Department of Neurology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Research Centre for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia.
CNS Drugs. 2023 Nov;37(11):957-972. doi: 10.1007/s40263-023-01047-y. Epub 2023 Nov 17.
Neurotuberculosis has the highest morbidity and mortality risk of all forms of extrapulmonary tuberculosis (TB). Early treatment is paramount, but establishing diagnosis are challenging in all three forms of neurotuberculosis: tuberculous meningitis (TBM), spinal TB and tuberculomas. Despite advancements in diagnostic tools and ongoing research aimed at improving TB treatment regimens, the mortality rate for neurotuberculosis remains high. While antituberculosis drugs were discovered in the 1940s, TB treatment regimens were designed for and studied in pulmonary TB and remained largely unchanged for decades. However, new antibiotic regimens and host-directed therapies are now being studied to combat drug resistance and contribute to ending the TB epidemic. Clinical trials are necessary to assess the effectiveness and safety of these treatments, addressing paradoxical responses in neurotuberculosis cases and ultimately improving patient outcomes. Pharmacokinetic-pharmacodynamic analyses can inform evidence-based dose selection and exposure optimization. This review provides an update on the diagnosis and treatment of neurotuberculosis, encompassing both sensitive and resistant antituberculosis drug approaches, drawing on evidence from the literature published over the past decade.
神经结核是所有肺外结核（TB）中发病率和死亡率风险最高的一种。早期治疗至关重要，但在结核性脑膜炎（TBM）、脊柱结核和结核瘤这三种形式的神经结核中，诊断都具有挑战性。尽管诊断工具不断进步，并且一直在进行旨在改善结核病治疗方案的研究，但神经结核的死亡率仍然很高。虽然抗结核药物是在 20 世纪 40 年代发现的，但结核病治疗方案是针对肺结核设计和研究的，几十年来基本没有变化。然而，现在正在研究新的抗生素方案和宿主导向疗法，以对抗耐药性并为结束结核病流行做出贡献。需要进行临床试验来评估这些治疗方法的有效性和安全性，解决神经结核病例中的矛盾反应，并最终改善患者的预后。药代动力学-药效学分析可以为基于证据的剂量选择和暴露优化提供信息。本综述提供了神经结核的诊断和治疗的最新信息，包括敏感和耐药抗结核药物方法，借鉴了过去十年发表的文献中的证据。
