Incidence and clinical characteristics of amyotrophic lateral sclerosis during the post-COVID-19 Period: a population-based study from Isfahan, Iran

Abstract

AIMS: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder. Understanding the underlying causes would help further studies on the pathogenesis and treatments. Recent interest has emerged in evaluating whether the COVID-19 pandemic and vaccination have any influence on the epidemiological patterns of ALS. MATERIALS & METHODS: To assess this association in Isfahan, Iran, during the post-COVID-19 era, we conducted this retrospective study. Newly diagnosed ALS cases were identified, and demographic data, environmental exposures, comorbidities, vaccination history, and other aspects were collected. RESULTS: A total of 63 patients were diagnosed with definite ALS, yielding an incidence rate of 0.74 per 100,000 person-years (95 CI: 0.57-0.94). The mean age was 59.7 +/- 11.6 years, and cases were predominantly male (73). Of the 63 new ALS-diagnosed cases, 45 of patients reported probable prior COVID-19 infection, and 95.3 mentioned at least one dose of COVID-19 vaccination. Bulbar signs, including facial muscle weakness, tongue atrophy, and fasciculation, were present in 46 of cases, and emotional lability and cognitive decline were observed in 20.6. CONCLUSION: We showed a probable relation between COVID-19 infection and the epidemiology of ALS in post-COVID era. However, our results and symptom alterations require further investigation. Amyotrophic lateral sclerosis (ALS) is a rare and serious disease that causes the nerve cells controlling movement to gradually stop working. Because ALS has no cure, understanding when and how it appears in the community is important for improving care and planning future research.Since the COVID-19 pandemic affected many body systems, including the brain and immune system, some people have wondered whether COVID-19 infection or vaccination might influence the development of ALS. To explore this question, we studied all new ALS cases diagnosed in Isfahan Province, Iran, between May 2023 and December 2024. This is the first study to examine ALS patterns in this region after the pandemic.We identified 63 new patients with definite ALS. The number of new cases was higher than the rate reported in Isfahan before the pandemic, suggesting that COVID-19 changed how often ALS occurs in this population. Almost half of the patients reported a previous COVID-19 infection, and most had received at least one COVID-19 vaccine dose, which reflects the high vaccination rate in the general population. We did not find evidence that infection or vaccination affected the type or severity of ALS symptoms.However, many patients showed bulbar symptoms (such as speech or swallowing problems) and some had cognitive changes at diagnosis, which highlights the need for early evaluation and support.Overall, our findings show that ALS patterns in Isfahan have changed after the COVID-19 pandemic, and continued monitoring is important.