Tuberculosis Related Movement Disorders: A Systematic Scoping Review Highlighting Geographic Disparities, Phenotypic Patterns, Treatment Responses, and Knowledge Gaps in Global Reporting.

BACKGROUND: Tuberculosis (TB) of the central nervous system (CNS) is a severe complication of TB, with movement disorders representing an under-recognized yet impactful manifestation. Despite their clinical significance, knowledge gaps persist in epidemiology, pathophysiology, and management of TB-related movement disorders (TBRMDs).

OBJECTIVE: This scoping review synthesizes evidence on TBRMDs, aiming to characterize their spectrum, evaluate diagnostic approaches, and summarize management strategies and outcomes.

METHODS: Following PRISMA-ScR guidelines, a systematic search of PubMed, EMBASE, and Scopus (final search: December 31, 2024) identified studies of all designs and languages reporting movement disorders in CNS TB. Data extraction, quality assessment (Joanna Briggs Institute tools), and thematic synthesis were conducted.

RESULTS: Of 36 included studies (91 cases), tremor (27.5%), chorea (26.4%), and dystonia (16.5%) were most prevalent. Tremor predominated in tuberculous meningitis (48.9%), while chorea was common in tuberculomas (42.3%). Lesion location correlated with phenomenology: basal ganglia lesions linked to chorea/dystonia, cerebellar involvement to ataxia. Pathogenesis included meningitis (54.9%), tuberculomas (32.9%), and vasculitis (8.8%). Treatment with anti-tubercular therapy and corticosteroids resulted in complete resolution in 43.9% of cases, but 32.9% showed no improvement. Geographically, South America (61.8%) and Asia (19.7%) reported most cases, with a temporal surge post-2000.

CONCLUSION: TBRMDs are heterogeneous in presentation, linked to lesion location and pathogenic mechanisms. Early recognition, multimodal management, and neuroimaging are critical. Significant variability in diagnostic and reporting standards highlights the need for consensus criteria and prospective studies, particularly in high-burden regions. This review underscores the need of global collaborations to optimize clinical care and advance research in this neglected domain.