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New Options (or not) for Treatment of Idiopathic Intracranial Hypertension

  • Neuro-Ophthalmology (H. Moss, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of review

Idiopathic intracranial hypertension (IIH) is a disorder primarily affecting obese women of childbearing age and, if left untreated, can lead to irreversible vision loss. No consensus exists on the best management strategy for IIH. Weight loss is advocated and few useful medical options exist. There is an unmet need to discover new treatment options for this increasingly prevalent condition. This article reviews the recent advances and research on the treatment of IIH.

Recent findings

Venous sinus stenting (VSS) is now performed in many experienced centers, and there is growing interest in bariatric surgery as a treatment modality. Newly approved anti-obesity drugs are showing effectiveness in weight loss, and novel targeted disease-modifying IIH therapies are being explored.

Summary

Further evaluation of these novel therapeutic strategies as well as studies exploring the use of anti-obesity drugs in IIH is needed. While VSS is gaining popularity due to its efficacy and low complication rate, there is insufficient evidence to support any surgical procedure over another. Bariatric surgery is appealing for patients with non-sight-threatening IIH and needs to be further explored.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol. 2016;15:78–91.

    Article  Google Scholar 

  2. Kilgore KP, Lee MS, Leavitt JA, Mokri B, Hodge DO, Frank RD, Chen JJ. Re-evaluating the incidence of idiopathic intracranial hypertension in an era of increasing obesity. Ophthalmology. 2017;124:697–700.

    Article  Google Scholar 

  3. Mollan SP, Aguiar M, Evison F, Frew E, Sinclair AJ. The expanding burden of idiopathic intracranial hypertension. Eye (Lond). 2019;33:478–85.

    Article  Google Scholar 

  4. Piper RJ, Kalyvas AV, Young A. Interventions for idiopathic intracranial hypertension. Database Syst Rev. 2015;(8). https://doi.org/10.1002/14651858.CD003434.pub3.

  5. Damkier HH, Brown PD, Praetorius J. Cerebrospinal fluid secretion by the choroid plexus. Physiol Rev. 2013;93:1847–92.

    Article  CAS  Google Scholar 

  6. Wall M, McDermott MP, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, et al. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA. 2014;311:1641–51.

    Article  Google Scholar 

  7. •• Wall M, Kupersmith, MJ, Thurtell MJ, Moss HE, Moss EA, Auinger P, NORDIC Idiopathic Intracranial Hypertension Study Group. The Longitudinal idiopathic hypertension trial: Outcomes from months 6–12. Am J Ophthalmol. 2017;176:102–107. This follow-up study of the idiopathic intracranial hypertension treatment trial highlights the benefits and safety of acetazolamide for treatment of IIH.

  8. Celebisoy N, Gökçay F, Sirin H, Akyürekli O. Treatment of idiopathic intracranial hypertension: Topiramate vs acetazolamide, an open-label study. Acta Neurol Scand. 2007;116:322–7.

    Article  CAS  Google Scholar 

  9. Scotton WJ, Botfield HF, Westgate CS, Mitchell JL, Yiangou A, Jensen RH, et al. Topiramate is more effective than acetazolamide at lowering intracranial pressure. Cephalalgia. 2019;39:209–18.

    Article  Google Scholar 

  10. Panagopoulos GN, Deftereos SN, Tagaris GA, Gryllia M, Kounadi T, Karamani O, et al. Octreotide: a therapeutic option for idiopathic intracranial hypertension. Neurol Neurophysiol Neurosci. 2007;10:1.

    Google Scholar 

  11. Sinclair AJ, Walker EA, Burdon MA, van Beek AP, Kema IP, Hughes BA, et al. Cerebrospinal fluid corticosteroid levels and cortisol metabolism in patients with idiopathic intracranial hypertension: a link between 11b-HSD1 and intracranial pressure regulation? J Clin Endocrinol Metab. 2010;95:5348–56.

    Article  CAS  Google Scholar 

  12. •• Hornby C, Mollan SP, Botfield H, O’Reilly MW, Sinclair AJ. Metabolic concepts in idiopathic intracranial hypertension and their potential for therapeutic intervention. J Neuroophthalmol. 2018;38:522–530. This review discusses the possible role of the adipose/gut/brain metabolism axis in IIH and hypothesizes how this may impact the pathogenesis of IIH and the development of therapeutic options.

  13. •• Mitchell JL, Mollan SP, Vijay V, Sinclair AJ. Novel advances in monitoring and therapeutic approaches in idiopathic intracranial hypertension. Curr Opin Neurol. 2019;32:422–431. This article provides a comprehensive updated review of IIH.

