LONDON — Endemic in certain regions of Central and West Africa for decades, the viral disease monkeypox began spreading around the globe earlier this year. Now, new findings from the University College London report that monkeypox is associated with, and can sometimes lead to, neurological complications including encephalitis (brain inflammation), confusion, and seizures.
After a comprehensive, systematic review and meta-analysis of monkeypox research, scientists say symptoms such as muscle aches, fatigue, headache, anxiety, and depression are all relatively common among patients.
Across all included studies, two to three percent of monkeypox patients experienced severe complications such as seizures or encephalitis, a serious form of brain inflammation known to cause long-term disability.. It’s important to clarify those projects mainly involved hospitalized patients from previous years. For now, study authors note there is just not enough evidence to estimate the prevalence of neurological complications occurring during the current global monkeypox outbreak.
The research team also included scientists from Barts Health NHS Trust, Guy’s and St Thomas’ NHS Foundation Trust, and King’s College London. Scientists searched for any and all studies focusing on the neurological or psychiatric symptoms linked to monkeypox published prior to May 2022, when this latest outbreak began. The project encompassed 19 studies featuring a total of 1,512 people (1,031 of whom had a confirmed monkeypox infection) living in various nations such as the United States, the United Kingdom, Nigeria, Democratic Republic of Congo, and Republic of Congo.
“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,” says lead study author Dr. Jonathan Rogers (UCL Institute of Mental Health, UCL Psychiatry, and South London & Maudsley NHS Foundation Trust) in a statement. “There is also evidence that mood disorders such as depression and anxiety are relatively common for people with monkeypox.”
Monkeypox impact on brain still a mystery
The primary symptoms associated with monkeypox are skin lesions and fever. The virus can be fatal, but during this latest outbreak significantly less than one in 1,000 confirmed cases have resulted in death.
Researchers estimate that 2.7 percent of included monkeypox patients experienced at least one seizure, 2.4 percent dealt with confusion, and two percent had encephalitis. While these findings are noteworthy, further research is needed to better determine just how common these serious symptoms are in monkeypox patients. On a related note, it’s still poorly understood in general just how monkeypox impacts the human brain.
Study authors were unable to perform a similar analysis on psychosocial symptoms due to incomplete evidence, but it’s worth noting that some studies reported at least half of patients dealt with at least one of the following issues: myalgia (muscle aches), fatigue, headache, anxiety, or depression.
The analyzed studies didn’t track patients long enough to determine if any of these symptoms persist past the acute phase of the illness. Study authors also add the caveat that most people included in this project were hospitalized patients, meaning studied symptoms may not be as prevalent in people with more mild cases.
“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,” concludes study co-author Dr. James Badenoch (Barts Health NHS Trust). “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.”
The study is published in EClinicalMedicine.