NEUROLOGICAL COMPLICATIONS in adult survivors of the Ebola virus, are widespread, often persistent, and may continue more than seven years after infection, according to new data.
This new evidence emerges amid the latest ongoing Ebola virus outbreak, caused by the Bundibugyo virus in the Democratic Republic of the Congo and Uganda.
Longitudinal Cohort Study in Liberia
Researchers analysed 148 antibody-positive survivors and 81 antibody-negative close contacts (control) in Liberia, with neurological assessments conducted biannually from 2015 to 2023.
During acute Ebola infection, common symptoms include headache, altered mental state, and stroke-like presentations. In the post-acute phase, survivors displayed a broad spectrum of neurological symptoms.
These included persistent headaches in 98 patients (66.2%), cognitive dysfunction in 83 (56.1%), fatigue in 71 (51.1%), depression in 73 (49.3%), and cranial nerve abnormalities in 60 (40.5%). Sleep abnormalities, sensory disturbances, tremor, and sexual dysfunction were also frequently reported.
Symptom Burden Improves but Persists
Over the course of the longitudinal study, the researchers observed that survivors’ neurological symptoms generally improved. However, several symptoms remained significantly more prevalent in the survivor group than the control group.
Memory loss persisted in 66 survivors (57.4%) as opposed to 16 control participants (26.2%; P<.001), irritability in 42 (36.5%) versus 9 (14.8%; P=.006), and trouble concentrating in 34 (29.6%) versus 6 (9.8%; P=.002).
Although headache, fatigue, and depressive symptoms remained common, the researchers found these differences were no longer statistically significant during long-term follow-ups. Neurological examination scores also improved over time and were no longer significantly different between the survivor and control groups at the final assessment.
Addressing the Chronic Consequences of Ebola Virus
These findings suggest that the Ebola virus is associated with substantial and enduring neurological complications, which may present a long-term healthcare and socioeconomic burden.
The study demonstrates the need for sustained neurological follow-up in Ebola survivors. Especially since persistent symptoms such as memory impairment and concentration difficulties may affect quality of life and functional outcomes, even years after recovery.
Overall, the study reinforces the need for long-term monitoring of Ebola survivors to better understand and address the chronic complications of the Ebola virus.
Reference
Billioux BJ et al. Neurological Manifestations in Adult Survivors of Ebola Virus Disease. JAMA Neurol. 2026; DOI:10.1001/jamaneurol.2026.2112
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