Neuropathy from anti-tubercular drugs. What to do?

Question

Hello doctor,

My mother is 75 years old. She had been treated for TB (tuberculosis) of the abdomen as her ultrasound of abdomen finding was thickened bowel loop. In general terms, it was informed about TB in her abdomen. Accordingly, medicines were given to her as per the advise of a local MD doctor. Treatment continued for three months and due to some discontinuation of medicine it relapsed and again she was diagnosed with Thicken bowel loop as per ultrasonography (USG). Again treatment continued. However, while undergoing treatment she lost sensation in her legs and complained of losing sensation in her legs and numbness in her feet and was unable to put on slippers in her feet with difficulty in moving. She also complained that while moving she felt as if she was moving on a bed of soft cotton. Subsequent treatment by neuro experts revealed that overdose of treatment of her TB in abdomen resulted in this condition and she was diagnosed for peripheral neuropathy and was advised for biopsy for proper diagnosis. Meanwhile, she fell and hurt herself which was later on diagnosed that her spine at L3 - L4 was compressed due to felling abruptly and accordingly she was advised to take bed rest for three months. Slowly, she recovered from this condition felt pain in her back and was facing another kind of problem as she could not sit for a longer time and preferred to lay down on the bed. Finding her bad condition subsequently, we also took consultation from other neuro experts at a prestigious institution where she was prescribed Lupivitin one tablet and Sammy one tablet. When condition persisted thereafter she was given Primosa one tablet daily, Neurox one tablet daily, Maxglobin 50 mg one tablet and Defcort 6 mg. But, whenever she was given medicine her condition further aggravated. After about six months of treatment by the neuro expert, she has now been referred to the department of immunology for their advice. Meanwhile, we also took advice from a rheumatologist who diagnosed a kind of arthritis and started treating accordingly. He also started the course of Deflazacort (steroid) along with other medicines. The steroid was prescribed with a decreasing dose per week from 60 mg per day to 6 mg per day. However, after taking about two months of steroid course her condition deteriorated and had severe breathlessness. Her blood sugar level also shot up and ultimately she was hospitalized and the treatment of steroid withdrawn. After 15 days of treatment at the hospital she recovered to her previous condition. But, her neuro problem of numbness in her legs and loss of sensation in legs still continues. Please help.

Answer 1

Hello,

Welcome to icliniq.com. I have carefully gone through the details provided by you and have short-listed the following possibilities. Isoniazid-induced peripheral neuropathy, which occurs in a few patients who are on anti-tubercular drugs (including Isoniazid-INH). The specific treatment for drug-induced neuropathy is Pyridoxine (vitamin B9), available under the brand name of Pyricontin 100 mg tablets. You may, therefore, start immediately with 50 mg Pyridoxine per day for two months initially. The decision to continue further will depend on the response and, whether the neuropathy is reversible or has reached an irreversible stage. In addition, the addition of vitamin B12 (Methylcobalamin) 1500 micrograms/day would be of great benefit. Compressive Myelopathy, due to compression over the terminal end of the spine at L3-L4 level, following trauma. If that is the cause, then surgical decompression is the only treatment of choice. The neurosurgeon will get a repeat MRI (magnetic resonance imaging) myelogram done and depending on the findings, remove part of the discs or bone which is pressing over the nerves supplying the legs. Consult your doctor and apprise him of my opinion. I am certain that he will agree with me, order the required test, and based on the reports we will arrive at a certain diagnosis and prescribe suitable treatment as advised. I hope this helps.