Movement Disorders in Central Nervous System Tuberculosis: A Systematic Review.

BACKGROUND

Tuberculosis (TB) affecting the central nervous system (CNS) can lead to a broad range of movement disorders, which are frequently overlooked in clinical settings. This review explores the various presentations, underlying mechanisms and patient outcomes related to these disorders.

METHODS

We systematically reviewed published case reports, series and cohort studies that described patients with CNS TB who developed movement disorders. Extracted data included patient characteristics, type of CNS TB, imaging and CSF findings, types of movement disorders, treatments used and outcomes.

RESULTS

A total of 61 patients with CNS TB and associated movement disorders were analyzed. The most common manifestations were ataxia, dystonia, chorea or hemiballismus and parkinsonism. Less frequent symptoms included opsoclonus-myoclonus, segmental myoclonus, tremors, cervical dystonia and stereotypy. TB meningitis was the predominant form, often accompanied by infarcts, hydrocephalus or tuberculomas. Proposed causes included vascular injury, inflammatory lesions, immune mechanisms and drug-related effects. All patients received anti-tuberculosis treatment, and nearly half required corticosteroids or surgical procedures. About 25 patients (41%) fully recovered, 17 (27.9%) had significant improvement, 13 (21.3%) showed partial improvement, 11 (18.0%) had ongoing problems and 1 (1.6%) died. Cohort studies also reveal that movement disorders - particularly tremors, dystonia, parkinsonism and ataxia - are frequent but underrecognized in CNS TB. These typically emerge early, often within three weeks, and are linked to lesions in the basal ganglia or thalamus.

CONCLUSIONS

Movement disorders in CNS TB are more common than generally recognized. Prompt diagnosis through imaging and timely therapy can greatly improve neurological outcomes.