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Regional cerebral blood flow in epilepsy studied with xenon enhanced CT.

a lesion disappears without antitubercular treatment it cannot be tubercular. The human body has an immune system which is able to look after diseases be they in the lungs or brain. The authors mention managing some of these cases without anti tuberculosis drugs. We discussed this and since the paper was submitted we too have treated some this way and in some cases the lesion has disappeared. The number so far is below 12. (Three of these have failed to clear). But the control trial mentioned has not to our knowledge been attempted anywhere as yet. That this lesion may at times represent a postictal change was discussed but the reason for this is not described in western literature remains unclear. Whether this lesion is due to focal encephalitis has been discussed. The chronicity of the illness would mean that subacute or chronic encephalitis is much commoner than any other slow virus CNS infection in this country. Of course the focal encephalitis may not be viral, but then in our context a tuberculoma would be an important candidate for "focal encephalitis". That it is focal it is obvious. That it is inflammatory is also an assumption: therefore our non commital use of the term ring/disc lesion. That a biopsy would be helpful is agreed. We would certainly not agree to biopsy without an adequate antitubercular trial either immediately or after 3 months. We are virtually sure this would be the feeling of most neurologists in India. Drs Diwate and Apte also speak of arbitary anti tuberculosis trial as their present plan. Our policy of giving antitubercular therapy to all cases has changed since the reported series was closed in 1985. At mentioned, we too in 1988 are using anti tuberculosis treatment much less often. Our paper was an attempt to highlight the problem of ring/disc lesion in India, to assess its incidence and clinical characteristics and to discuss its aetiology with special reference to the proportion which are tubercular. In these respects we found no prior published work from this subcontinent and we felt the problem needed to be highlighted.