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Updated: Jun 15, 2025
A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data
Published on: December 9, 2015
Infection, Relapses, and Pseudo-Relapses in Individuals With Multiple Sclerosis
Amber Salter1,2, Samantha Lancia1, Mudita Sharma1
1Department of Neurology, Section on Statistical Planning and Analysis, University of Texas Southwestern, Dallas.
Background And Objectives:
Infections are associated with an increased risk of relapse and pseudo-relapse in persons with multiple sclerosis (MS). However, the relationship with relapses and pseudo-relapses after SARS-CoV-2 infections (COVID) vs other infections in MS is poorly understood. Therefore, we compared the occurrence of relapse and pseudo-relapse after COVID and other infections with noninfected participants with MS.
Methods:
In spring 2023, we surveyed participants from the North American Research Committee on Multiple Sclerosis Registry regarding whether they had had a COVID infection, other infections, relapses, and pseudo-relapses. Recent infections, occurring in the 6 months before the survey, were used to categorize participants into groups: recent COVID, non-COVID infection (with no history of ever having COVID), COVID and non-COVID infections, or uninfected.
Results:
Of the 4,787 participants eligible for analysis, 2,927 participants were included, of whom 294 (10%) had a recent COVID infection; 853 (29.1%) had 1 recent infection other than COVID; 246 (8.4%) had a recent COVID and non-COVID infection; and 1,534 (52.4%) had no infection with COVID nor any infection within the past 6 months (uninfected). Compared with no infections, non-COVID infection was associated with a 39% increased likelihood of relapse (1.39, 95% CI [1.04-1.87]), whereas a recent COVID infection was associated with a decreased likelihood of relapse (0.45 [0.23, 0.87]), adjusting for covariates. All infection groups were associated with increased odds of pseudo-relapse compared with the uninfected group (non-COVID infections: 1.78 [1.44, 2.20]; COVID infection: 1.80 [1.32, 2.45]; COVID and non-COVID infection: 3.04 [2.24, 4.12]).
Discussion:
Because individuals with MS are at increased risk of infections, the association of infections with relapses and pseudo-relapses is clinically important. The high prevalence of acute worsening after infection, regardless of the type of infection, compared with those with no reported infection, needs to be considered in the management of persons with MS.
Insights
Infections in multiple sclerosis (MS) patients increase relapse risk, with non-COVID infections raising it by 39%. COVID-19 infections, however, showed a decreased relapse likelihood. All infections significantly raised pseudo-relapse risk.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Infections are known to increase relapse and pseudo-relapse risk in multiple sclerosis (MS).
- The specific impact of SARS-CoV-2 (COVID-19) infections versus other infections on MS relapses is not well understood.
- Understanding these associations is crucial for managing MS patients, who are more susceptible to infections.
Purpose of the Study:
- To compare the occurrence of relapse and pseudo-relapse following COVID-19 infections versus other infections in individuals with MS.
- To analyze the relationship between different types of recent infections and subsequent neurological events in MS.
Main Methods:
- A survey was conducted in spring 2023 among participants in the North American Research Committee on Multiple Sclerosis Registry.
- Participants were categorized based on recent infections (COVID-19, non-COVID, both, or none) within the prior 6 months.
- Statistical analysis compared relapse and pseudo-relapse rates across infection groups, adjusting for covariates.
Main Results:
- Non-COVID infections increased relapse likelihood by 39% (OR 1.39), while COVID-19 infections decreased it (OR 0.45).
- All infection groups showed significantly increased odds of pseudo-relapse compared to uninfected individuals (ORs ranging from 1.78 to 3.04).
- Out of 2,927 participants, 10% had recent COVID-19, 29.1% had non-COVID infections, 8.4% had both, and 52.4% were uninfected.
Conclusions:
- Infections, regardless of type, are associated with a higher risk of pseudo-relapse in MS patients.
- While non-COVID infections elevate relapse risk, COVID-19 may decrease it, warranting further investigation.
- Clinical management of MS should consider the heightened risk of acute worsening following any infection.
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