Q: My 55 years old father suffered from dengue fever eight months back. After three months, he was diagnosed with cervical tuberculosis and on treatment for the last four months. But till now he is unable to walk properly. Moreover, he complains that his joints are becoming weak and have very less strength. Fifteen days back, he experienced swelling also with no itching. Why is my father unable to walk properly? How can cervical tuberculosis be treated?

A:Neurological affection in TB could be due to the direct effect of the disease (involvement of specific anatomical sites controlling neurological function), complications of disease (pain, paralysis, paraesthesia or abnormal sensation, paresis or weakness- e.g. bone TB affecting spine complicated by neurological involvement), or side effects of treatment (isoniazid or INH induced neuropathy). It is likely from the description provided that the condition being experienced in your father could be due to INH or isoniazid induced neuropathy which is due to vitamin B6 or pyridoxine depletion (a common complication which is preventable and treatable with vitamin B6 or pyridoxine therapy).

The neuropathy induced by INH is generally sensory and may manifest as abnormal sensations (paraesthesia) or ataxia (lack of coordination of muscle movement). The condition is more common in elderly individuals and in those who are diabetic, malnourished, alcoholic. Sometimes other conditions, such as vitamin deficiency (Vitamin B1, B12) may have similar manifestations. The time required for treatment and possible cure depends on the cause. I suggest you consult a TB specialist for further advice, and consider consultation with a neurologist. My best wishes for your family.