Dreaded drug saves TB kids
Cape Town - Thalidomide, the controversial drug banned for use by pregnant women, may be the key to helping save the lives of children with severe tuberculosis meningitis – a life-threatening disease.
At least one case of a child with TB meningitis (TBM) is reported to the Tygerberg Children’s Hospital each week.
Children who had gone blind from the disease “regained full vision,” after the Thalidomide treatment, doctors said.
A four-year clinical study conducted by a team of senior specialists at the Paediatric Neurology Department at Stellenbosch University and Tygerberg Children’s Hospital has yielded “the best results in the world” for children with TBM.
Senior specialist Dr Ronald van Toorn recorded an 80 percent success rate. Most of the 184 child patients in the study no longer required brain surgery after the treatment. “There were no relapses. Our results are the best in the world. No other hospital where children have been treated for TB meningitis has had the same success.”
Many of the 184 patients had developed “life-threatening mass lesions in the brain” despite being on anti-TB medication.
Thalidomide was administered to some of the children and within three months, a reduction of lesions was evident.
“All children with TBM who developed visual impairment due to excessive inflammation around the optic nerves, showed improvement on Thalidomide,” said Dr Regan Solomons.
The study, conducted between 2011 and last year was initiated by fellow senior specialist Van Toorn.
While Solomons focused on achieving earlier detection of childhood TBM, Van Toorn wanted to “challenge” existing treatment of the disease. He hoped that with a different treatment it would improve the chances of survival for children with the disease.
Within days of children being given Thalidomide, Van Toorn said those who were “completely blind regained full vision”.
Most children with TBM require steroids to reduce the amount of inflammation. But those patients who develop brain abscesses and inflammation of their eye nerves which may cause blindness require stronger anti-inflammatory drugs, said Van Toorn.
Instead of the recommended treatment period of one year, the young TBM patients were given higher dosages of TB drugs for just six months.
A “unique” method was also used whereby some spinal fluid was replaced with air so that brain cavities appear clearer on X-rays to indicate where spinal fluid is being blocked.
“The study showed that childhood TB meningitis can be effectively treated for six months instead of the 12 months currently advocated.
“Secondly, Thalidomide, can restore vision and be life-saving in selected children with complicated TBM,” said Solomons.
The children were monitored and after two years on the treatment it was found that TB had not recurred.
What is childhood TBM?
Childhood tuberculosis meningitis (TBM) affects children aged between two to four, as their immune systems are still maturing. It is the most common bacterial meningitis in the Western Cape.
Its symptoms are similar to flu, and hard to diagnose. Patients exhibit poor weight gain, fever, headaches and vomiting. As it gets more severe, patients can have seizures, fluid on the brain, inflammation of blood vessels and eye nerves and brain abscesses. Children living in overcrowded conditions are often infected with it.
“TBM is the most devastating manifestation of tuberculosis and is an important cause of neurological handicap in poor-resource countries,” says Dr Regan Solomons.
Thalidomide was developed in the 1950s as a sedative to help treat morning sickness in pregnant women. By the late 1960s it was withdrawn from use after women who had used it gave birth to children with limb deformities.
It re-emerged in use in the late 1990s as a “wonder drug” when doctors and scientists began using it to treat conditions ranging from blindness to HIV to certain cancers.