  14. • Markey K, Mitchell J, Botfield H, Ottridge RS, Matthews T, Krishnan A, et al. 11β-hydroxysteroid dehydrogenase type 1 inhibition in idiopathic intracranial hypertension: a double-blind randomized controlled trial. Brain Commun.2020;2(1):fcz050. https://doi.org/10.1093/braincomms/fcz050. This is the first prospective study looking at the use of a selective 11β-hydroxysteroid dehydrogenase type 1 inhibitor for treatment of IIH.

  15. Larsen PJ, Tang-Christensen M, Holst JJ, Orskov C. Distribution of glucagonlike peptide-1 and other preproglucagon-derived peptides in the rat hypothalamus and brainstem. Neuroscience. 1997;77:257–70.

    Article  CAS  Google Scholar 

  16. Botfield HF, Uldall MS, Westgate CSJ, Mitchell JL, Hagen SM, Gonzalez AM, et al. A glucagon-like peptide-1 receptor agonist reduces intracranial pressure in a rat model of hydrocephalus. Sci Transl Med. 2017;9:eaan0972.

  17. Mitchell J, Walker J, Lyons H, Brock K, Vijay V, Yiangou A, et al. 2 IIH Pressure – a randomised, controlled, double blind physiology study of the effect of Exenatide on intracranial pressure. https://doi.org/10.1136/bmjmilitary-2021-RSMabstracts.2

  18. Mollan SP, Hoffmann J, Sinclair AJ. Advances in the understanding of headache in idiopathic intracranial hypertension. Curr Opin Neurol. 2019;32:92–8.

    Article  Google Scholar 

  19. •• Friedman DI, Quiros PA, Subramanian PS, Mejico LJ, Gao S, McDermott M, Wall M, and the NORDIC IIHTT Study Group. Headache in idiopathic intracranial hypertension: findings from the idiopathic intracranial hypertension treatment trial. Headache. 2017;57:1195–1205. This article provides the largest data set from a prospective randomized clinical trial regarding headache outcomes in idiopathic intracranial hypertension.

  20. Mulla Y, Markey KA, Woolley RL, Patel S, Mollan SP, Sinclair AJ. Headache determines quality of life in idiopathic intracranial hypertension. J Headache Pain. 2015;16:521.

    Article  Google Scholar 

  21. Feldon SE. Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension. Neurosurgic Focus. 2007;23(5):E6.

    Article  Google Scholar 

  22. Gilbert AL, Chwalisz B, Mallery R. Complications of optic nerve sheath fenestration as a treatment for idiopathic intracranial hypertension. Semin Ophthalmol. 2018;33:36–41.

    Article  Google Scholar 

  23. Hickman SJ, Raoof N, Panesar H, McMullan JM, Pepper IM, Sharrack B. Visual outcomes from shunting for idiopathic intracranial hypertension. Neuroophthalmology. 2014;38:310–9.

    Article  CAS  Google Scholar 

  24. Moreau A, Lao KC, Farris BK. Optic nerve sheath decompression: a surgical technique with minimal operative complications. J Neuroophthalmol. 2014;34:34–8.

    Article  Google Scholar 

  25. Satti SR, Leishangthem L, Chaudry MI. Meta-analysis of CSF diversion procedures and dural venous sinus stenting in the setting of medically refractory idiopathic intracranial hypertension. Am J Neuroradiol. 2015;36:1899–904.

    Article  CAS  Google Scholar 

  26. Alsuhaibani AH, Carter KD, Nerad JA, Lee AG. Effect of optic nerve sheath fenestration on papilledema on the operated and the contralateral nonoperated eyes in idiopathic intracranial hypertension. Ophthalmology. 2011;118:412–4.

    Article  Google Scholar 

  27. Sinclair AJ, Kuruvath S, Sen D, Nightingale PG, Burdon MA, Flint G. Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review. Cephalgia. 2011;31:1627–33.

    Article  Google Scholar 

  28. King JO, Mitchell PJ, Thomson KR, Tress BM. Cerebral venography and manometry in idiopathic intracranial hypertension. Neurology. 1995;45:2240–8.

    Article  Google Scholar 

  29. Higgins JN, Owler BK, Cousins C, Pickard JD. Venous sinus stenting for refractory benign intracranial hypertension. Lancet. 2002;359:228–30.

    Article  Google Scholar 

  30. Fargen KM, Liu K, Garner RM, Greeneway GP, Wolfe SQ, Webster CR. Recommendations for the selection and treatment of patients in idiopathic intracranial hypertension for venous sinus stenting. J Neurointerv Surg. 2018;10:1203–8.

