Questions about covid antibodies and my Multiple Sclerosis diagnosis

Here is My Question:
I know you can’t give me specific medical advice but I have 2 questions if you have time to answer them.

1. Regarding covid antibodies. I received the Pfizer vaccine about 4 months after my last Ocrevus infusion and the second dose about 3-4 weeks prior to the next infusion. My doctor wanted to test my antibodies because she is not convinced of the effectiveness. She checked the covid antibodies to the spike protein and they were totally negative. Does this have any value or should I assume it was ineffective? Do you ever suggest people get a second vaccine if they didn’t develop antibodies?

2. This is regarding misdiagnosis. I was dx in 2018 and now on ocrevus. I accepted the diagnosis but I still have moments of denial. I am wondering if I have a clear cut dx or one i should second guess. initial symptoms never required hospitalization. started with what I now know as the hug. Around the lower ribs/chest and upper abdomen. IT has always been the worst symptom to the point of almost not being able to breath. I have it controlled on trileptal. I had memory loss of entire situations and had an EEG (negative) and MRI. The MRI shows lesions in all the typical spots including “dawsons fingers”. Other MRIs showed 2 spinal cord lesions. I had negative o bands though. I have major cognitive issues and now on disability. Main things are tremor, hug, memory, word mixing, numbness/tingle, spasms and spasticity, temp issues, FATIGUE. Should I question the diagnosis since I don’t have o bands? It seems to just get worse with no relapse or new lesions.

Answer:
Very good questions and hard to answer. Here are my thoughts:

1. Antibodies against the spike protein for COVID19 is a surrogate marker for either immunization or a prior infection only in people without compromised immune system. A surrogate marker can best be thought of as an indirect marker of an outcome that is more difficult to measure, in this case adequate vaccination. This surrogate marker is not validated as a marker of effective vaccination in people on chronic B cell depleting therapies like Ocrevus. In fact, we know that people on these therapies tend to produce lower antibody responses to vaccinations and some produce no antibodies at all. This does not mean the vaccinations do not work, but it is a cause for concern since you have no easy way to determine if the vaccination is effective. Therefore,we advise that our patients on immunosuppression get vaccinated and continue to wear masks and avoid contact with non-vaccinated people.
2. The presence of CSF oligoclonal bands is not diagnostic of MS and the absence of oligoclonal bands does not exclude a diagnosis of MS. One study correlating CSF oligoclonal bands with brain pathology suggested that some forms of MS are not typically associated with oligoclonal bands in the CSF. I always suggest a second opinion if anyone is uncomfortable with their diagnosis. This is particularly true if you are not being managed by a fellowship trained MS specialist. 

Good luck

​Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego