Neurological complications linked to monkeypox

Monkeypox has been linked to rare cases of neurological complications, including encephalitis and confusion, according to a new review of evidence.

Led by UCL, Barts Health NHS Trust, Guy’s and St Thomas’ NHS Foundation Trust, and King’s College London,UK, the systematic review and meta-analysis of evidence of several studies found that as well as encephalitis, confusion or seizures, the viral disease can also lead to muscle aches, fatigue, headache, anxiety and depression.

However, the researchers, whose findings are published in *eClinical Medicine*, point out the studies mainly involved hospitalised patients from previous years and there is not enough evidence to estimate neurological complication prevalence in the current outbreak.

They found that across the 19 studies with relevant evidence they examined, all before May 2022, 2 to 3% of patients had severe complications such as seizure or encephalitis.

Lead author Dr Jonathan Rogers, of UCL Institute of Mental Health, UCL Psychiatry, and South London & Maudsley NHS Foundation Trust, said: “We found that severe neurological complications such as encephalitis and seizures, while rare, have been seen in enough monkeypox cases to warrant concern, so our study highlights a need for further investigation.

“There is also evidence that mood disorders such as depression and anxiety are relatively common for people with monkeypox.”

The studies they looked at involved 1,512 participants, of whom 1,031 had a confirmed infection, in the USA, Nigeria, Democratic Republic of Congo, Republic of Congo, and the UK.

By pooling data from across a sub-set of studies with relevant evidence, the researchers estimated that 2.7% of monkeypox patients experienced at least one seizure, 2.4% experienced confusion, and 2.0% had encephalitis.

The team says because there was very limited evidence for the prevalence of such symptoms, larger studies are needed to better calculate prevalence.

They were not able to pool data for psychosocial symptoms because of incomplete evidence, but some studies found at least half of patients experienced at least one of myalgia, fatigue, headache, anxiety or depression.

Co-author Dr James Badenoch, of Barts Health NHS Trust, said: “As there is still limited evidence into neurological and psychiatric symptoms in the current monkeypox outbreak, there is a need to set up coordinated surveillance for such symptoms.

“We suggest that clinicians should be watchful of psychiatric symptoms such as depression and anxiety and ensure that patients have access to psychological and psychiatric care if needed.”

Badenoch JB, Conti I, Rengasamy ER et al. Neurological and psychiatric presentations associated with human monkeypox virus infection: a systematic review and meta-analysis. *eClinicalMedicine* 9 September 2022; doi: 10.1016/j.eclinm.2022.101644

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