Multiple Sclerosis Disease Activity in Patients Not Exacerbated by COVID-19

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In a retrospective study, researchers determined whether the COVID-19 pandemic and COVID-19 infection affects disease course in patients with MS.

Multiple sclerosis (MS) disease activity likely did not increase during the COVID-19 pandemic, according to findings of a retrospective study published in Multiple Sclerosis and Related Disorders.

Infection with SARS-CoV-2 can have central nervous system pathology which could potentially exacerbate diseases of the nervous system, such as MS. To evaluate whether the COVID-19 pandemic and infection with COVID-19 has affected MS disease course, researchers at King Faisal Specialist Hospital and Research Center in Saudi Arabia retrospectively reviewed patient records. Patients (N=301) with MS who were seen at the center between 2017 and 2021 were evaluated for disease activity before and during the pandemic and for data about COVID-19 infection.

The study population comprised 72% women or girls, aged mean 38 (standard deviation [SD], 11) years, median Expanded Disability Status Scale (EDSS) score was 0.5 (range, 0-8), and most patients (n=270) had relapsing-remitting MS.

Most patients (n=256) were on disease modifying treatment, among whom 77% had moderate to high efficacy from their treatment and 16% reported poor treatment compliance.

Prior to the pandemic, 51% of patients had clinical relapse or radiological activity. During the pandemic, 26% had relapse or activity. These rates indicated that disease activity was worse prior to the pandemic (adjusted odds ratio [aOR], 3.1; 95% CI, 1.41-7.14; P =.005).

Significant reductions in disease activity were reported during the pandemic among patients aged 35 years and older (P =.01), with an EDSS score of 1.5 or lower (P =.03), an EDSS score of 1.6 or more (P =.03), and patients on treatment (P =.03).

A total of 30 patients tested positive for COVID-19. More men (43% vs 27%; P =.05) with lower EDSS scores (mean, 0.6 vs 1.7; P =.01) were infected with SARS-CoV-2.

Stratified by COVID-19 status, no differences in the probability of a relapse free state (P =.27) or probability of a stable magnetic resonance imaging (P =.68) were observed.

Following infection, no clinical characteristics associated with clinical relapse. Significant predictors of radiological activity after infection were age (OR, 0.96; 95% CI, 0.93-0.99; P =.03) and EDSS score (OR, 1.19; 95% CI, 1.02-1.39; P =.03).

The major limitation of this study was that interruptions during the COVID-19 pandemic may have led to under reporting.

“MS disease activities did not increase during the pandemic, yet the apparent decrease in the disease activities is probably due to under reporting and not a real decrease in disease activities because of the pandemic,” the researchers concluded.

Despite the findings, the researchers advise patients with MS to follow the standard precautions to reduce the risk for COVID-19 transmission in the community.


Babtain F, Bajafar A, Nazmi O, et al. The disease course of multiple sclerosis before and during COVID-19 pandemic: A retrospective 5-year study. Mult Scler Relat Disord. Published online June 20, 2022. doi:10.1016/j.msard.2022.103985