Table 1.
Demographical and clinical findings of the included studies.
| Study | Country | Type of MS | Age | Sex | MS disease duration | Clinical presentation of MS before relapse | DMTs | MRI Findings | Type COVID-19 vaccine | Vaccine dosage | Time interval between vaccination and relapse | Relapse clinical presentations | Treatments | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lagosz et al. 2022 | Poland | NR | 64 | M | NR | NR | NR | A hypodense lesion in the left frontal-parietal area | NR | NR | 1 day | Feeling numbness, worsened mobility in the arms and fatigue | Glucocorticoids | Recovered |
| Kataria et al. 2022 | USA | NR | 57 | F | 6 years | NR | Interferon-beta | Multiple confluent and distinct hyperintense white matter enhancing lesions in both hemispheres on T2-weighted and diffusion-weighted images. Spine MRI was normal. | BNT162b2/PfizerBioNTech | 2nd | 18 days | Fatigue, involuntary eye movements, numbness, tingling, stiffness in her left upper and lower limbs | Intravenous methylprednisolone and physiotherapy , baclofen | Recovered |
| Etemadifar et al. 2021 | Iran | RRMS | 34 | F | 13 years | optic neuritis and bilateral lower limb paresthesia / paraparesis | Interferon-beta 1a. | Several new periventricular, juxtacortical and brainstem lesions on T2 | Sputnik | 1st | 3 days | Severe right hemiplegia and ataxia | Oral methylprednisolone for 3 weeks | Recovered |
| Ahadi et al. 2021 | Iran | RRMS | 42 | F | 20 years | optic neuritis/ hemiparesthesia and monoparesis/ paraparesis | Interferon-beta 1b. | Showed numeral periventricular, anterior medullary white matter hyper-intensities | Sinopharm | 1st | 2 days | Progressive paraparesis without paresthesia | Intravenous methylprednisolone | Recovered |
| Maniscalco et al. 2021 | Italy | NR | 31 | F | 5 years | Tinnitus and dizziness | Fingolimod | Three new voluminous enhancing lesions | BNT162b2/PfizerBioNTech | 1st | 48 hours | Paraesthesia and weakness in her left arm and limbs | Intravenous methylprednisolone | Recovered |
| Fragoso et al. 2021 | Brazil | RRMS | 22 | F | 5 years | NR | Fingolimod | Non-Gd tumefactive lesion | Oxford/AstraZeneca | 1st | 7 days | Facial paralysis, hemiparesis, ataxia | Pulsotherapy methylprednisolone | Not yet recovered |
| RRMS | 32 | F | 2 years | NR | Dimethyl fumarate | New Gd + lesions in the left eye | Oxford/AstraZeneca | 1st | 10 days | Loss of vision and papillitis in the left eye | Pulsotherapy methylprednisolone Immunoglobulin | Partial recoved | ||
| SPMS | 35 | M | 3 years | NR | Natalizumab | High lesion load , new lesions | Oxford/AstraZeneca | 1st | 7 days | Worsening of disability, could not walk, severe weakness of both legs | Oral prednisone | Not yet recovered | ||
| RRMS | 30 | F | 1 year | NR | Natalizumab | New Gd + lesions | Oxford/AstraZeneca | 1st | 25 days | Right hemiparesis | Pulsotherapy methylprednisolone | Recovered | ||
| RRMS | 42 | F | 3 years | NR | Fingolimod | New Gd+ lesions in spinal cord, T2 level | Oxford/AstraZeneca | 1st | 15 days | Rapidly progressive weakness in both arms , grade III at its worst | Pulsotherapy methylprednisolone | Recovered | ||
| RRMS | 35 | M | 4 years | NR | Teriflunomide | New Gd+ lesions in brainstem | Oxford/AstraZeneca | 1st | 20 days | Incoordination of right arm and hand | Pulsotherapy methylprednisolone | Not yet recovered | ||
| PPMS | 51 | M | 2 years | NR | NR | New Gd+ lesions in cervical cord | Oxford/AstraZeneca | 1st | 25 days | Hypoesthesia in both arms | No treatment | Not yet recovered | ||
| RRMS | 32 | F | 6 years | NR | Glatiramer acetate | New Gd+ lesions+ new lesions | Oxford/AstraZeneca | 1st | 7 days | Motor and sensitive deficits in right leg and foot | Pulsotherapy methylprednisolone | Not yet recovered | ||
| Nistri et al. 2021 |
Italy |
NR | 48 | F | New diagnosis | visual acuity deficit from right eye | NR | Enhancing lesion in the corpus callosum, multiple white matter unenhanced lesions and lesions in the occipital lobe were detected | Oxford/AstraZeneca | 1 st | 8 days | Visual acuity deficit from right eye | High dose of intravenous methylprednisolone | Recovered |
