Post-vaccinal Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, is a rapidly progressive, invariably fatal neurological disease that attacks the nerve cells responsible for controlling voluntary muscles in the central nervous system, with death usually occurring within two to five years of symptom onset. 

In this case study, a previously asymptomatic 47-year-old male presented with left-sided weakness, declining speech, dysphagia, and recurrent falls for nine months, which began one day after receiving the J&J/Janssen viral vector COVID -19 vaccine. His family history of ALS included his grandmother being diagnosed with it. 

After getting the vaccine, the patient initially experienced painful inflammation at the injection site. Within a week, he began to feel weakness in his left arm and a weak hand grip. Over the following months, this weakness progressed to his entire left side, and he started to experience declining speech, difficulty swallowing, and falling down repeatedly. After a negative MRI of his spine and brain, he was referred to a neurologist and diagnosed with ALS with a pseudobulbar affect after electromyography.

We previously covered post-vaccinal Guillain-Barré syndrome (GBS) that affects the peripheral nervous system and multiple sclerosis (MS) which also impacts the central nervous system similarly to ALS. While MS can cause issues with memory and thought, ALS mostly affects bodily functions.

There are more than 25 genes known to be associated with ALS and about 5–10% of cases of ALS are directly inherited. Overall, first-degree relatives of an individual with ALS have a 1% risk of developing ALS. ALS has an oligogenic mode of inheritance, meaning that mutations in two or more genes are required to cause disease.

C9orf72 (needed for motor neurons and nerve cells) and SOD1 (involved in production of the enzyme copper-zinc superoxide dismutase 1) are the most common genetic causes for ALS1. Mutations in TARDBP, FUS, C9orf72 and other genes can cause ALS as well as related forms of frontotemporal dementia (FTD–ALS) caused by atrophy of the brain's temporal and frontal lobes. 

REFERENCE

Feghali EJ, Challa A, Mahdi M, Acosta E, Jackson J. New-Onset Amyotrophic Lateral Sclerosis in a Patient who Received the J&J/Janssen COVID-19 Vaccine. Kans J Med. 2023 Mar 15; 16:69-70. doi: 10.17161/kjm.vol16.18969. PMID: 36970039; PMCID: PMC10035647.