The association between tuberculosis susceptibility and manifestation of ADHD in their generation

Dr. Nicky Seth

ABSTRACT
This article explores the intriguing link between Tuberculosis (TB), specifically Tubercular meningitis, and the manifestation of Attention Deficit Hyperactivity Disorder (ADHD) symptoms in subsequent generations. Tracing back to the seminal discovery of the tubercle bacilli by Robert Koch, the discussion integrates how the tubercle bacilli was derived as a Homeopathic preparation. Through an extensive review of homoeopathic symptomatology documented in various materia medica, the article elucidates the potential hereditary implications of TB infections. Additionally, the article presents clinical observations and data from research papers, highlighting the classical presentation of ADHD in outpatient departments (OPD). This interdisciplinary approach aims to deepen the understanding of ADHD’s etiology and underscores the importance of considering familial and infectious disease histories in diagnostic and therapeutic strategies.

UNDERSTANDING THE HIDDEN LINK – TUBERCULOSIS AND ADHD IN CHILDREN –
The link between tuberculosis and ADHD in children is an area of emerging interest and research. While direct causation may not be firmly established, several possible connections can be explored:

1. Neuro-inflammation: Tuberculosis, particularly when it affects the central nervous system (CNS), can lead to Neuro-inflammation. Chronic inflammation in the brain has been associated with various neuropsychiatric conditions, including ADHD.
2. Immune System Dysregulation: Both tuberculosis and ADHD have been linked to immune system abnormalities. Tuberculosis can alter immune responses, potentially affecting neurological development and function, which may contribute to ADHD symptoms.
3. Genetic and Environmental Factors: Shared genetic predispositions and environmental risk factors (e.g., prenatal exposure to infections, toxins, or stress) might increase the susceptibility to both tuberculosis and ADHD.
4. Psychosocial Stress: Children with tuberculosis may experience significant stress and social disruption, which could exacerbate or contribute to ADHD symptoms. Chronic illness and its associated stressors can impact cognitive and behavioral functioning.
5. Nutritional Deficiencies: Tuberculosis can lead to nutritional deficiencies due to poor appetite and nutrient absorption issues. Nutritional deficiencies, particularly in essential fatty acids, iron, and zinc, have been linked to ADHD.

KOCH`S DISCOVERY OF THE TUBERCLE BACILLI
We cannot talk about the remedy without first giving credits to the person responsible for finding the causative agent in the first place. In the year 1882, a German physician and a bacteriologist, aka the father of Medical Bacteriology was thoroughly involved in trying to find out the causative agent of Tuberculosis, i.e. the tubercle bacilli. However, using the tubercle Bacilli in patients with active T.B as a medication failed disastrously and was even dangerous (What we term today as Isopathy).

It was after this controversy when Koch finally revealed that the derivative of the bacilli that we have been using was a glycerine extract of a pure cultivation of the tuberculosis bacilli.

Some of few important species of Mycobacterium include M.tuberculosis and M.leprae causing tuberculosis and leprosy, respectively in humans. M.bovis causes tuberculosis in cattle. From cattle, it can even spread to humans. With this, let us first understand the different sources of this remedy as mentioned by our Stalwarts in the Materia Medica. Dr. William Boericke mentions that the source of this drug is from a tubercular abscess. John Henry Clarke relates it to its original source, i.e. a glycerine extract of a pure cultivation of the tubercle bacilli. However, the preparation used by J.T. Kent was something different than that was been used already.  He secured and extracted from the tubercular glands of slaughtered cattle in Pennsylvania.

FINDING THE LINK BETWEEN TUBERCULINUM SYMPTOM PROVING AND THE PREVALENCE OF PSYCHIATRIC AILMENT – (PROBING THE MATERIA MEDICA)

Dr. William Boericke in his materia medica says that this remedy is of undoubted value in the treatment of incipient tuberculosis. The patient is hypersensitive to cold exposure (an allergy concept of ADHD linked with Tuberculosis that we will soon discuss).  They are very irritable and have a desire to use foul language, curse and swear. In the respiratory section, we see typical symptoms related to chest affections in general like enlarged tonsils, hard, dry cough with shortness of breath and easy expectoration.

Dr. Clarke in his introduction to this drug mentions very clearly that there is something more than a pyrexial power in Tuberculinum; insanity being a very frequent manifestation. He also says that these people tend to outgrow their melancholic disposition and they become more whining and complaining. They are highly sensitive to music, have an aversion to mental labor and love to be on their own. Another ADHD symptom that we can find in Clarke materia medica is the trembling of their hands (i.e. fidgety movements). That is something they keep doing to release their internal stress.

