Neurologic Sequelae Following Ebola Virus Disease in Children in Liberia: An Observational Cohort Study
Hanalise V Huff, Collin van Ryn, Cavan S Reilly, Avindra Nath, B Jeanne Billioux, Helen D Tarfeh-Burnette, Kumblytee L Johnson, David R Bearden
Background
The West Africa Ebola virus disease (EVD) outbreak impacted over 28,000 individuals primarily in Liberia, Guinea, and Sierra Leone. Neurological sequelae in adult EVD survivors have been characterised, but there are few data on children. Here, we discuss the neurologic and neurocognitive symptoms in pediatric EVD survivors compared to close contacts as controls.
Methods
In this cross-sectional observational cohort study, participants were seen at a median of 17 months following EVD for a single visit involving a neurologic history and symptom questionnaire, neurologic exam, and neurocognitive testing.
Findings
Thirty-one EVD cases and 41 controls were enrolled. Neurologic symptoms reported significantly more frequently in cases than controls included: arm/leg weakness (67.7%% versus 4.9%), problems with sitting, standing, or walking (22.6% versus 4.9%), difficulty seeing (38.7% versus 9.8%), trouble understanding speech (32.3% versus 0%), difficulty walking (25.8% versus 4.9%), fecal incontinence (19.4% versus 0%), concentration issues (44.4% versus 16.7%), personality changes (18.5% versus 2.8%), and lack of motivation (22.2% versus 0%). On Modified Rankin Scale, cases more often had “some level of disability” versus no symptoms when compared to controls. On an executive function questionnaire, cases more commonly “either sometimes or often” face consequences for poor behavior, get upset for no reason, and have trouble completing tasks independently. There were no significant differences between cases and controls on individual neurologic exams components, cases of uveitis, or cognitive test scores
Interpretation
Numerous neurologic symptoms were found more commonly in EVD cases than controls suggesting that EVD may have a lasting effect on the nervous system of children. Larger pediatric EVD survivor studies are needed to further characterize long-term impacts.
Link | PDF (Preprint)
Hanalise V Huff, Collin van Ryn, Cavan S Reilly, Avindra Nath, B Jeanne Billioux, Helen D Tarfeh-Burnette, Kumblytee L Johnson, David R Bearden
Background
The West Africa Ebola virus disease (EVD) outbreak impacted over 28,000 individuals primarily in Liberia, Guinea, and Sierra Leone. Neurological sequelae in adult EVD survivors have been characterised, but there are few data on children. Here, we discuss the neurologic and neurocognitive symptoms in pediatric EVD survivors compared to close contacts as controls.
Methods
In this cross-sectional observational cohort study, participants were seen at a median of 17 months following EVD for a single visit involving a neurologic history and symptom questionnaire, neurologic exam, and neurocognitive testing.
Findings
Thirty-one EVD cases and 41 controls were enrolled. Neurologic symptoms reported significantly more frequently in cases than controls included: arm/leg weakness (67.7%% versus 4.9%), problems with sitting, standing, or walking (22.6% versus 4.9%), difficulty seeing (38.7% versus 9.8%), trouble understanding speech (32.3% versus 0%), difficulty walking (25.8% versus 4.9%), fecal incontinence (19.4% versus 0%), concentration issues (44.4% versus 16.7%), personality changes (18.5% versus 2.8%), and lack of motivation (22.2% versus 0%). On Modified Rankin Scale, cases more often had “some level of disability” versus no symptoms when compared to controls. On an executive function questionnaire, cases more commonly “either sometimes or often” face consequences for poor behavior, get upset for no reason, and have trouble completing tasks independently. There were no significant differences between cases and controls on individual neurologic exams components, cases of uveitis, or cognitive test scores
Interpretation
Numerous neurologic symptoms were found more commonly in EVD cases than controls suggesting that EVD may have a lasting effect on the nervous system of children. Larger pediatric EVD survivor studies are needed to further characterize long-term impacts.
Link | PDF (Preprint)
