAIR (F) sequence showing right optic nerve hyperintensity throughout the intraorbital segment with anterior-most portion showing diffusion restriction (G). The intraorbital segment shows T1 post contrast enhancement (H). I,J: MRI Brain axial images of patient 16: T2 Flair hyperintense (I) left middle cerebellar peduncle lesion with diffusion restriction (J). K, L: MRI brain (K) and spine (L) of patient 16: T2/FLAIR hyperintense lesions in bilateral anterior temporal poles (right more than left), occipital juxtacortical white matter. Spinal cord showing T2 hyperintense short segment lesion at C6 cervical cord. M,N: MRI spine (M, N) of patient 2: T1 isointense and T2 hyperintense (M) long segment hyperintensity extending from C2 to lower dorsal cord with no post contrast enhancement. Axial section (N) at C3 level showing central cord T2 hyperintensity –H Pattern.
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Comment in

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