Keddie, S;
Bharambe, V;
Jayakumar, A;
Shah, A;
Sanchez, V;
Adams, A;
Gnanapavan, S;
(2018)
Clinical perspectives into the use of thalidomide for central nervous system tuberculosis.
European Journal of Neurology
, 25
(11)
pp. 1345-1351.
10.1111/ene.13732.
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Abstract
BACKGROUND: Central nervous system (CNS) tuberculosis (TB) accounts for over 4% of all TB notifications in the United Kingdom, and causes death or significant disability in over half of those affected. TNF-alpha is a critical cytokine involved in the neuropathogenesis of CNS TB. Thalidomide has been trialled in CNS TB due to its immunomodulatory and immune reconstitution effects, through inhibition of TNF-alpha. Despite animal models demonstrating dramatic improvement in survival, studies in paediatric patients have been associated with higher levels of mortality. The effects of thalidomide have not yet been studied in adults with CNS TB. This narrative case series guides clinicians through a range of CNS TB clinical cases seen in a large London teaching hospital, serving a region with a high TB incidence of 32 per 100,000, with 55% of TB manifesting as extrapulmonary disease. We aim to illustrate our experiences of using thalidomide to treat a range of severe CNS TB complications. METHODS: Five inpatients at the Royal London Hospital, London, UK treated with thalidomide in addition to standard TB treatment are described in detail. The rationale for treatment initiation with thalidomide is explained. RESULTS: The case examples are used to guide our reflections and lessons learnt regarding the use of thalidomide. Responses to treatment and functional outcomes suggest thalidomide may be a useful adjunct to standard TB therapy in selected adult cases. CONCLUSIONS: The experience gained from using thalidomide in this small case series may provide evidence towards more research into using thalidomide to treat severe CNS TB. This article is protected by copyright. All rights reserved.
| Type: | Article |
|---|---|
| Title: | Clinical perspectives into the use of thalidomide for central nervous system tuberculosis |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/ene.13732 |
| Publisher version: | https://doi.org/10.1111/ene.13732 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | CNS, TB, Central nervous system, thalidomide, tuberculosis |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10053234 |
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