Much remains unknown about the long-term neurologic effects of monkeypox. In an article published today in JAMA Neurology, researchers from the National Institute of Neurological Disorders and Stroke (NINDS) and colleagues described how reports of complications from other orthopoxviruses, such as smallpox, may offer clues about the neurologic consequences of monkeypox.
“Although the COVID-19 pandemic is the worst pandemic in a century, the recent past has seen several major pandemics, including Zika, Ebola, dengue, West Nile, and AIDS,” wrote B. Jeanne Billioux, M.D., of NINDS and colleagues. “A common thread to these pandemics is the long-term neurologic complications such as post–COVID-19 conditions, congenital Zika syndrome, post-Ebola syndrome, West Nile encephalitis, and HIV-associated neurocognitive disorders. … Yet often these manifestations go unrecognized, initially masked by the acute systemic involvement by the infection and later attributed to end-organ damage or to pandemic-related psychosocial stresses.”
Billioux and colleagues provided an overview of orthopoxviruses known to infect humans before describing the clinical features of smallpox and monkeypox. They described reports of headaches, febrile seizures/encephalopathy, and transverse myelitis among patients with smallpox as well as other symptoms. They noted that while “very few neurologic complications of monkeypox have been described,” existing reports highlight headache; neuropathic pain; and mood disturbance, including depression and anxiety as the most common symptoms in patients with monkeypox. Additionally, there have been several reports of patients with monkeypox experiencing encephalitis with seizures.
The authors offered several considerations for diagnosis, treatment, and prevention of monkeypox before concluding, “[B]ased on known neurologic complications of orthopoxviruses, we must be prepared for the possibility of viral encephalitis, myelitis, ADEM [acute disseminated encephalomyelitis], Guillain-Barré syndrome, neuropathic pain, and others, and treat them accordingly. Particular attention should be paid to patients with immunocompromised conditions… .”
In addition, health care professionals should be on the lookout for neurological adverse reactions to vaccines that protect against orthopoxviruses, they noted.
For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “Neuropsychiatry’s Role in the Postacute Sequelae of COVID-19: Report From the American Neuropsychiatric Association Committee on Research.”
(Image: iStock/Hank Grebe)
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