The Association of Upper Respiratory Infections With Neuro-Radiological Course and Attack Rate of Multiple Sclerosis: Results From a Large Prospective Cohort Publisher



Ghasemi M¹ ; Farazandeh D¹ ; Amini B¹ ; Sedaghat M² ; Najafi A¹ ; Khayatzadeh Kakhki S¹ ; Torabi P¹ ; Jafarimehrabady N³ ; Bitaraf A⁴ ; Shariati H⁵ ; Gholampour G¹ ; Kazemi S¹ ; Naser Moghadasi A⁶ ; Vajihinejad M⁷
Source: Multiple Sclerosis Journal - Experimental# Translational and Clinical Published:2023

Abstract

Background: Although upper respiratory infections (URIs) are linked to multiple sclerosis (MS) attacks, SARS-COV2 has not been compared to URIs for attack rates. Objectives: This study aimed to evaluate the attack rate and the results of neuroimaging in MS patients with URIs caused by COVID-19 and non-COVID-19 infections (NC-URI). Methods: From May 2020 to April 2021, we followed 362 patients with relapsing-remitting MS in a prospective cohort design. Patients were monitored regularly every 12 weeks; an magnetic resonance imaging (MRI) scan was performed at enrollment and every time a relapse occurred. Poisson analysis was used to determine exacerbation rate ratios (RR) and the MRI parameters were tested using chi-square analysis. Results: 347 patients with an average age of 38 and a female ratio of 86% were included. A RR of 2.24 (p < 0.001) was observed for exacerbations during the at-risk period (ARP). Attacks related to COVID-19 (RR = 2.13, p = 0.001) and NC-URIs (RR = 2.39, p < 0.001) were comparable regarding the increased risk of exacerbation (p = 0.62). Exacerbations within or outside the ARP did not significantly alter the number of baseline GAD-enhancing lesions (p > 0.05 for both). Conclusion: COVID-19 has been shown to increase the risk of MS exacerbations, like other viral URIs. © The Author(s), 2023.