Follow-up for Tuberculosis of the Central Nervous System in Children

Frequency of Office Visits

• Tuberculomas and TB abscesses: Patients should be followed closely every month for the first 6 months and every 3 months fore next 6 months. Any new or worsening neurological signs in patients being treated for CNS TB should prompt immediate imaging and neurosurgical review.
• Shunt for hydrocephalus: Patients with shunts for hydrocephalus need close and frequent follow-up every month in the initial 6 months. The mortality rates might be higher if the follow-up duration is longer, as those with severe disability might go on to die. The risk of shunt dysfunction (obstruction or infection) in TB meningitis is as high as 30%. This percentage has been attributed to the high CSF protein content and also to the high incidence of shunt infection resulting from shunts being implanted mostly in general emergency rooms (56).

Frequency of Imaging

• Tuberculomas and TB meningitis – every 3–6 months: The first scan is done at the time of diagnosis and start of treatment. Repeat imaging is required every 3–6 months for the first year to monitor the decrease in the size of the lesion or paradoxical increase.
• Shunt for hydrocephalus: An immediate postoperative scan done as a baseline. Subsequent scans can be done if there is any change in neurological status.

Other Investigations Required

• Cultures: Sputum test for AFB conversion should be done after the start of chemotherapy.
• Examination for side effects: Clinical examination and visual testing should be carried out for children on ethambutol. Liver function tests are done to rule out drug-induced hepatitis.