Risk of adverse effects and exacerbation in autoimmune neurological conditions(ANC)are frequently cited reasons for COVID-19 vaccine hesitancy. This study evaluates the ANC safety of COVID-19 vaccines in the real world. We selected studies that provided data on the occurrence of adverse effects and exacerbation of conditions related to ANC after vaccination. The pooled incidence rates for various adverse effects, stratified for the disease category, dosage, and type of vaccine were estimated. Twenty-eight studies (31 vaccination cohorts) were included. The pooled incidence rate of general adverse events was 0.35 (95%CI, 0.27–0.43, I ²= 100%). The pooled incidence rate of exacerbation adverse events was 0.05(95%CI, 0.04-0.07, I ² = 84%). The pooled incidence rates of local injection reaction, fatigue, weakness, myalgia, fever, headache, and chills were 0.27 (0.18–0.36, I ² = 98%), 0.16(0.11-0.21, I ² = 93%), 0.15(0.00-0.31, I ² = 97%), 0.13(0.08-0.19, I ² = 97%), 0.11(0.07-0.15, I ² = 95%), 0.11(0.07-0.16, I ² = 97%), and0.09(0.03-0.16, I ² = 96%), respectively. According to available evidence, the administration of COVID-19 vaccines in individuals with ANC seems to be well-tolerated, with few reports of adverse events. Furthermore, exacerbation of ANC following vaccination appears to be infrequent.