| NR | 45 | M | 9 years | NR | Ocrelizumab | Two new lesions in the temporal gyri and a new spinal cord lesion at T3 level | Oxford/AstraZeneca | 1st | 3 weeks | Dysesthesia in both legs | Steroids | NR | ||
| NR | 54 | F | 28 years | NR | NR | One enhancing lesion in the spinal cord | Oxford/AstraZeneca | 1 st | 3 days | Developed hypoesthesia below the T6 level | Intravenous methylprednisolone | Recovered | ||
| NR | 66 | F | New diagnosis | visual disturbance and postural instability on the right limbs | NR | Multiple white matter lesions, four of them enhancing in the left paratrigonal and periventricular white matter | Oxford/AstraZeneca | 1 st | 1 week | Visual disturbance and postural instability on the right limbs | Intravenous methylprednisolone | Partial recovered | ||
| NR | 42 | F | 2 years | progressive weakness on the right side of body | Ocrelizumab | Enhancing brain lesion in the right corona radiata | Moderna | 1 st | 2 weeks | Slight weakness of the left upper limb | NR | NR | ||
| NR | 57 | M | 20 yeas | NR | NR | Enhancing pontine lesion | Moderna | booster | 2 weeks | Severe motor deficit in both legs | Intravenous methylprednisolone | Partial recovered | ||
| NR | 49 | F | 8 years | NR | Dimethyl fumarate | A periventricular lesion and a spinal lesion at C3 level, both enhancing | BNT162b2/PfizerBioNTech | 1 st | 5 days | Numbness on the left hand and left side of her head | Intravenous methylprednisolone | Recovered | ||
| NR | 39 | M | 7 years | hypoesthesia on left side | Dimethyl fumarate | Three new lesions, two of which were enhancing in the left parietal lobe and in the periventricular white matter | BNT162b2/PfizerBioNTech | 1st | 10 days | Paresthesia on left leg | Oral steroids | Partial recoverd | ||
| NR | 39 | F | New diagnosis | NR | NR | A new enhancing lesion in the mesencephalon | BNT162b2/PfizerBioNTech | 1st | 3 days | Dysesthesia on her right hand and foot | Intravenous methylprednisolone | Recovered | ||
| NR | 60 | F | 23 years | NR | Dimethyl fumarate | One enhancing brain lesion in the left periventricular white matter | BNT162b2/PfizerBioNTech | 1st | 2 days | Fatigue and numbness in both legs | NR | NR | ||
| NR | 30 | F | 3 years | optic neuritis | Cladribine | Two enhancing brain lesions, one in the right corona radiata and one with conspicuous oedema in the left centrum semiovale | BNT162b2/PfizerBioNTech | booster | 20 days | Language disturbance | NR | NR | ||
| NR | 58 | F | 21 years | NR | NR | A new area with ring enhancement in the white matter of the left frontal lobe | BNT162b2/PfizerBioNTech | 1st | 3 days | Headache, balance disturbance, urinary incontinence, difficulties in walking and dysphagia | Intravenous methylprednisolone | Recovered | ||
| NR | 34 | F | 3 months | numbness and hyposthenia on her right hand | NR | Three brain enhancing lesion (one right posterior paraventricular and two in the left periventricular white matter) and a new unenhanced lesion on spinal cord | BNT162b2/PfizerBioNTech | booster | 4 days | Neck pain and hypoesthesia on right arm | NR | NR | ||
| NR | 35 | F | 16 years | NR | Dimethyl fumarate | Three enhancing lesions in the left temporal lobe and left centrum semiovale | BNT162b2/PfizerBioNTech | booster | 1 day | Paresthesia on the left side of body | NR | NR | ||
| NR | 54 | M | 18 years | NR | Teriflunomide | Two ring-enhancing lesions located in the left periventricular white matter | bNT162b2/PfizerBioNTech | 1st | 1 week | Right hemiparesis | Intravenous methylprednisolone | Recovered | ||
| NR | 37 | M | 2 years | NR | Dimethyl fumarate | A new tumefactive contrast-enhancing lesion in the left fronto-parietal white matter | BNT162b2/PfizerBioNTech | booster | 11 days | Weakness on right limbs | Intravenous methylprednisolone | Partial recovered |
Abbreviations: NR, Not Reported, RRMS, relapsing remitting multiple sclerosis; SPMS, secondary progressive multiple sclerosis; PPMS, primary progressive multiple sclerosis, DMTs, disease modyfing therapies.