OBJECTIVE: The impact of SARS-CoV-2 infection on brain and spinal cord pathology in patients with multiple sclerosis (pwMS) remains unclear. We aimed to describe changes in brain lesion activity and brain and spinal cord volumes following SARS-CoV-2 infection. METHODS: We included 177 pwMS (570 MRI scans) diagnosed with and tested positive for SARS-CoV-2 infection between August 2020 and May 2021. All patients were free of clinical disease activity, disease-modifying therapy changes, and corticosteroids during the study. MRI scans were performed using a standardized protocol on a 3-Tesla scanner. We analyzed the effect of SARS-CoV-2 on brain lesion load accrual and brain and spinal cord volume measures using adjusted mixed-effect models. RESULTS: During SARS-CoV-2 infection, patients had a median disease duration of 14.2 years, a median age of 44.9 years, and a median Expanded Disability Status Scale of 2.0. SARS-CoV-2 infection did not lead to any changes in the number or volume of T1 or T2 lesions in the brain. However, SARS-CoV-2 was associated with an increased whole brain (B = -0.17; SE = 0.08; p = 0.028), grey matter (B = -0.25; SE = 0.12; p = 0.040), and cortical grey matter volume loss (B = -0.32; SE = 0.13; p = 0.014). Greater ventricular enlargement following SARS-CoV-2 infection was evident only in individuals over the age of 40 (interaction of age vs. ventricular enlargement: B = 0.17; SE = 0.05; p = 0.0003). Only patients with more severe SARS-CoV-2 infection showed a reduction in mean upper cervical cord area (MUCCA) (B = 1.14; SE = 0.52; p = 0.030). INTERPRETATION: SARS-CoV-2 infection in clinically stable pwMS was linked to increased neuronal tissue loss.

Buffalo Neuroimaging Analysis Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo New York USA

Danish Multiple Sclerosis Registry Department of Neurology Copenhagen University Hospital Rigshospitalet Glostrup Denmark

Department of Neurology and Centre of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czechia

Department of Neurology Faculty of Medicine Slovak Medical University Bratislava Slovakia

Department of Radiology 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czechia

IRCCS Fondazione Don Carlo Gnocchi ONLUS Milan Italy

National Multiple Sclerose Centrum Melsbroek Belgium

Universitair Ziekenhuis Brussel Department of Neurology Brussels Belgium

Vrije Universiteit Brussel Research Group Brussels Belgium

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