Paroxysmal Sympathetic Hyperactivity in Childhood Tuberculous Meningitis: A New Association

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Tuberculous meningitis (TBM) can lead to severe neurological sequelae in children.
• Paroxysmal sympathetic hyperactivity (PSH) is a recognized complication in various neurological conditions.
• The prevalence and characteristics of PSH in childhood TBM are not well-established.

Purpose of the Study:

• To estimate the prevalence of PSH in children diagnosed with TBM.
• To describe the clinical characteristics and timing of PSH onset in this population.
• To identify potential risk factors and outcomes associated with PSH in TBM.

Main Methods:

• Retrospective analysis of hospital records for children aged 6 months to 14 years with TBM from September 2019 to January 2022.
• Systematic screening for PSH using the Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM) since September 2019.
• Prospective assessment of 3-month outcomes using the Pediatric Cerebral Performance Category score.

Main Results:

• PSH was identified in 6 out of 41 (14.6%) children with TBM.
• PSH onset occurred between 4 and 25 weeks post-TBM diagnosis.
• Children with PSH were younger (median 5 years) and had a higher incidence of hydrocephalus (83.3%) compared to those without PSH.
• Hospital stay was significantly prolonged for children with PSH (mean 71.2 days vs. 20.8 days).

Conclusions:

• PSH is a significant late complication of childhood tuberculous meningitis, occurring in 14.6% of cases.
• Early recognition of PSH is crucial, especially in children presenting with recurrent fever or neurological worsening.
• PSH is associated with younger age, hydrocephalus, and prolonged hospitalization in TBM patients.