Impact of COVID-19 Vaccination on Neurologic Manifestations of Long COVID: Igor Koralnik, MD

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"Long COVID is a multisystem syndrome that predominantly affects the nervous system and severely impairs patients’ quality of life, including cognitive issues, fatigue, sleep disturbances, and mental health challenges such as anxiety and depression."

Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), often includes neurological symptoms, collectively termed Neuro-PASC. A newly published study in Brain Communications examined whether vaccination prior to SARS-CoV-2 infection influenced Neuro-PASC symptoms among 200 post-hospitalization (PNP) and 1100 nonhospitalized (NNP) patients treated at a neuro-COVID clinic from May 2020 to January 2023.^1,2 Although vaccination reduced the severity of acute COVID-19, it did not alter the overall neurologic burden of Long COVID. The most common symptoms in both patient groups included brain fog, headache, and dizziness, with minor variations in symptom prevalence observed between prevaccination and breakthrough infection cases.

Additional findings showed that both PNP and NNP groups experienced substantial impairments in quality of life, particularly in cognitive, fatigue, sleep, and mental health domains, with similar deficits in cognitive testing regardless of vaccination status. Patients who had a breakthrough infection displayed a higher prevalence of pre-existing conditions, such as anxiety, depression, and organ-specific comorbidities, which may influence symptom severity and management needs. All told, these findings suggested that although vaccination does not mitigate neurologic manifestations of Long COVID, evolving viral strains and individual risk factors warrant further investigation as well as targeted care strategies.

In a recent interview with NeurologyLive^®, senior author Igor Koralnik, MD, chief of neuroinfectious diseases and global neurology at Northwestern Medicine, emphasized the importance of translating these findings into actionable strategies for patient care. He noted how addressing the neurologic burden of Long COVID requires a multidisciplinary approach that prioritizes cognitive rehabilitation, mental health support, and symptom-specific management to improve quality of life. Koralnik also highlighted the need for further research to unravel the mechanisms driving neurologic symptoms in Long COVID and to identify effective interventions. Additionally, he underscored the broader economic and societal implications, particularly for middle-aged individuals in their prime working years, urging healthcare systems to adapt and mitigate these cascading challenges.

REFERENCES
1. Mukherjee S, Singer T, Venkatesh A, et al. Vaccination prior to SARS-CoV-2 infection does not affect the neurologic manifestations of long COVID. Brain Commun. 2025;7(1):fcae448. Published 2025 Jan 7. doi:10.1093/braincomms/fcae448
2. New research finds COVID-19 vaccination prior to infection does not affect the neurological symptoms of long COVID. News Release. Northwestern Medicine. Published January 13, 2024. Accessed January 13, 2024. https://news.nm.org/new-research-finds-covid-19-vaccination-prior-to-infection-does-not-affect-the-neurological-symptoms-of-long-covid

Editor’s Note: Koralnik has disclosed that he has engaged in activities such as speaking, advising, consulting, or providing educational programs for the following companies or other entities: American Society for Clinical Investigation, Inc.; Antisense Therapeutics Limited; Teladoc, Inc. He also has the right to receive payments or may receive future financial benefits for inventions or discoveries related to the following companies or other entities: UpToDate, Inc.