Table 1.
COVID-19 and NMOSD: Cases of para- and post-infectious disease development, relapse or pseudo-relapse.
| References | Number of patients | Diagnosis | Gender | Age | Ethnicity | Clinical presentation | AQP4-IgG status | Time from diagnosis of COVID-19 to clinical onset | Method of COVID-19 diagnosis | CSF SARS-CoV-2 PCR | Treatment of acute attack | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Barone et al. (22) | 1 | New onset | M | 35 | NA | ON + acute myositis | Positive (titer not reported) | 1 month | Clinical criteria + serology | NA | IVMP | Poor recovery of vision, full recovery of muscle symptoms |
| Batum et al. (23) | 1 | New onset | F | 50 | NA | LETM | Positive (titer not reported) | Concomitant | Clinical symptoms | NA | IVIG 0.4 g/kg for 5 days, then PLEX (10 courses every other day) + IVMP (750 mg every other day) | Some improvement in sensory function in the upper limbs, no motor improvement |
| Shaw et al. (29) | 1 | New onset | M | NA *Septuagenarian |
NA | ON + TM | Positive (titer not reported) | 9 days | SARS-CoV-2 PCR | NA | NA | Died due to sepsis and multiorgan failure |
| Chuang and Miskin (24) | 1 | New onset | NA | NA | NA | LETM + APS | Positive (titer not reported) | Neurological symptoms appeared shortly after COVID-19 diagnosis | Clinical symptoms + serology | NA | NA | NA |
| Corrêa et al. (25) | 1 | New onset | F | 51 | Caucasian | Encephalomyeloradiculitis | Positive (titer not reported) | 2 weeks | SARS-CoV-2 PCR | Negative | IVMP 1 gr X5 days followed by PLEX | Remarkable improvement |
| Nasreldein et al. (28) | 1 | New onset | F | 56 | NA | BON+ diencephalic syndrome (lethargy and disorientation) | NA | 2 weeks | SARS-CoV-2 PCR | NA | IVMP 1 gr/day (treatment duration not reported) | Deceased |
| Hooshmand et al. (27) | 1 | New diagnosis *Patient suffered from intractable emesis and visual loss 30 years prior |
M | 49 | NA | ON | Positive (1:10 by FACS assay) | 2 weeks | SARS-CoV-2 PCR | NA | NA | NA |
| Shukla et al. (30) | 1 | New onset | F | 13 | Asian | BON, APS, brainstem syndrome, cerebral syndrome | Negative | NA | Clinical criteria + serology | NA | CS, IVIG, Rituximab | Improved |
| Khair et al. (86) | 1 | New onset *Patient had an undiagnosed ADEM-like demyelinating episode 6 month prior |
F | 14 | NA | Left eye blurring of vision, neck pain, generalized fatigue, and right leg numbness | Positive (titer not reported) | Concomitant | SARS-CoV-2 PCR | NA | NA | NA |
| Ghosh et al. (26) | 1 | New onset | M | 20 | Asian-Indian | APS + LETM | Positive (titer not reported) | 5 days | SARS-CoV-2 PCR | NA | IVMP 1 gr/d for 5 days; RTX | Some improvement of the motor power in all limbs and resolution of the sensory symptoms |
| Jentzer et al. (31) | 1 | New onset | F | 71 | Caucasian | LETM | Positive (titer not reported) | 3 months | SARS-CoV-2 PCR | NA | NA | NA |
| Das et al. (32) | 1 | New onset | F | 16 | ON + LETM | Negative | 4 months | Clinical symptoms + serology | NA | IVMP + oral prednisone taper + RTX | Improvement of vision; outcome of myelopathic symptoms not reported | |
| Aubart et al. (87) | 1 *Also describes 3 MOGAD cases |
New onset | F | 14 | NA | ON | Positive (titer not reported) | NA *Inclusion criteria required positive testing for SARS-CoV-2 infection performed <6 weeks before onset of neurological symptoms or seroconversion following the symptoms with a prior history of SARS-CoV-2 exposure. |
SARS-CoV-2 PCR | NA | IVMP | Complete recovery |
| Apostolos-Pereira et al. (21) | 34 NMOSD patients who developed COVID-19 | Five patients (15%) presented neurologic manifestations (relapse or pseudo exacerbation) during or after SARS-CoV2 infection | NA | 48, 25, 16, 22, 32 | NA | 2- ON, 1-visual acuity worsening in previous ON, 1-TM, 1- not reported | 15 patients- positive; 7- negative; 7- not tested (all patients fulfilled the NMOSD diagnostic criteria). *The antibody status of the five patients who had relapse is not specified. |
In one patient neurological symptoms appeared 7 days after the viral infection, in one- concomitantly with the febrile illness, in the other 3- not reported | 18- SARS-CoV-2 PCR; 16- Clinical symptoms *The method of diagnosis of the five patients who had relapse is not specified. |
NA | 2- oral CS; 2- IVMP; 1- not reported | 3- Good recovery; 1- Poor recovery; 1- Worsening of EDSS from 4.0 to 5.0 |
APS, area postrema syndrome; BON, bilateral optic neuritis; CS, corticosteroids; IVIG, intravenous immunoglobulins; IVMP, intravenous methylprednisolone; LETM, longitudinally extensive transverse myelitis; ON, optic neuritis; PLEX, plasma exchange; RTX, rituximab; TM, transverse myelitis.