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Some long COVID symptoms were more likely for persons with multiple sclerosis (MS), traumatic brain injury (TBI), or spinal cord injury (SCI), a retrospective cohort study found.

After having COVID-19, such patients with preexisting neurologic disabling conditions were more likely than matched controls to experience new weakness (OR 1.54, 95% CI 1.19-2.00), mobility difficulties (OR 1.66, 95% CI 1.17-2.35), and cognitive dysfunction (OR 1.79, 95% CI 1.38-2.33).

The associations were despite controlling for co-morbidities, risk factors, and presence of those symptoms before infection, Liliana Pezzin, PhD, JD, of the Medical College of Wisconsin in Milwaukee, and co-authors reported in .

"Our findings lend additional support for concerns for widening health disparities among individuals with premorbid disabilities due to unique health care barriers that have been exacerbated by COVID-19," the authors wrote.

And there may be actionable clinical implications, given the overlap in symptoms between and the disabling conditions, suggested co-author Benjamin Abramoff, MD, of the University of Pennsylvania in Philadelphia.

"Clinicians should ask about persistent symptoms and not solely attribute new symptoms to patients' pre-existing disability," he told MedPage Today in an email. "New symptoms may be driven by long COVID instead and may be exacerbated in the setting of the patients' pre-existing disability."

Research to date, the authors wrote, has focused on acute COVID-19 outcomes for patients with physical disabilities, and not on long COVID. Given the similarity of long COVID and disabling condition symptoms, "it is plausible to assume that the SARS-CoV-2 infection may exacerbate such symptoms leading to a disproportional number of these persons" in the long-COVID population, they suggested.

Jeffrey Cohen, MD, of the Cleveland Clinic in Ohio, who was not involved with the study, had two interpretations of the findings: "One possibility is that the COVID triggered worsening of the multiple sclerosis or worsening of symptoms from their pre-existing brain injury," he told MedPage Today. "The other possibility is that people with those conditions are more at an increased risk of those neurologic symptoms from COVID."

This study "emphasizes the importance of continuing vaccination for COVID," Cohen said. And, he added, "attention needs to be paid to proactively managing any neurologic complications that [people with these conditions] may have, including proactive rehabilitation."

Cohen added that, because having more comorbidities was associated with worse COVID-19 outcomes in the study, "it's important for anybody, but particularly people with MS and these other conditions, to manage their comorbidities."

The study used electronic medical records data from the TriNetX Research Network to identify patients 18 or older diagnosed with COVID-19 from March to December 2020. Of the nearly 400,000 COVID-positive patients, ICD-10 codes identified 2,204 with a diagnosis of TBI, MS, or SCI in their record 6 months prior to the COVID-19 diagnosis. COVID-positive patients without these conditions were matched to them by age, sex, race, ethnicity, and comorbidities.

TBI accounted for the majority of the neurologic disabling conditions, at 51.3%, followed by MS (31.4%) and SCI (17.3%). This group averaged around age 47, with 54.7% female and 60.3% white patients. They were more likely than the overall COVID-positive population to have comorbidities and to have experienced symptoms associated with COVID even before the acute infection, including cognitive dysfunction, dyspnea, fatigue, and mobility difficulty.

Patients with the disabling conditions were more likely to have been hospitalized for acute COVID-19, especially those with a spinal cord injury.

However, the two groups had no difference in long COVID symptoms of fatigue, pain, and dyspnea or in total hospitalizations, duration of admission, or mortality in the 6 months after COVID-19 diagnosis.

The researchers were limited by an inability to capture the potential effects of disability severity on COVID-19 outcomes or the heterogeneity of patients with the same diagnoses and ICD codes. Unmeasured confounders like socioeconomic status and insurance coverage may have contributed to differences in outcomes.

It is also possible, the authors acknowledged, that the control group might have had disabling conditions other than MS, TBI, and SCI. They noted that individuals without lab-confirmed COVID-19 were excluded from the analysis, as were those with disabilities who had not encountered the healthcare system in the 6 months prior to their infection.

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