Reasearch on the effectiveness of thalidomide in curing complications of tuberculosis meningitis at PGI has shown good results over the last five years. Many patients who did not respond to any other treatment have shown remarkable improvement after treatment with the drug.
Tuberculosis meningitis (TBM) is a serious neurological disorder which affects young population more often. It occurs when tuberculosis bacteria invade the membranes and fluid surrounding the brain and the spinal cord.
Every month, 50 to 60 cases of TBM are reported at the Neurology Department, and a similar number at the Paediatrics Centre. Dr Manish Modi, a neurologist, is using thalidomide drug in curing complications of TBM.
“Its initial symptoms are severe headache, vomiting and fever. Often it is misdiagnosed as viral infection, and clinicians give antibiotics suppressing the disease for a couple of weeks,” said Dr Modi.
Weeks later, more obvious symptoms like raised intracranial pressure, abnormal behaviour, dislike of lights, vision loss and seizures occur. Without proper medical treatment, the disease progresses to the last stage, causing confusion, nerve damage and eventually coma.
“Because of the ignorance on the part of physicians, we are getting TBM patients at PGI at a very late stage where the disease becomes difficult to treat,” Dr Modi said.
He added, “The first line of treatment is the standard four-drug anti-tubercular treatment, along with a high dose of steroids. We give this treatment to a patient and wait for four to six weeks. In case the patient’s condition worsens, that is the time when we start using experimental drugs.”
Thalidomide is a very powerful anti-inflammatory-like steroid, but with a very different mechanism of action. The drug is very old and used in some malignancies, but its use in TBM is something new.
“We are using thalidomide on a group of patients where there is no other treatment left. It is being done with their consent. For six weeks or so, we see the response and if it works, then we continue it for six months,” Dr Modi said.
Over the last five years, the doctor has given the drug to some 50 patients.
“The results are remarkable. About 60 per cent patients have shown wonderful recovery. They came on trolleys, then on wheelchairs and now they come walking to me,” Dr Modi said.
The project is partly ICMR-funded. By early next year, it will be published in one of the top journals.
Parasitic infection of the brain (Neurocysticercosis) and Tuberculosis affecting nervous system (TB meningitis) have emerged as the common infections of Central Nervous System, in this part of the region. Though preventable, most of the cases are reported in PGI when damage has already been done.
Neurocysticercosis, a parasitic infection of the brain, is quite rampant in the area. The parasitic infection has emerged as a major treatable cause of epilepsy among adults and children.
About 500 cases of NCC among adults are reported annually at Neurology OPD of PGI. Similar number of the infection among children is also seen at the Advanced Paediatrics Center.
It is caused by the intake of food contaminated with eggs of taenia solium, commonly called tapeworm.
“The eggs enter the body by ingestion of infected raw vegetables or uncooked infected pork. These young tapeworms release larvae that develop into adult tapeworms in the intestine, and shed thousands of extremely contagious eggs in the faeces. If tapeworm larvae move out of the intestine, they can cause local growths and damage tissues such as the central nervous system, eye, heart, or muscles,” Dr Manish Modi, Neurologist, PGI said.
Discarding the myth that it is caused by intake of cabbage, he said, “It is not caused by only cabbage, but any vegetable or fruit which is either washed or irrigated in a water contaminated with faeces, can cause NCC.”
“You will never get NCC, if you wash every vegetable and fruit under running water thoroughly and then cook it properly, so that the eggs of tapeworm can be washed away and killed,” said Dr Manish Modi.
Another infection,Tuberculous Meningitis (TB affecting nervous system), is emerging as one of the serious neurological disorder at PGI.
It’s initial symptoms are severe headache, vomiting and fever. Often it is misdiagnosed as viral infection, where in clinicians give antibiotics suppressing the disease for some time. If not timely treated, it leads a patient to coma.
He added, “do not ignore a fever that lasts for more than a week. Further, headaches accompanied by vomiting and fever should be taken care off. One should consult a neurologist in such cases.”
‘Young women shouldn’t ignore headache as it can lead to vision loss’
No headache should be ignored, especially by young women, for it can lead to permanent vision loss, say neurologists from the Post-Graduate Institute of Medical Education and Research.
At the Neurology Department of PGI, about 70 cases of neuro-ophthalmology are reported every month. Neuro-ophthalmology is a branch of neurology which deals with the neurological causes of visual morbidity, including loss of vision and double vision.
The common causes of visual morbidity among young women are optic-neuritis (inflammation of the optic nerve causing blurred vision), migraine and obesity. “Optic-neuritis is a very common reason of visual loss in young female population. We still do not know why it occurs, but we do know it can be prevented if the treatment starts in time,” says Dr Vivek Lal, head of the Neurology Department.
Unfortunately, most of the cases report very late at PGI and lose their vision.
Migraine and headaches are other causes of acute vision loss which is often irreversible. Doctors maintain as many as 50 per cent patients coming to the nero OPD have complaints of headaches and migraine. Of them, about 30 per cent have vision problems.
“Migraine leads to acute vision loss among the young population, especially females. The problem is that it is often not diagnosed before it causes vision loss. It is very sudden, and takes only 24 to 48 hours,” says Dr Vivek Lal.
He adds, “In the last 10 years, I have seen more than 200 such cases of vision loss due to migraine. Sadly, correct diagnosis was not given in any of the cases before the patient was referred to PGI.’’
Vision loss caused by these reasons is different from common vision loss as it strikes the younger age group (20-40), is more severe and irreversible in many cases.
The other most common cause of vision loss in obese women is increased intracranial pressure, which affects the optic nerve and leads to permanent vision loss.
“In one month, we get to see about 20 patients of vision loss because of intracranial hypertension. Again, an overwhelming number of patients come late, when permanent damage to the vision has been done,” he adds.
Besides, about 30 per cent patients suffering from tuberculosis meningitis suffer from vision loss and again, unfortunately, it is irreversible.
Dr Lal’s advice for young women: “When you have headaches, do not ignore it and do visit the neurologist. No headache is to be ignored in the young women because it can lead to permanent visual loss.”