What to know about neurological symptoms from monkeypox

Chia-Yi Hou

Story at a glance

  • Monkeypox cases are trending downward in the U.S.

  • The CDC published a report about neurologic complications in two patients this summer.

  • Symptoms may include headaches and mood disturbance.

A new report and a paper on monkeypox include information about neurological complications affecting the brain and how those were treated.

There have been more than 24,000 monkeypox cases reported in the U.S., according to the Centers for Disease Control and Prevention. The number of cases seems to have peaked, although we are still learning about how the illness has spread and affected people.

The CDC reported two acute monkeypox virus (MPXV) cases in Colorado and Washington, D.C., this past summer where the patients also had encephalomyelitis — inflammation in the brain and/or spinal cord. For the two patients, neurological symptoms appeared within five and nine days of illness onset. Both patients were given oral tecovirimat, a treatment developed for smallpox.

The mechanism for how the neurological symptoms appears “is unclear but might represent either MPXV invasion of the [central nervous system]” or an autoimmune process triggered by systemic MPXV infection, according to the report.

In a paper published in the journal JAMA Neurology, doctors review the neurologic complications associated with monkeypox and smallpox cases, and they note the known neurological symptoms from monkeypox, which include headaches and mood disturbances. There’s also the possibility for postvaccinal encephalomyelitis, where there is inflammation in the brain and spinal cord after vaccination.

Headaches are common with MPXV infections, according to the paper. Other symptoms include mood disturbance, like depression and anxiety, and nerve pain, also known as neuropathic pain.

For physicians who may be treating MPXV patients, these new reports may help to understand the range of neurological complications their patients may be experiencing. This may include pain management in the form of topical agents, oral medications or nerve blocks, according to the paper.

“Painful lesions may respond to antiviral treatments; hence, access to them is crucial,” the report says.

“Clinicians and public health professionals should be aware of the range of possible clinical presentations of MPXV infections and potential treatments,” the report says. “Suspected cases should be reported to state, tribal, local, or territorial health departments to improve understanding of the range of clinical manifestations of MPXV infections and treatment options.”

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