The effect of tuberculous meningitis on the cognitive and motor development of children.
OBJECTIVE
To evaluate and compare the different degrees of cognitive and motor impairment of children surviving tuberculous meningitis (TBM), with a view to establishing areas amenable to remedial intervention.


METHODS
Neurodevelopmental testing of a previously reported cohort, performed 1-7 years after completion of 9-12 months of treatment of TBM.


METHODS
Bloemfontein and environs.


METHODS
A total of 19 subjects out of a possible 25 (76%) in a geographically accessible area.


METHODS
Cognitive and fine and gross motor development.


RESULTS
Cognitive and motor development were scored and expressed as percentages of those expected for normal children of similar age and background. The median cognitive development was 66.9% (95% confidence intervals (CIs) 59.1-73.2). The degree of impairment was similar for all 10 cognitive areas tested, ranging from 61.8% to 70.4%. The median fine motor development score was 68.6% (95% CIs 54.7-81.5). The median gross motor function score was 51.2% (95% CIs 36.4-77.1). Comparison of impairment between stage 2 and stage 3 disease showed median differences of 28.7% (95% CI 2.7-55.1) (P = 0.02) for cognitive function, 21.6% (95% CI -9.9-54.1) (P = 0.15) for fine motor function, and 35.2% (95% CI 14.2-59.6) (P = 0.01) for gross motor function. No TBM relapses had occurred.


CONCLUSIONS
Our findings show the occurrence of marked generalised impairment of cognitive and motor development following TBM, with no specific areas amenable to early remedial intervention. Shortened treatment regimens of 9-12 months were effective, but prevention of TBM remains the priority.
Schoeman
C J
CJ
Department of Paediatrics and Child Health, University of the Orange Free State, Bloemfontein.
Herbst
I
I
Nienkemper
D C
DC
D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D003906:Developing Countries; D002658:Developmental Disabilities / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D011596:Psychomotor Disorders / Q000209:etiology*; D013019:South Africa; D014390:Tuberculosis, Meningeal / Q000523:psychology*