{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:31:06Z","timestamp":1789047066912,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tuberculous meningitis (TBM) carries a case fatality rate of up to 50% in resource\u2010limited settings despite standard anti\u2010tuberculosis therapy. Adjunctive corticosteroids are widely recommended, yet their effect on mortality and safety across diverse populations remains imprecisely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic review and meta\u2010analysis of randomized and quasi\u2010randomized controlled trials identified through PubMed, Cochrane Library, ClinicalTrials.gov, Scopus, and Google Scholar up to May 2025. The outcomes were all\u2010cause mortality, gastrointestinal bleeding, visual and auditory impairment, hydrocephalus, and joint disorders. Statistical heterogeneity was assessed using the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic. Certainty of evidence was assessed with the GRADE framework.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven studies enrolling 1917 patients were included. Corticosteroids significantly reduced all\u2010cause mortality (RR = 0.84, 95% CI: 0.76\u20130.94,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002) with low heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%). Subgroup analysis revealed pronounced benefits in low\u2010income countries (RR = 0.82, CI: 0.72\u20130.95) and dexamethasone use (RR = 0.87, CI: 0.77\u20130.97). In HIV\u2010positive patients, corticosteroids did not significantly impact mortality (RR = 0.90, CI: 0.77\u20131.05,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.18). No statistically significant increase in adverse outcomes was detected, including gastrointestinal bleeding (RR\u00a0 = \u00a00.87), visual impairment (RR\u00a0 = \u00a01.62), auditory impairment (RR\u00a0 = \u00a00.79), hydrocephalus (RR\u00a0 = \u00a00.47), or joint disorders (RR\u00a0 = \u00a00.63).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adjunctive corticosteroids, particularly dexamethasone, significantly reduce mortality in TBM without increasing major adverse effects. The absence of benefit in HIV\u2010positive patients highlights the need for targeted trials in this subgroup and in pediatric populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71639","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:49:36Z","timestamp":1785250176000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Corticosteroids in Tuberculous Meningitis: Systematic Review, Meta\u2010Analysis, and Meta\u2010Regression"],"prefix":"10.1002","volume":"16","author":[{"given":"Ayesha","family":"Younas","sequence":"first","affiliation":[{"name":"Department of Medicine Allama Iqbal Medical College  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rizwana","family":"Noor","sequence":"additional","affiliation":[{"name":"Department of Medicine Khyber Medical College  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Talha","family":"Shaukat","sequence":"additional","affiliation":[{"name":"Department of Medicine King Edward Medical University  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha","family":"Ijlal","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irra","family":"Tariq","sequence":"additional","affiliation":[{"name":"Department of Medicine United Medical and Dental College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murtaja","family":"Satea","sequence":"additional","affiliation":[{"name":"Department of Surgery College of Medicine University of Warith Al\u2010Anbiya  Karbala Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Sameer","family":"Almas","sequence":"additional","affiliation":[{"name":"Department of Medicine Allama Iqbal Medical College  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosheen","family":"Jamil","sequence":"additional","affiliation":[{"name":"Department of Medicine Jefferson Abington Memorial Hospital  Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mifrah Rahat Khan","family":"Sherwani","sequence":"additional","affiliation":[{"name":"Department of Cardiology Duke University Health  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norma Nicole Gamarra","family":"Valverde","sequence":"additional","affiliation":[{"name":"Department of Medicine Universidad Peruana Cayetano Heredia  Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Qadri","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahwash","family":"Siddiqi","sequence":"additional","affiliation":[{"name":"Department of Medicine Penn State Health Milton S. 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