Co-VAN study: COVID-19 vaccine associated neurological diseases- an experience from an apex neurosciences centre and review of the literature. (February 2023)

• Record Type: Journal Article
• Authors: Samim, M.M.; Dhar, Debjyoti; Arshad, Faheem; Anudeep, D.D.S.; Patel, Vishal G.; Neeharika, Sriram Ramalakshmi; Dhamija, Kamakshi; Ravindranath, Chowdary Mundlamuri; Yadav, Ravi; Raja, Pritam; Netravathi, M.; Menon, Deepak; Holla, Vikram V.; Kamble, Nitish L.; Pal, Pramod K.; Nalini, Atchayaram; Vengalil, Seena
• Is Part Of: Journal of clinical neuroscience. Volume 108(2023)
• Page Start: 37
• Page End: 75
• Publication Date: 2023-02
• Subjects: COVID19 -- COVID19 vaccination -- SARS-CoV2 vaccine -- AEFI -- Vaccine side effect; ACE-2 angiotensin-converting enzyme 2 -- ADEM Acute disseminated encephalomyelitis -- AEFI Adverse events following immunization -- AHEM Acute haemorrhagic encephalomyelitis -- BBB blood–brain barrier -- CLOCC Cytotoxic Lesion of the Corpus Callosum -- COVID-19 Coronavirus disease 2019 -- CSF cerebrospinal fluid -- EEG electroencephalography -- GBS Guillain-Barré syndrome -- IVIg intravenous immunoglobulin -- IQR Interquartile range -- MeSH Medical Subject Headings -- MS Multiple Sclerosis -- MOG anti-Myelin oligodendrocyte-glycoprotein -- MOGAD MOG associated demyelination -- NMDAR N-methyl-d-aspartate receptor -- NMO neuromyelitis optica -- NMOSD Neuromyelitis optica spectrum disorders -- OCB oligoclonal bands -- PLEX plasma exchange -- RTPCR reverse transcriptase polymerase chain reaction -- SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 -- SD Standard deviation -- VGKC voltage-gated potassium channel -- VVr viral vector replicating -- VVnr viral vector non-replicating -- WHO GACVS World Health Organization Global Advisory Committee on Vaccine safety; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2022.12.015
• Languages: English
• ISSNs: 0967-5868

Abstract

Graphical abstract: Highlights: We retrospectively reviewed neurologic syndromes in temporal association with COVID-19 vaccination. The spectrum comprised CNS demyelination, Guillain Barre syndrome, stroke, encephalitis and myositis. Female sex had a greater pre-disposition. Majority of neurologic events occurred after the first dose (79.3%). Majority of the patients had favourable clinical outcome at discharge. The incidence of adverse events following COVID-19 vaccination is low and hence the benefits outweigh the risk. Abstract: Background: Recent studies have shown various neurological adverse events associated with COVID-19 vaccine. Objective: We aimed to retrospectively review and report the neurological diseases temporally associated with COVID-19 vaccine. Methods: We performed a retrospective chart review of admitted patients from 1st February 2021 to 30th June 2022. A total of 4672 medical records were reviewed of which 51 cases were identified to have neurological illness temporally associated with COVID-19 vaccination. Results: Out of 51 cases, 48 had probable association with COVID-19 vaccination while three had possible association. Neurological spectrum included CNS demyelination (n = 39, 76.5 %), Guillain-Barré-syndrome (n = 3, 5.9 %), stroke (n = 6, 11.8 %), encephalitis (n = 2, 3.9 %) and myositis (n = 1, 2.0 %). Female gender had a greater predisposition (F:M, 1.13:1). Neurological events were more commonly encountered after the first-dose (n = 37, 72.5%). The mean latency to onset of symptoms was 13.2 ± 10.7 days after the last dose of vaccination. COVIShield (ChAdOx1) was the most commonly administered vaccine (n = 43, 84.3 %). Majority of the cases with demyelination were seronegative (n = 23, 59.0 %) which was followed by anti-Myelin oligodendrocyte-glycoprotein associated demyelination (MOGAD) (n = 11, 28.2 %) and Neuromyelitis optica (NMOSD) (n = 5, 12.8 %). Out of 6 Stroke cases, 2 cases (33.3 %) had thrombocytopenia and coagulopathy. At discharge, 25/51 (49.0 %) of the cases had favourable outcome (mRS 0 to 1). Among six patients of stroke, only one of them had favourable outcome. Conclusion: In this series, we describe the wide variety of neurological syndromes temporally associated with COVID-19 vaccination. Further studies with larger sample size and longer duration of follow-up are needed to prove or disprove causality association of these syndromes with COVID-19 vaccination.