Neurological manifestations of Mpox virus during the recent global outbreak: a systematic review.

INTRODUCTION: Mpox is a zoonotic infection caused by the Mpox virus (MPXV), an Orthopoxvirus known to cause fever, lymphadenopathy, mucocutaneous lesions, and some systemic complications. With the recent global outbreak, an increasing number of neurological manifestations have been reported. This systematic review aims to assess and summarize the neurological manifestations associated with Mpox virus infection, highlighting its prevalence, frequency, and clinical impact. METHODS: Studies that included data from recent outbreaks, published between May 2022 to January 2025 that reported neurological manifestations in patients infected by Mpox were systematically reviewed using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. RESULTS: Our systematic review included data from 20 studies encompassing data from 2,245 individuals across multiple regions. Neurological manifestations ranged from common symptoms such as fatigue (32.6%), myalgia (29.7%), and headache (29.2%) to severe complications like encephalitis (0.23%), encephalomyelitis (0.23%), transverse myelitis (0.09%), Guillain-Barré Syndrome (0.045%), and Parsonage-Turner Syndrome (0.045%). Autonomic nervous system involvement, including bowel and bladder incontinence, was reported in 0.26% of cases. Severe cases required immunomodulatory therapies such as corticosteroids, intravenous immunoglobulin (IVIG), and antiviral treatments. Recovery varied, from a few weeks, with some patients experiencing prolonged symptoms lasting up to 32 weeks, and a few reporting persistent deficits. CONCLUSION: This systematic review highlights the wide spectrum of neurological complications associated with Mpox infection, ranging from mild symptoms to severe, debilitating conditions. While most patients experienced resolution of symptoms with appropriate management, a subset developed long-term deficits, underscoring the need for vigilant monitoring and early intervention. Given the increasing global incidence of Mpox, healthcare professionals must be aware of its potential neurological impact to ensure timely diagnosis and effective treatment.