Abstract

PIP: Corticosteroid therapy is used widely in the routine management of tuberculous meningitis (TBM). 141 consecutive children with stages 2 and 3 TBM were studied in an investigation of the mechanism of action of high dose prednisone in such subjects. Randomly assigned to either the treatment or control group, 70 subjects received steroids and 71 were in the nonsteroid group. The first 16 patients in the steroid group were given prednisone in a dose of 2 mg/kg/day, while the remaining 54 subjects in the group received it in a dose of 4 mg/kg/day for the first month of treatment. Antituberculous treatment consisted of isoniazid, rifampicin, ethionamide, and pyrazinamide all given for 6 months. Clinical outcome was assessed after completing 6 months of antituberculous treatment. The administration of corticosteroid significantly improved the survival and intellectual outcome of children with TBM. 4 patients in the second group and 13 in the nonsteroid group died before completing 6 months of therapy. No significant difference was noticed between the 2 treatment groups with regard to motor deficit, blindness, or deafness, and the clinical outcome of children receiving high- and low-dose prednisone did not differ significantly. No significant difference in intracranial pressure or the degree of hydrocephalus was noted between the 2 groups after the first month of treatment. Both the response of the tuberculoma to treatment and the incidence of delayed occurrence of tuberculomas were significantly improved after steroid therapy.