Lucknow: A study found that four in 10 patients with brain tuberculosis continue to take medicines despite complete recovery.
Reason: The MRI scans keep showing abnormalities without active disease. The findings challenge prolonging treatment based solely on scan results and could reduce unnecessary medication, side effects and financial burdens.
The study, led by Prof Ravindra Kumar Garg of the neurology department at a private medical college, involved researchers from King George’s Medical University and Sanjay Gandhi Postgraduate Institute of Medical Sciences. It was published online on Oct 15 in the American Journal of Tropical Medicine and Hygiene.
Most people with brain tuberculomas improve with treatment.
However, MRI scans may still show lesions after treatment is completed. In this study of 201 patients, 83 people (41%) still had visible lesions on MRI, while the lesions completely disappeared in about 70 people (35%).
During treatment, about 94 patients (47%) experienced a paradoxical reaction, meaning that existing lesions became larger or new lesions appeared on scans. This is often a normal immune response to treatment and does not necessarily mean the treatment has failed.
Overall, about 98 patients (49%) recovered completely, with no symptoms or MRI abnormalities. Another 74 patients (37%) improved but still had some remaining lesions or other complications. The infection returned in about seven patients (3.5%), showing that relapse was uncommon.
Treatment frequently continued beyond one year and sometimes exceeded two years, often because MRI abnormalities persisted. Prof Garg said residual lesions may represent inflammation, swelling, scar tissue or calcium deposits rather than active TB bacteria.
Brain tuberculosis affects the central nervous system and can cause headaches, seizures, weakness, paralysis and other neurological problems. Some patients develop inflammatory lumps called tuberculomas, which are monitored through MRI scans during and after treatment. These lesions may remain visible for months or years even after symptoms improve.
The study also involved Dr Neeraj Kumar, Dr Imran Rizvi and Dr Sanjay Singhal, who said decisions to stop or continue treatment should not be based on MRI findings alone. Doctors should consider symptoms, neurological condition, overall recovery, changes in scans over time and evidence of ongoing infection.
However, the findings do not mean treatment can be stopped early in all patients. Those with worsening symptoms, growing lesions or suspected drug-resistant TB require careful evaluation and individualised treatment. Patients should not stop or alter medicines without consulting doctors.
Researchers called for further studies to determine when treatment can safely stop in patients who have clinically recovered but retain MRI abnormalities.
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