Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis

Objectives-The role of EEG and evoked potentials has not been evaluated in predicting the prognosis of tuberculous (TB) meningitis. The present study was aimed at evaluating the prognostic significance of clinical, radiologic al, and neurophysiological variables using multivariable analysis. Methods-Patients with TB meningitis diagnosed on the basis of clinical, rad iological, and CSF criteria have been prospectively evaluated. All the pati ents were subjected to a detailed neurological evaluation. The outcome was defined 6 months after starting treatment on the basis of the Barthel index (BI) score into poor (BI <12) and good recovery (BI greater than or equal to 12). Death was included in the poor recovery group for statistical analy sis. Thirteen clinical (age, sex, seizure, focal weakness, stage of meningi tis, Glasgow coma scale score, methyl prednisolone therapy), CT (infarction , hydrocephalus, tuberculoma) and neurophysiological (EEG, motor and somato sensory evoked potentials) variables were evaluated employing single variab le logistic regression followed by multivariable logistic regression analys is. The best set of predictors were obtained by step-down logistic regressi on analysis. Results-Fifty four patients were included in the present study. Their age r anged between 5 and 62 years, 11 were children younger than 12 years and 11 were female. Nine patients were in stage I meningitis, 12 in stage II, and 33 in stage III. On single variable logistic regression analysis the signi ficant predictors of 6 months outcome of TB meningitis included focal weakn ess, Glasgow coma scale (GCS), motor evoked potential (MEP) and somatosenso ry evoked potential (SEP). On multivariable analysis the best set of predic tors comprised focal weakness, GCS, and SEP. Conclusions-In patients with TB meningitis focal weakness, GCS, and SEP are the best predictors of 6 month outcome.