COVID-19 infections in NMOSD and MOGAD: a population based study

Background: High dose corticosteroids (HDC) are standard of care for MS relapses There is scant literature regarding whether relapse localization or timing of HDC affects relapse recovery or blood brain barrier (BBB) recovery Objectives: 1) To gather data on BBB recovery after HDC treatment using a novel CT technique measuring BBB permeability;and 2) to better understand BBB recovery and examine the clinical correlates associated with BBB recovery after HDC relapse treatment Methods: Consecutive persons with MS diagnosed with a relapse requiring HDC treatment were approached Subjects were excluded if they received HDC in the last 30 days/had started HDC, had an allergy to iodine/CT contrast, had eGFR < 35 mL/min or were diabetic, or if the relapse localized to the optic nerve Subjects underwent a CT with contrast on days 0 (before HDC), and days 2, 4, and 6 after starting HDC CT studies were analyzed to generate functional maps of blood flow, blood volume and BBB permeability Clinical evaluations (EDSS) occurred at relapse, and 4, 12, or 24 weeks after HDC Planned recruitment was 26 subjects;early termination occurred due to the COVID19 pandemic Results: Sixteen subjects agreed to participate;one subject did not to take HDC and was removed At the time of this abstract, CT data on 2 subjects had not yet been analyzed All subjects had relapsing MS, with a mean age of 33 1 (+/- 8 3) years Nine (69 2%) were female;median EDSS was 3 0 (2 0-5 0) at relapse assessment Mean number of days between symptom onset and HDC was 8 9 (SD 6 5) Relapses clinically localized to the brain (3), posterior fossa (4) or cervical spinal cord (6) Six (46 0%) of subjects demonstrated an improvement in BBB permeability early (responders), while 5 (38 5%) responded slowly and 2 (15 4) did not respond to HDC There was no significant difference between responders vs non-responders in terms of age, gender, days between onset and HDC, or relapse localization There was no significant difference between recovery (EDSS) at 4, 12, or 24 weeks between responders vs non-responders Conclusions: We did not show any difference between BBB permeability in responders vs non responders (or slow responders) after HDC treatment in terms or relapse recovery Also, there were no predictors regarding responders vs non-responders This study may have been underpowered due to early termination The finding that some subjects' BBB permeability did not respond at all to HDC warrants further exploration