As a neurologist, I have spent the past year and a half observing the various and widespread effects of the SARS-CoV-2 virus. As we have progressed through 2021, researchers and the medical community have come to a much greater understanding about the effects of SARS-CoV-2 and COVID-19 illness on the brain and nervous system.
We have also gained much more information about the potential neurologic risks of vaccination. I continue to see a lot of confusion in the community as to what risks exist. Given that one in seven people in our community lives with a neurologic disease, I feel it is important to provide as much information as possible on how COVID-19, and the vaccine, affect the nervous system.
The major takeaway from the massive amount of research articles and databases that track patients with neurologic diseases is that there are absolutely NO contraindications to receiving the Pfizer or Moderna mRNA COVID-19 vaccines in any patient with neurologic disease.
I’d like to break down this statement by reviewing some of the more common neurologic diseases in our community and some of the more feared neurological side effects:
Guillain-Barré syndrome (GBS) is a rare, rapidly progressive neuropathy causing weakness and numbness that commonly follows a viral illness (usually diarrheal or respiratory). In the 1970s, there was an increased risk of acquiring GBS from a variation of the flu vaccine. My godmother almost died from a severe case of GBS related to the 1970s flu vaccine, and for the remainder of her life, she was terrified of receiving any vaccine. Should she receive the COVID-19 vaccine? Yes.
The COVID-19 vaccine does not appear to increase the risk for GBS, and I am not currently aware of any cases of GBS associated with the vaccine occurring in Laramie County. I have encouraged all my patients with a history of GBS to receive a COVID-19 vaccine, including my own godmother, and none have had any side effects or recurrence of GBS.
Data out of Israel is also convincing. The study, which followed 702 patients with a history of GBS who received the Pfizer mRNA COVID-19 vaccine, shows that only one patient had mild recurrence of GBS symptoms. This provides further evidence that history of GBS is not a contraindication to receiving the COVID-19 vaccine.
On the other hand, COVID-19 illness appears to cause GBS, but, similar to other viruses, the risk is low. Thus far in Laramie County, I have cared for four definite and one probable case of GBS related to the COVID-19 illness.
Neuromuscular diseases pose a higher risk for complications from COVID-19, as these diseases often weaken respiratory muscles, rendering the patient more vulnerable to more severe forms of respiratory illnesses. Pneumonia is a common cause of death in this population. In diseases such as ALS (Lou Gehrig’s disease) and myasthenia gravis, there is a much higher rate of hospitalization and death from COVID-19 pneumonia. The COVID-19 vaccine does not pose any increased risk of worsening of neurologic disease for these patients.
Persons with seizures or epilepsy are at no clear increased risk of seizures with the COVID-19 vaccines or with the COVID-19 illness itself. Fevers and infections of any sort can lower the seizure threshold in a susceptible individual, particularly the young and the elderly, so it is always possible for a person with a seizure disorder to have a seizure in the setting of any severe infection.
While the link between stroke and COVID-19 is still being investigated, COVID-19 does appear to increase the risk for stroke in some people, including young persons who have no other underlying reason to have a stroke. In just the past month, Cheyenne Regional Medical Center has identified ischemic stroke in three patients who were hospitalized for COVID-19 pneumonia. There are many reasons why this can happen, including an increased risk for clotting, in general, an increase in inflammation and damage to the lining of blood vessels, cytokine release during the inflammatory response and variations in the receptors in the brain that the SARS-CoV-2 virus can bind to.
There is no increased risk of stroke or cerebral venous thrombosis with the mRNA COVID-19 vaccines. The Johnson & Johnson vaccine is not recommended in most women under age 60 because of the rare potential risk of cerebral venous thrombosis in young women.
Many patients with multiple sclerosis (MS) are on immunosuppressive medications, which increase the risk for many different types of infections, including more severe COVID-19 infections. Immunosuppressive medications also can potentially reduce the effectiveness of the vaccine, which can result in breakthrough COVID-19 illness, despite vaccination. I have been encouraging these patients to get vaccine boosters, as data show that a booster will improve immunity in this population.
There is an active database tracking all MS patients who get COVID-19, so we encourage any cases of COVID-19 in MS patients to be reported by their medical provider. Thus far, there is no evidence that the COVID-19 vaccines approved in the United States can trigger MS or any type of central nervous system inflammation or demyelination.
There were some cases of spinal cord inflammation in the AstraZeneca vaccine clinical trial, but this vaccine is not approved in the United States. The AstraZeneca vaccine is a live attenuated vaccine, which poses a higher risk of triggering an autoimmune response; this type of response would not be expected with an mRNA vaccine due to the mechanism of the vaccine.