Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar;31(3):314-323.
doi: 10.1177/13524585241310104. Epub 2025 Jan 3.

Post-acute sequela of COVID-19 infection in individuals with multiple sclerosis

Amber Salter  1   2 , Samantha Lancia  1 , Gary R Cutter  3 , Robert J Fox  4 , Ruth Ann Marrie  5   6
Affiliations

Post-acute sequela of COVID-19 infection in individuals with multiple sclerosis

Amber Salter et al. Mult Scler. 2025 Mar.

Abstract

Background: Many common symptoms in post-acute sequelae following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) overlap with those of multiple sclerosis (MS). We examined symptoms and performance of the PASC score, developed in the general population, in MS based on infection history.

Methods: We surveyed North American Research Committee on Multiple Sclerosis (NARCOMS) registry participants regarding infections and categorized participants based on infection history. Symptoms experienced before, during, and after infection were used to identify persistent new symptoms. PASC was defined as a score ⩾ 12 based on the National Institutes of Health (NIH) study RECOVER.

Results: Of 4787 participants surveyed, 2927 were included: 294 (10%) having recent COVID-19; 853 (29.1%) recent non-COVID-19 infection; 246 (8.4%) recent COVID-19 and non-COVID-19 infection; 1534 (52.4%) uninfected, defined as never having COVID-19 nor any infection within the past 6 months. Compared to those uninfected, infection groups reported at least a two-fold increase in fever, cough, loss of smell/taste, and shortness of breath. Based on persistent new symptoms, PASC was identified in only 1.5% of participants with COVID-19.

Conclusion: Our study suggests lower than expected prevalence of PASC in MS and a complex association between infections and development of new persistent symptoms following infections. The similar proportions classified with PASC across infection groups shows that symptoms of PASC are common and complicate assessment of PASC in MS.

Keywords: COVID-19; SARS-CoV-2; multiple sclerosis; post-acute sequela; symptoms.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Amber Salter receives research funding from Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, CMSC and the Department of Defense Congressionally Directed Medical Research Program and is a member of editorial board for Neurology. She serves as a consultant for Gryphon Bio, LLC, Sora Neuroscience and Abata Therapeutics. She has equity in Owl Therapeutics. She is a member of the Data and Safety Monitoring Board for Premature Infants Receiving Milking or Delayed Cord Clamping (PREMOD2), Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS), Video Telehealth Pulmonary Rehabilitation to Reduce Hospital Readmission in Chronic Obstructive Pulmonary Disease (Tele-COPD) and Methotrexate treatment of Arthritis caused by Chikungunya virus (MARCH). She is supported (in part) by a Biostatistics/Informatics Junior Faculty Award (BI-2105-37656) from the National Multiple Sclerosis Society. She holds the Kenney Marie Dixon-Pickens Distinguished Professorship in Multiple Sclerosis Research. Samantha Lancia has nothing to disclose. Gary Cutter serves on Data and Safety Monitoring Boards for Applied Therapeutics, AI therapeutics, AMO Pharma, Astra-Zeneca, Avexis Pharmaceuticals, Biolinerx, Brainstorm Cell Therapeutics, Bristol Meyers Squibb/Celgene, CSL Behring, Galmed Pharmaceuticals, Green Valley Pharma, Horizon Pharmaceuticals, Immunic, Karuna Therapeutics, Mapi Pharmaceuticals LTD, Merck, Mitsubishi Tanabe Pharma Holdings, Opko Biologics, Prothena Biosciences, Novartis, Regeneron, Sanofi-Aventis, Reata Pharmaceuticals, Teva Pharmaceuticals, NHLBI (Protocol Review Committee), University of Texas Southwestern, University of Pennsylvania, Visioneering Technologies, Inc., Consulting or Advisory Boards for Alexion, Antisense Therapeutics, Biogen, Clinical Trial Solutions LLC, Entelexo Biotherapeutics, Inc., Genzyme, Genentech, GW Pharmaceuticals, Immunic, Immunosis Pty Ltd, Klein-Buendel Incorporated, Merck/Serono, Novartis, Perception Neurosciences, Protalix Biotherapeutics, Regeneron, Roche, SAB Biotherapeutics. He is employed by the University of Alabama at Birmingham and President of Pythagoras, Inc. a private consulting company located in Birmingham AL. Robert Fox receives personal consulting fees from AB Science, Biogen, Bristol Myers Squibb, EMD Serono, Genentech, Genzyme, Greenwich Biosciences, Immunic, INmune Bio, Janssen, Lily, Novartis, Sanofi, Siemens, and TG Therapeutics; clinical trial contract and research grant funding from Biogen, Novartis, and Sanofi. Ruth Ann Marrie receives research funding from: CIHR, MS Canada, Crohn’s and Colitis Canada, National Multiple Sclerosis Society, CMSC, the Arthritis Society, Pfizer Foundation and the US Department of Defense, and is a co-investigator on studies receiving funding from Biogen Idec and Roche Canada. She holds the Waugh Family Chair in Multiple Sclerosis and serves on the editorial board of Neurology.

Figures

Figure 1.
Figure 1.
Recent COVID versus no infection. Recent COVID-19 was defined as those participants reporting COVID-19 within 6 months of survey completion.
Figure 2.
Figure 2.
Non-COVID infection versus no infection. Recent non-COVID infection is defined as a participant reporting if they had any of the non-COVID-19 infections in the past 6 months.
Figure 3.
Figure 3.
Recent COVID-19 and non-COVID-19 infection versus no infection.
Figure 4.
Figure 4.
Percentage of participants in each infection group meeting the definition of PASC based on the RECOVER score.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization. Coronavirus disease (COVID-19): Post COVID-19 condition. https://www.who.int/news-room/questions-and-answers/item/coronavirus-dis...
    1. Proal AD, VanElzakker MB. Long COVID or post-acute sequelae of COVID-19 (PASC): An overview of biological factors that may contribute to persistent symptoms. Front Microbiol 2021; 12: 698169. - PMC - PubMed
    1. Buoite Stella A, Furlanis G, Frezza NA, et al.. Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: A prospective multidomain observational study. J Neurol 2022; 269: 587–596. - PMC - PubMed
    1. Thaweethai T, Jolley SE, Karlson EW, et al.. Development of a definition of postacute sequelae of SARS-CoV-2 infection. JAMA 2023; 329: 1934–1946. - PMC - PubMed
    1. Choutka J, Jansari V, Hornig M, et al.. Unexplained post-acute infection syndromes. Nat Med 2022; 28: 911–923. - PubMed

LinkOut - more resources