Background: Clinical disability is among the risk factors of a more severe coronavirus disease of 2019 (COVID-19) course in patients with multiple sclerosis (PwMS), but might provide an insensitive reflection of actual tissue pathology. Brain volume loss has emerged as a magnetic resonance imaging (MRI) proxy of neurodegeneration in PwMS. Our main objective was to investigate whether brain volume predicts COVID-19 severity in PwMS. Methods: Clinical data of PwMS followed at the Belgian National Multiple Sclerosis (MS) Center in Melsbroek are collected in a local database in case of COVID-19 diagnosis. One hundred ninety-eight unique PwMS with a suitable 3D brain MRI available, conducted maximally 24 months before their COVID-19 infection, were included. Results: An unfavorable outcome due to COVID-19 was noted in fourteen PwMS (hospitalization: 7.1 \%, death: 0.5 \%). Neither global nor regional normalized brain volumes predicted COVID-19 severity. Similar results were obtained in patients fulfilling the criteria for benign MS. Being unprotected by vaccination was the only variable significantly associated with a poor COVID-19 outcome (OR 3.7; CI 1.2–10.2). We observed a significant worsening of Symbol Digit Modality Test performance in PwMS with the lowest (Q4) whole brain volume, as compared to those with the highest (Q1) (2.2 ± 8.5 versus −1.2 ± 9.1; P = 0.037). Conclusion: Brain volume does not predict COVID-19 outcome in PwMS, including those with benign MS. Unvaccinated individuals remain susceptible to developing a more severe infection. PwMS with the most profound pre-existing brain atrophy may be at risk for cognitive deterioration after COVID-19.
De Vogelaere, J, Van Remoortel, A, Van Laethem, D, Della Faille, L, D'hooghe, MB, Van Schependom, J, Stastna, D, Uher, T, Nagels, G & D'Haeseleer, M 2025, 'Impact of brain volume on coronavirus disease of 2019 severity and subsequent cognitive decline in patients with multiple sclerosis', Journal of the Neurological Sciences, vol. 475, 123552. https://doi.org/10.1016/j.jns.2025.123552
De Vogelaere, J., Van Remoortel, A., Van Laethem, D., Della Faille, L., D'hooghe, MB., Van Schependom, J., Stastna, D., Uher, T., Nagels, G., & D'Haeseleer, M. (2025). Impact of brain volume on coronavirus disease of 2019 severity and subsequent cognitive decline in patients with multiple sclerosis. Journal of the Neurological Sciences, 475, Article 123552. https://doi.org/10.1016/j.jns.2025.123552
@article{df42cbaeae5e402ab3e1c83b3ce6ddde,
title = "Impact of brain volume on coronavirus disease of 2019 severity and subsequent cognitive decline in patients with multiple sclerosis",
abstract = "Background: Clinical disability is among the risk factors of a more severe coronavirus disease of 2019 (COVID-19) course in patients with multiple sclerosis (PwMS), but might provide an insensitive reflection of actual tissue pathology. Brain volume loss has emerged as a magnetic resonance imaging (MRI) proxy of neurodegeneration in PwMS. Our main objective was to investigate whether brain volume predicts COVID-19 severity in PwMS. Methods: Clinical data of PwMS followed at the Belgian National Multiple Sclerosis (MS) Center in Melsbroek are collected in a local database in case of COVID-19 diagnosis. One hundred ninety-eight unique PwMS with a suitable 3D brain MRI available, conducted maximally 24 months before their COVID-19 infection, were included. Results: An unfavorable outcome due to COVID-19 was noted in fourteen PwMS (hospitalization: 7.1 \%, death: 0.5 \%). Neither global nor regional normalized brain volumes predicted COVID-19 severity. Similar results were obtained in patients fulfilling the criteria for benign MS. Being unprotected by vaccination was the only variable significantly associated with a poor COVID-19 outcome (OR 3.7; CI 1.2–10.2). We observed a significant worsening of Symbol Digit Modality Test performance in PwMS with the lowest (Q4) whole brain volume, as compared to those with the highest (Q1) (2.2 ± 8.5 versus −1.2 ± 9.1; P = 0.037). Conclusion: Brain volume does not predict COVID-19 outcome in PwMS, including those with benign MS. Unvaccinated individuals remain susceptible to developing a more severe infection. PwMS with the most profound pre-existing brain atrophy may be at risk for cognitive deterioration after COVID-19.",
keywords = "Brain volume loss, COVID-19, Multiple sclerosis, Outcome, SDMT",
author = "\{De Vogelaere\}, Jens and \{Van Remoortel\}, A and \{Van Laethem\}, D and \{Della Faille\}, L and MB D'hooghe and \{Van Schependom\}, J and D Stastna and T Uher and G Nagels and M D'Haeseleer",
note = "Publisher Copyright: {\textcopyright} 2025",
year = "2025",
month = aug,
day = "15",
doi = "10.1016/j.jns.2025.123552",
language = "English",
volume = "475",
journal = "Journal of the Neurological Sciences",
issn = "0022-510X",
publisher = "Elsevier",
}