Dr. J.T Kent`s observations were pre-dominantly focused upon the mind symptoms of this remedy. He clearly disapproves the idea of isopathy, i.e. treating Syphilis with Rx. Syphilinum, Gonorrhoea with Medorrhinum, also Tuberculosis with Tuberculinum. The remedy Tuberculinum has also been contra-indicated in patients with active T.B. Being a constitutionally deep-acting remedy, this drug is inherently rooted in the deep psyche/temperament and diathesis of a person. He goes on to say that patients who have a hereditary history of Pthisis/Tuberculosis in their family will never throw off their inherited tendencies.

Pthisis and insanity infact are convertible conditions and many cases that have been physically treated of Tuberculosis shift towards the mental sphere. The intellectual symptoms and the lung symptoms are interchangeable, he says. A constitution who might have a taint of this remedy are hopeless, averse to mental work. They have constant intrusive thoughts that crowd upon each other. A constant desire to travel, to change places, go somewhere else and do something else remains their inner calling. He also mentions about cases of having history of Tubercular meningitis cured with Tuberculinum.

Dr. S.R Phatak in his materia medica says that this remedy specifically affects the mind, the lungs, the head, glands and the larynx. Just like a child with ADHD symptoms keep changing their position, posture, activities, similarly, the symptoms of Tuberculinum are also constantly changing, beginning suddenly and ceasing suddenly. Being constantly on the go, they are always tired. These children can be mentally deficient with recurrent episodes of Adenoids, Nocturnal enuresis, Nightmares and Epilepsy. They are very sensitive to noise, music, mental excitement and standing at one position for a long time. These children can also have fits of violent temper, they suddenly turn violent and throw things away even without a cause. They are always dissatisfied, reckless and always changing mood. One rubric, typical of ADHD that we can find in the Materia Medica is Loquacity. But here this loquacity is typically during fever.

EXPLORING THE CLASSICAL SYMPTOM PRESENTATION OF ADHD IN SCHOOL/HOME/OPD SETTING –

1. Inattention:

•    – Easily distracted by unrelated thoughts or stimuli
•    – Difficulty sustaining attention in tasks or play
•    – Often does not seem to listen when spoken to directly
•    – Avoids or dislikes tasks requiring sustained mental effort
•    – Frequently loses items necessary for tasks and activities
•    – Often forgetful in daily activities
•    – Fails to follow through on instructions and fails to finish schoolwork or chores

2. Hyperactivity:

•    – Fidgeting with hands or feet or squirming in seat
•    – Inability to stay seated in situations where it is expected
•    – Running or climbing in inappropriate situations
•    – Difficulty playing or engaging in leisure activities quietly
•    – Often “on the go” or acts as if “driven by a motor”
•    – Excessive talking (Loquacity)

3. Impulsivity:

•    – Blurting out answers before questions have been completed
•    – Difficulty waiting for their turn
•    – Interrupting or intruding on others’ conversations or games

DECODING OUR UNDERSTANDING OF THE REMEDY –

First goes, the physical generals –

1. THEME AND ESSENCE – Looks weak, exhausted and emaciated.
2. DIATHESIS – Susceptible to cold and has impaired immunity.
3. Recurrent tonsillitis
4. Chronic Asthma
5. Recurrent Chest Infections
6. Enuresis with history of worm infestation in children.

The mental essence
Tuberculinum can be seen as a child who is fidgeting, sitting in first row and first bench of his classroom. No, not out of will, but as a punishment. A reckless, obstinate `NO` child who is the troublemaker of the class and of the home. Their violent temper tantrums bring chaos in the environment they are in. Kicking, howling, screaming, going to the point of even self-destruction. We all have at least heard off or seen a child banging or thumping their heads out of extreme stubbornness. Being extremely restless, they are always `on the go` i.e. hyperactive (both physically as well as mentally). They have so much of nervous energy that they rush all around in the house to relieve their nervous tension.

When they grow as adults, they are always changing jobs, homes, relationships. They love to travel, not because they want to explore, but because they are bored. This dissatisfaction and boredom often leads them to resort to substance abuse. Tuberculinum people hate a strict routine just like Sepia. While Sepia may succumb to her circumstances, Tuber. will not.

