Movement Disorders Society of India

Movement disorders in TB can present in remarkably diverse ways, ranging from tremor, chorea, and dystonia to myoclonus, ataxia, and even parkinsonism. These manifestations may occur during active infection, emerge paradoxically during treatment, or appear later as a sequelae of the CNS injury. Such variability makes recognition particularly challenging in routine clinical practice.

One of the notable findings of the review was the predominance of hyperkinetic movement disorders, especially tremor and chorea. Interestingly, specific phenomenology appeared to correlate with the underlying CNS pathology. Tremor was more commonly associated with tuberculous meningitis, whereas chorea and dystonia were frequently linked to tuberculomas involving the basal ganglia and thalamus. These observations reinforce the critical role of lesion localization in shaping movement disorder phenomenology.

The pathophysiology of TBRMDs appears multifactorial. Proposed mechanisms include direct inflammatory injury, vasculitis-related ischemia, hydrocephalus, immune reconstitution inflammatory syndrome (IRIS), and structural damage involving motor control circuits such as the basal ganglia, cerebellum, and brainstem. Neuroimaging is an essential tool for understanding the underlying neuroanatomical substrate of these disorders.

Much of the existing literature on TBRMDs consists of isolated case reports and retrospective series, with considerable heterogeneity in diagnostic approaches and phenomenological descriptions. Furthermore, despite the highest TB burden in Africa and Southeast Asia, these regions remain underrepresented in published literature, likely reflecting disparities in neurological expertise, imaging availability, and research infrastructure.

Treatment outcomes were similarly heterogeneous. While many patients improved with anti-tubercular therapy and adjunctive corticosteroids, others experienced persistent neurological disability despite treatment. Some severe cases required surgical interventions such as shunt placement or pallidotomy, emphasizing the potentially disabling nature of these complications.

Beyond summarizing available evidence, this review serves as a reminder that TB should not be viewed solely as an infectious disease, but also as a disorder capable of producing diverse neurological network dysfunction. Greater awareness of TBRMDs among neurologists, infectious disease specialists, and general physicians may facilitate earlier recognition, targeted evaluation, and improved functional outcomes.

Importantly, the study also highlights the need for standardized diagnostic frameworks, prospective multicentre registries, and systematic phenomenological characterization. As neuroinfectious disease research continues to evolve, TBRMDs represent an area where closer collaboration between infectious disease and movement disorder specialists may substantially improve both recognition and care.

Reference:

1. Desai S, Yadav R, Garg D, Schneider SA, Pal PK. Tuberculosis related movement disorders: A systematic scoping review highlighting geographic disparities, phenotypic patterns, treatment responses, and knowledge gaps in global reporting. Mov Disord Clin Pract. 2025; 12; 1043-1052. doi: 10.1002/mdc3.70099.