Use of M/XDR-TB Regimen in Patients with Seizure Disorders

The treating physician should elicit the history of past or present seizure disorders in all Drug-resistant TB (DR-TB) patients.​

If the seizures are not under control, initiation or adjustment of anti-seizure medications will be needed before the start of DR-TB treatment. ​In addition, if other underlying conditions or causes for seizures exist, they should be corrected.​

Second-line drugs (Cycloserine (Cs), Ethionamide (Eto) and Fluoroquinolone (FQ)) should be used carefully amongst DR-TB patients with a history of seizures.​ Though the seizure is not common with newer drugs (Bedaquiline/ Delamanid), it should also be considered while assessing the causality assessment.​

Pyridoxine should be given with Cycloserine (Cs) to prevent seizures.​ Cs should, however, be avoided in patients with active seizure disorders that are not well controlled with medication.​

• In patients where no other drug is appropriate, Cs can be given, and the anti-seizure medication adjusted as needed to control the seizure disorder.​
• The risk and benefits of using Cs should be discussed with the patient and the decision on whether to use Cs is made together with the patient.​
• Anti-epileptic drugs may have drug interactions with Cs and FQ. Hence, close monitoring of serum levels of antiepileptic drugs should be done.​

TB itself might affect the central nervous system and cause seizures. However, when seizures present for the first time during anti-TB treatment, they are likely to be the result of an adverse effect of one of the anti-TB drugs.​

Resources​

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• WHO Consolidated Guidelines on Tuberculosis: Module 4- Treatment: Drug-resistant TB Treatment, 2020.
• Technical and Operational Guidelines for TB in India, 2016. 
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.

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