Lucknow: Treatment for brain tuberculosis (TB) may be falling short as several commonly used tuberculosis drugs fail to reach the brain and spinal fluid in sufficient amounts, an international review has warned.The review, led by Prof Ravindra Kumar Garg, former head of neurology at King George’s Medical University, highlighted major gaps in diagnosis and treatment that could affect survival.“Tuberculous meningitis remains the most severe form of TB. Early diagnosis and medicines that effectively reach the brain are critical,” Prof Garg said.Published in the journal Expert Review of Anti-infective Therapy, the study analysed international clinical trials, WHO guidelines and studies from multiple countries till July 2025.Researchers said doctors may need higher doses of some TB medicines, drugs with better brain penetration and faster tests for early detection. The review also found that several drug-resistant TB medicines effective in lung TB work poorly in brain TB.The paper said TB bacteria can spread through the bloodstream to the brain, causing inflammation and blood vessel damage, leading to stroke, seizures, paralysis, hydrocephalus, vision loss and coma.Diagnosis is often delayed as early symptoms — headache, fever, vomiting and weakness — resemble common illnesses. Routine spinal fluid tests also miss many cases because bacterial levels remain very low.The review discussed newer diagnostic tools, including GeneXpert Ultra, nanopore sequencing and metagenomic sequencing, which can detect TB bacteria and drug resistance faster than conventional methods.One key finding related to rifampicin, a cornerstone anti-TB drug that it cannot pass blood-brain barrier. Studies from Indonesia and Uganda showed standard doses often fail to achieve adequate brain levels, while higher doses improved survival in some patients.The review recommended greater use of drugs with better brain penetration, such as, especially for drug-resistant brain TB.
