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Preprint: Neuropathic symptoms with SARS-CoV-2 vaccination, 2022, Safavi, Walitt, Oaklander, Nath et al

Discussion in 'Long Covid research' started by Andy, May 19, 2022.

  1. Andy

    Andy Committee Member

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    Location:
    Hampshire, UK
    Abstract
    Background and Objectives Various peripheral neuropathies, particularly those with sensory and autonomic dysfunction may occur during or shortly after acute COVID-19 illnesses. These appear most likely to reflect immune dysregulation. If similar manifestations can occur with the vaccination remains unknown.

    Results In an observational study, we studied 23 patients (92% female; median age 40years) reporting new neuropathic symptoms beginning within 1 month after SARS-CoV-2 vaccination. 100% reported sensory symptoms comprising severe face and/or limb paresthesias, and 61% had orthostasis, heat intolerance and palpitations. Autonomic testing in 12 identified seven with reduced distal sweat production and six with positional orthostatic tachycardia syndrome. Among 16 with lower-leg skin biopsies, 31% had diagnostic/subthreshold epidermal neurite densities (≤5%), 13% were borderline (5.01-10%) and 19% showed abnormal axonal swelling. Biopsies from randomly selected five patients that were evaluated for immune complexes showed deposition of complement C4d in endothelial cells. Electrodiagnostic test results were normal in 94% (16/17). Together, 52% (12/23) of patients had objective evidence of small-fiber peripheral neuropathy. 58% patients (7/12) treated with oral corticosteroids had complete or near-complete improvement after two weeks as compared to 9% (1/11) of patients who did not receive immunotherapy having full recovery at 12 weeks. At 5-9 months post-symptom onset, 3 non-recovering patients received intravenous immunoglobulin with symptom resolution within two weeks.

    Conclusions This observational study suggests that a variety of neuropathic symptoms may manifest after SARS-CoV-2 vaccinations and in some patients might be an immune-mediated process.

    Open access, https://www.medrxiv.org/content/10.1101/2022.05.16.22274439v1
     
    Binkie4, Hutan, Wyva and 8 others like this.
  2. Andy

    Andy Committee Member

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    21,810
    Location:
    Hampshire, UK
    Ariel, Binkie4, Hutan and 6 others like this.
  3. Hutan

    Hutan Moderator Staff Member

    Messages:
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    Location:
    Aotearoa New Zealand
    An obvious question is 'did the patients have the symptoms before the vaccination?' - the researchers do seem to have tried to exclude that possibility:
    Another is 'is the timing of symptoms appearing within a month of vaccination a coincidence'? Could the symptoms actually be related to a Covid-19 infection, or just chance? The median time for the appearance of symptoms was 4 days after vaccination.


    It's an interesting study, not least because of the people involved, and the acceptance the study seems to indicate for infectious (and now potentially non-infectious) immune challenges resulting in dysautonomia and small fibre neuropathy.
     
    Lilas, shak8, Ariel and 3 others like this.
  4. Hutan

    Hutan Moderator Staff Member

    Messages:
    26,528
    Location:
    Aotearoa New Zealand
    On potential complement involvement:
     
    Lilas, shak8, Ariel and 1 other person like this.

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