No randomized controlled trials (RCTs) have been conducted till date to determine the efficacy of Thalidomide in treating CNS tuberculoma. This is despite it being a clinical challenge in endemic areas. Most of these patients are on prolonged ATT, second line ATT as well as recurrent or persistent high doses of corticosteroids, with resultant side effects of the same. So, there is significant knowledge gap in treatment of CNS tuberculomas.  The evidence of efficacy of Thalidomide is limited to case reports and cohorts of paediatric patients, although it equally affects adult patients as well.

Our study would be the first of its kind to explore an adjuvant therapy for better resolution of CNS tubercular lesions along with standard treatment. Our clinical trial would also help in determining the safety and efficacy of thalidomide in treating CNS tuberculoma patients. This novel treatment would also help in determining the significance of Thalidomide in resolving paradoxical lesions developing during ATT regimen. Recovery from CNS Tuberculoma is long and critical process and using an adjuvant like Thalidomide to reduce the recovery time would also make the entire process of treating CNS TB cost-effective, especially in resource-limited settings.

Therefore, our hypothesis is that Thalidomide used as an adjuvant along with ATT and corticosteroids for treatment of CNS tuberculoma would be safe and effective in resolution of CNS tuberculoma in terms of functional outcome and radiological improvement.