Related Experiment Video
Updated: Aug 25, 2025
A Murine Model of Dengue Virus-induced Acute Viral Encephalitis-like Disease
Published on: April 28, 2019
Neurological and psychiatric presentations associated with human monkeypox virus infection: A systematic review and
James B Badenoch1,2, Isabella Conti3, Emma R Rengasamy4
1Barts Health NHS Trust, Charterhouse Square, London EC1M 6BQ, UK.
Background:
Neuropsychiatric presentations of monkeypox (MPX) infection have not been well characterised, despite evidence of nervous system involvement associated with the related smallpox infection.
Methods:
In this pre-registered (PROSPERO ID 336649) systematic review and meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, AMED and the preprint server MedRxiv up to 31/05/2022. Any study design of humans infected with MPX that reported a neurological or psychiatric presentation was included. For eligible symptoms, we calculated a pooled prevalence using an inverse variance approach and corresponding 95% confidence intervals. The degree of variability that could be explained by between-study heterogeneity was assessed using the I 2 statistic. Risk of bias was assessed with the Newcastle Ottawa Scale and the Joanna Briggs Institute quality assessment tool.
Findings:
From 1705 unique studies, we extracted data on 19 eligible studies (1512 participants, 1031 with confirmed infection using CDC criteria or PCR testing) most of which were cohort studies and case series with no control groups. Study quality was generally moderate. Three clinical features were eligible for meta-analysis: seizure 2.7% (95% CI 0.7-10.2%, I2 0%), confusion 2.4% (95% CI 1.1-5.2%, I2 0%) and encephalitis 2.0% (95% 0.5-8.2%, I2 55.8%). Other frequently reported symptoms included myalgia, headache and fatigue, where heterogeneity was too high for estimation of pooled prevalences, possibly as a result of differences in viral clades and study methodology.
Interpretation:
There is preliminary evidence for a range of neuropsychiatric presentations including severe neurological complications (encephalitis and seizure) and nonspecific neurological features (confusion, headache and myalgia). There is less evidence regarding the psychiatric presentations or sequelae of MPX. This may warrant surveillance within the current MPX outbreak, with prospective longitudinal studies evaluating the mid- to long-term sequelae of the virus. Robust methods to evaluate the potential causality of MPX with these clinical features are required. More evidence is necessary to explain heterogeneity in prevalence estimates.
Funding:
UKRI/MRC (MR/V03605X/1), MRC-CSF (MR/V007181/1), MRC/AMED (MR/T028750/1) and the Wellcome Trust (102186/B/13/Z) and (102186/B/13/Z) and UCLH BRC.
Insights
Monkeypox (MPX) can cause neurological issues like seizures and confusion, with preliminary evidence for encephalitis. Further research is needed to understand the full range of neuropsychiatric effects and long-term outcomes of MPX infection.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Neuropsychiatric manifestations of monkeypox (MPX) are not well-understood.
- Nervous system involvement has been noted in related smallpox infections.
Purpose of the Study:
- To systematically review and meta-analyze the prevalence of neurological and psychiatric presentations in monkeypox (MPX) infection.
- To characterize the range and frequency of neuropsychiatric symptoms associated with MPX.
Main Methods:
- Systematic review and meta-analysis of studies reporting neurological or psychiatric symptoms in humans with MPX, searched across multiple databases and preprint servers up to May 31, 2022.
- Pooled prevalence calculated for eligible symptoms using inverse variance approach; heterogeneity assessed with I² statistic.
- Risk of bias evaluated using Newcastle Ottawa Scale and Joanna Briggs Institute quality assessment tool.
Main Results:
- Data extracted from 19 studies (1512 participants); study quality generally moderate.
- Pooled prevalence for seizure: 2.7% (95% CI 0.7-10.2%), confusion: 2.4% (95% CI 1.1-5.2%), and encephalitis: 2.0% (95% CI 0.5-8.2%).
- High heterogeneity noted for symptoms like myalgia, headache, and fatigue, hindering pooled prevalence estimation.
Conclusions:
- Preliminary evidence suggests MPX can cause severe neurological complications (encephalitis, seizure) and nonspecific symptoms (confusion, myalgia, headache).
- Limited evidence exists for psychiatric presentations or sequelae of MPX.
- Further prospective longitudinal studies are required to evaluate mid- to long-term sequelae and establish causality, necessitating robust methodologies and addressing prevalence estimate heterogeneity.
Related Concept Videos
01:28Disorders of the Nervous Tissue
Homeostatic Imbalances:
Alzheimer's disease manifests as a gradual decline in memory and cognitive abilities, attributed to the buildup of amyloid plaques and neurofibrillary tangles in the brain.
Parkinson's disease arises from the...
01:27Psychosis: Pathophysiology of Schizophrenia and Other Psychotic Disorders
Researchers have identified genetic factors that increase susceptibility to schizophrenia, underscoring the intricate interplay between genetics and environment in disease development. At the core of schizophrenia's pathophysiology is excessive dopaminergic neurotransmission within...