Ebola survivors sustain neurologic complications

Patients with Ebola virus disease (EVD) appear to experience neurological symptoms during acute infection and numerous neurological sequelae during recovery, according to a study.

Using data from the Ebola Natural History Study, researchers characterized neurological sequelae among EVD survivors over more than 7 years of follow-up.

Neurological assessments were performed biannually. The neurological examination score represented the cumulative abnormalities on neurological examinations, the general neurological examination score represented all examination abnormalities, and the central nervous system score represented the central nervous system–specific abnormalities on examination.

Study outcomes included neurological symptom prevalence and neurological examination scores. The analysis included 148 Ebola antibody-positive survivors (mean age 34.8 years, 50 percent female) and 81 antibody-negative controls (mean age 35.8 years, 51 percent female).

During acute infection, survivors reported headaches, altered mental status, and stroke-like symptoms or, rarely, meningoencephalitis. Survivors had significant neurological sequelae involving the entire neuraxis, including cognitive dysfunction (56.1 percent), persistent headaches (66.2 percent), sleep abnormalities (27 percent), depression (49.3 percent), sexual dysfunction (32.4 percent), tremor (20.3 percent), fatigue (51.1 percent), cranial nerve abnormalities (40.5 percent), and sensory abnormalities (30.4 percent).

A total of 115 survivors (77.7 percent) and 61 controls (75.3 percent) attended the final visit. Over 7 years of follow-up, most survivors demonstrated improvement in neurological status. However, significantly more survivors than controls reported persistent symptoms of memory loss (57.4 percent vs 26.2 percent; p<0.001), irritability (36.5 percent vs 14.8 percent; p=0.006), and trouble concentrating (29.6 percent vs 9.8 percent; p=0.002).