GOING BACK TO THE RESEARCH PAPERS – UNDERSTANDING WHAT CLINICAL EXPERIMENTS SAY ABOUT THEIR CONNECTION –  

The aetiology of ADHD in the first place, is multifactorial. It is caused by combined triggers that can be biological, psychological and behavioral. Children with symptoms of ADHD have visible neuro-anatomical abnormality in the region of the brain that is responsible for regulating attention, focus, behavior and other motor behaviors. It is the reason why brain damage as a result of cerebral infections, trauma or birth injuries have been attributed to the primary causes of ADHD.  An article published by PubMed concluded that ADHD can be a long-term complication of Tuberculosis Meningitis(TBM). The clinical experiment included 21 TBM group and control groups respectively where they thoroughly investigated the prevalence of attention deficit hyperactivity disorder(ADHD) in children who have already recovered from Tuberculosis Meningitis(TBM). They found that all the children in the TBM group exhibited symptoms of ADHD and were comparatively more aggressive, obsessive, compulsive than that of the control group.

Another article published by the European Child and Adolescent Psychiatry, published in May 2019 relates ADHD to immune-related alterations in the body. The children with diagnostic symptoms of ADHD showed increased levels of oxidative damage (a pathological progression also seen in patients with tuberculosis). When the body has chronically elevated oxidative stress, it can lead to impairment in the immunity as well as an increased level of IgE. The paper also clearly mentions about the general guiding symptoms of Tuberculinum that we have just discussed above. It quotes that `ADHD genetic risk was specifically associated with genetic risk of elevated serum C-Reactive protein which makes the person more susceptible to recurrent ear infections, psoriasis, Rheumatoid arthritis, and tuberculosis susceptibility`.

Another classical symptom in children with ADHD is Enuresis. It is also a common problem in children who have a differential diagnosis of Tuberculinum taint in their constitution. According to research, around 28-40% of people with ADHD may also have enuresis. This can be owed to a delay in the development of the central nervous system(CNS) where the child suffers from improper bladder control. If we think about the pathology of Tubercular meningitis (TBM) which is aka extra-pulmonary tuberculosis, the tubercle bacilli from the local lymph nodes spread via the Blood-Brain Barrier (BBB) and infects the subarachnoid process. There are analyses of research studies which also proposes that especially children with Mycobacterium Tuberculosis aged between 0 to 4 have a higher incidence of TBM.

CONCLUSION AND DISCUSSION
The association between tuberculosis (TB) and Attention Deficit Hyperactivity Disorder (ADHD) highlights the intricate interplay between chronic infections and neurodevelopmental disorders. The Homoeopathic preparation of the remedy Tuberculinum, derived from the tubercle bacillus, has clinically been employed to address a variety of symptoms linked to tuberculosis and its constitutional effects. As discussed above, there are so many emerging evidences and clinical experiences that suggest that Tuberculinum`s therapeutic potential for patients exhibiting ADHD-like symptoms, particularly when there is a family history of TB or a tubercular miasm.

While the exact mechanisms through which Tuberculinum exerts its effects remain to be fully elucidated, its application highlights the holistic approach of homeopathy in addressing both physical and psychological aspects of health. Further research and clinical studies are essential to validate these findings and to better understand the role of Tuberculinum in the management of ADHD.

REFERENCES 

1. A Dictionary of Practical Material Medica – JH Clarke
2. Homeopathic Materia Medica – William Boericke, MD
3. Lectures on Homeopathic Materia Medica – J.T. Kent
4. Materia Medica of Homeopathic Medicines – Dr. S.R. Phatak
5. Wait JW, Stanton L, Schoeman JF. Tuberculosis meningitis and attention deficit hyperactivity disorder in children. J Trop Pediatr. 2002 Oct;48(5):294-9. doi: 10.1093/tropej/48.5.294. PMID: 12405172.
6. Hoekstra, P.J. Attention-deficit/hyperactivity disorder: is there a connection with the immune system?. Eur Child Adolesc Psychiatry 28, 601–602 (2019). https://doi.org/10.1007/s00787-019-01344-2
7. Slane VH, Unakal CG. Tuberculous Meningitis. [Updated 2022 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541015/
8. Robert Koch and the discovery of Tubercle Bacilli
9. The co-relationship between ADHD and Bedwetting
10. A review of the interplay between tuberculosis and mental health
11. Tuberculous Meningitis and ADHD in children

Dr. Nicky Seth, PG(HOM)LONDON, BHMS, CERTIFIED IN NEUROPSYCHOLOGY