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. DESIGN: Neurodevelopmental testing of a previously reported cohort, performed 1-7 years after completion of 9-12 months of treatment of TBM. SETTING: Bloemfontein and environs. PARTICIPANTS: A total of 19 subjects out of a possible 25 (76%) in a geographically accessible area. MAIN OUTCOME MEASURES: 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.