Spinal arachnoiditis, a complication of
tuberculous meningitis, is not uncommon; it may develop despite specific
chemotherapy and
steroids, and existing avenues of treatment for it are unsatisfactory. The
enzyme hyaluronidase, by virtue of its action of hydrolysing the glucosaminidic bonds of
hyaluronic acid and other
mucopolysaccharides of the ground substance, offers a promising mode of treatment. Sixty-six patients with
spinal arachnoiditis secondary to
tuberculous meningitis were seen over an 8-year period. All these patients received antituberculous drugs and
steroids; 39 of them (group A), who, in addition, were given intrathecal
hyaluronidase, fared better than the remaining 27 (group B), who did not receive this
enzyme. This study was non-randomised. The disability and functional deficit score showed a significant decrease from 7.6 to 3.7 in the
enzyme-treated group in contrast to a mild change from 8.1 to 6.9 in the untreated group. Further, in group A the mortality was 5.2% whereas in group B it was 25.9%. There was a marked 5-fold decrease in mean CSF
protein in group A while in group B there was no significant change. There were no serious side effects due to repeated administration of intrathecal
hyaluronidase. Thus this study provides convincing evidence of the therapeutic role of
hyaluronidase in the management of tuberculous
spinal arachnoiditis and replicates our earlier observation of the safety of
hyaluronidase given intrathecally.