    Article  Google Scholar 

  31. Al-Mufti F, Dodson V, Amuluru K, Walia J, Wajswol E, Nuoman R, et al. Neuroendovascular Cerebral Sinus Stenting in Idiopathic Intracranial Hypertension. Intervent Neurol. 2019;8:164–71.

    Article  Google Scholar 

  32. Liu KC, Starke RM, Durst CR, Wang TR, Ding D, Webster Crowley R, Newman SA. Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study. J Neurosurg. 2017;127:1126–33.

    Article  Google Scholar 

  33. Dinkin MJ, Patsalides A. Venous sinus stenting in idiopathic intracranial hypertension: results of a prospective trial. J Neuroophthalmol. 2017;37:113–21.

    Article  Google Scholar 

  34. • Patsalides A, Oliveira C, Wilcox J, Brown K, Grover K, Gobin YP, Dinkin MJ. Venous sinus stenting lowers the intracranial pressure in patients with idiopathic intracranial hypertension. J Neurointerv Surg. 2019;11:175–178. This prospective study provides evidence that venous sinus stenosis significantly reduces the intracranial pressure at 3 months, independently of acetazolamide usage or weight loss.

  35. • Nicholson P, Brinjikji W, Radovanovic I, Hilditch CA, Tsang ACO, Krings T, et al. Venous sinus stenting for idiopathic intracranial hypertension: a systemic review and meta-analysis. J Neurointerv Surg. 2019;11:380–385. This article provides an updated systematic review and meta-analysis of the use of venous stenting in IIH, examining clinical outcomes and safety profile.

  36. Saber H, Lewis W, Sadeghi M, Rajah G, Narayanan S. Stent survival and stent-adjacent stenosis rates following venous sinus stenting for idiopathic intracranial hypertension: a systemic review and meta-analysis. Interv Neurol. 2018;7:490–500.

    Article  Google Scholar 

  37. Fields JD, Javedani P, Falardeau J, Nesbit GM, Dogan A, Helseth EK, et al. Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension. J Neurointerv Surg. 2013;5:62–8.

    Article  Google Scholar 

  38. Subramaniam S, Fletcher WA. Obesity and weight loss in idiopathic intracranial hypertension: A narrative review. J Neuroophthalmol. 2017;37:197–205.

    Article  Google Scholar 

  39. Astrup A, Rössner S, Van Gaal L, Rissanen A, Niskanen L, Al Hakim M, et al. Effects of liraglutide in the treatment of obesity: a randomised, double-blind, placebo-controlled study. Lancet. 2009;374:1606–16.

    Article  CAS  Google Scholar 

  40. Yanovski SZ, Yanovski JA. Progress in pharmacotherapy for obesity. JAMA. 2021;326:129–30.

    Article  CAS  Google Scholar 

  41. Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014:CD003641.

  42. Fridley J, Foroozan R, Sherman V, Brandt ML, Yosher D. Bariatric surgery for the treatment of idiopathic intracranial hypertension. J Neurosurg. 2010;114:34–9.

    Article  Google Scholar 

  43. Manfield JH, Yu K, Efthimiou E, Darzi A, Athanasiou T, Ashrafian H. Bariatric surgery or non-surgical weight loss for idiopathic intracranial hypertension? A systematic review and comparison of meta-analyses. Obes Surg. 2017;27:513–21.

    Article  Google Scholar 

  44. • Mollan SP, Mitchell JL, Ottridge RS, Aguiar M, Yiangou A, Alimajstorovic Z, et. Al. Effectiveness of bariatric surgery vs community weight management intervention for the treatment if idiopathic intracranial hypertension. A randomized clinical trial. Jama Neurol. 2021;78:678–686. This is the first prospective randomized study comparing the effectiveness of bariatric surgery with that of a community weight management intervention for the treatment of patients with active IIH.

  45. Merola J, Selezneva L, Perkins R, Lang J, Barry J, Leach P. Cerebrospinal fluid diversion versus bariatric surgery in the management of idiopathic intracranial hypertension. Br J Neurosurg. 2020;34:9–12.

    Article  Google Scholar 

  46. Jirapinyo P, Jin DX, Qazi T, Mishra N, Thompson CC. A metaanalysis of GLP-1 after Roux-en-Y gastric bypass: impact of surgical technique and measurement strategy. Obes Surg. 2018;28:615–26.

    Article  Google Scholar 

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  1. Department of Ophthalmology, Oregon Health and Science University, 3303 S Bond Avenue, 11th floor, Portland, OR, 97239, USA

    Julie Falardeau

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Falardeau, J. New Options (or not) for Treatment of Idiopathic Intracranial Hypertension. Curr Neurol Neurosci Rep 22, 257–264 (2022). https://doi.org/10.1007/s11910-022-01188-5

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