Neuro-cognitive impairment following acquired central nervous system infections in childhood: a systematic review

The morbid consequences of central nervous system (CNS) infections are often overlooked in the face of high mortality rates. However, neurological impairments not only affect the child's development and future prospects but also place an economic and social burden on communities and countries that often have few resources to deal with such problems. We conducted a systematic review to investigate the occurrence and pattern of persisting neurological impairment after common CNS infections. A comprehensive search of MEDLINE, EMBASE and PsycINFO databases, supplemented by hand-searches of key journals, resulted in forty-six eligible studies, five of which gave information on the spectrum of developmental domains. Despite the lack of comprehensive, methodologically-sound studies, the results show that postinfectious neurological impairment persists, most commonly in cognition and motor functions. Deficits include more subtle problems, which can be difficult to detect on gross neurological assessment but may still be deleterious to the child's social and educational functioning. Higher morbidity for similar mortality in acute bacterial meningitis compared with cerebral malaria in the epidemiological data may suggest future research directions for clinical research to devise more effective interventions. (C) 2003 Elsevier B.V. All rights reserved.