Objective: We conducted a critical review of the literature on movement disorders (MD) in patients with central nervous (CNS) tuberculosis (TB), with the goal of providing a comprehensive framework for their symptomatology, diagnosis, and management.

Background: CNS TB represents the severe end of the disease and can cause a long-standing impact on patients’ lives. It is associated with a myriad of clinical presentations; however, little is known about the development of MD and the best strategies for diagnosing and treating this condition.

Method: A systematic search was conducted according to PRISMA guidelines [figure1] in MEDLINE, EMBASE, Web of Science, Scopus, Lilacs, and Scielo for studies published from inception to February 25, 2024.  Studies evaluating patients who developed MD in the context of a CNS TB diagnosis were included. No age or language restrictions were imposed. Studies that used secondary data or included other potential causes of MD were excluded. The quality was assessed using the NewCastle-Ottawa scale for observational studies and its adapted version for case reports and case series.

Results: 719 studies were screened, resulting in 35 selected studies. A total of 861 patients with CNS TB were included of which 196 (23%) developed MD and ranged in age from 2 months to 78 years old. Tuberculous meningitis and tuberculomas were reported in 156 and 30 cases respectively. The most common movement disorder reported was chorea-ballismus (n= 82), followed by tremor (n= 67), dystonia (n= 19), parkinsonism (n= 5), myoclonus (n= 4) and one case of bobble head-doll syndrome. Not all studies specify the type of movement disorder presented and many patients experienced more than one movement disorder. Treatment consisted of antituberculous therapy, although some studies also used steroids (14/35), levodopa (3/35), benzodiazepines (2/35) and phenobarbital (2/35). Most movement disorders were transient with patients recovering completely or with mild deficits; however, 14 patients were left with severe sequelae and 8 patients died. Quality assessment showed medium to high risk of bias.

Conclusion: Our study demonstrated that a significant proportion of CNS TB patients present with MD. Therefore, a high level of suspicion should be established in these patients to ensure adequate care. Overall this condition has a good prognosis and antituberculous treatment is usually effective.

Figure 1

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorders-in-patients-with-central-nervous-system-tuberculosis-a-systematic-review/