Amid the crisis of COVID-19 pandemic, patients with certain underlying conditions including neurological diseases are at greater risk of developing severe illness if they become infected with COVID-19. More importantly, patients with pre-existing neurological conditions are more susceptible to life-threatening complications, such as pneumonia and acute respiratory distress syndrome, leading to increased mortality rates. Therefore, COVID-19 vaccination is highly recommended for these patients in order to minimize the risk of infections while decreasing disease severity. Although, most patients with neurological conditions are eligible for COVID-19 vaccination, it remains important for them to re-confirm their current health circumstances with their neurologists. 

Recommendations for patients with neurological disorders and conditions are as follows: 

1. Patients with neurovascular conditions, such as ischemic stroke and hemorrhagic stroke

  • Patients who have been regularly taking antiplatelet drugs (e.g. aspirin, clopidogrel and cilostizol), it is advised to use a fine needle while administrating the vaccine intramuscularly to prevent bleeding. Rubbing or massaging after vaccination must be avoided.   
  • Patients who have been regularly taking anticoagulant drugs (e.g. warfarin and new oral anticoagulants), it is advised to use a fine needle while administrating the vaccine intramuscularly to prevent bleeding. Rubbing or massaging after vaccination must be avoided. Particularly for patients who have been taking warfarin, INR level needs to be monitored and it must fall below 3 prior to vaccination. 

Please note: 

  • Neurovascular diseases are not considered a contraindication to COVID-19 vaccination.
  • If symptoms are exacerbating or unstable, vaccination should be postponed until the conditions have fully improved. 
  • Current medications can be taken as prescribed without discontinuation.

2. Patients with epilepsy, dementia, Parkinson’s disease, inherited neuromuscular disorders and migraine headache  

  • After being vaccinated, fever might develop. Vaccines can also trigger headaches. Paracetamol or pain killer drugs (non-steroidal anti-inflammatory drugs or NSAIDs) can be taken as prescribed.  

Please note: 

  • Epilepsy, dementia, Parkinson’s disease, inherited neuromuscular disorders and migraine headache are not considered a contraindication to COVID-19 vaccination.
  • Current medications can be taken as prescribed without discontinuation.

3. Autoimmune neurological disorders 

  • Autoimmune encephalitis
  • Multiple Sclerosis, neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and myelitis 
  • Acute inflammatory demyelinating polyneuropathy (AIDP), Guillain-Barre Syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP)
  • Myositis and myasthenia gravis
  • Bell’s palsy and cranial neuritis

Please note: 

  • Autoimmune neurological disorders are not considered a contraindication to COVID-19 vaccination.
  • If symptoms flare up or the conditions are unstable and fatal, vaccination must be postponed until the conditions have fully improved. Vaccine consideration will be made individually for each patient by the neurologist. 
  • In patients who have not yet started taking immunosuppressant medications, COVID-19 vaccination must be completely administered for at least 2 weeks prior to starting immunosuppressant medications.
  • In patients who have been taking immunosuppressant medications with well-controlled symptoms, vaccination can be scheduled as the neurologist recommends.  

These practical recommendations have been derived from updated information available in June 2021. However, standard guidelines might be further obtained once there are more medical studies in the near future. 

Reference: 

Dr. Chanjira Satukijchai

Neurologist, Neuroscience Center, Bangkok International Hospital.