Idiopathic intracranial hypertension: the association between weight loss and the requirement for systemic treatment

Abstract

BackgroundTo determine whether weight loss is significantly associated with a discontinuation of treatment for idiopathic intracranial hypertensionMethodsThe notes of 36 patients with idiopathic intracranial hypertension under regular review for at least 12 months by a single neuro-ophthalmologist were retrospectively reviewed. Weight was recorded at each assessment and weight loss recommended. Treatment was adjusted according to symptoms, visual function including visual fields and optic disc appearance only. Patients were divided according to duration of continuous follow-up, and then sub-divided as to whether they were on or not on treatment at most recent review and whether weight loss had been achieved compared to presentation. Survival analysis was performed to assess the probability of remaining on treatment having lost weight.ResultsConsidering the patients as 3 groups, those with at least 12 months follow-up (n = 36), those with at least 18 months follow-up (n = 24) and those with 24 months or more follow-up (n = 19), only the group with 24 months or more follow-up demonstrated a significant association between weight loss and stopping systemic treatment (Fisher's exact test, p = 0.04). Survival analysis demonstrated that the probability of being on treatment at 5 years having gained weight was 0.63 and having lost weight was 0.38 (log rank test, p = 0.04). The results suggest that final absolute body mass index is more important than the change in body mass index for patients who stop treatment (Mann Whitney U, p = 0.05).ConclusionThis is the first study to demonstrate that weight loss is associated with discontinuation of treatment. Unlike previous studies, our results suggest that final absolute body mass index is more important for stopping treatment than a proportional reduction in weight.

Venous obstruction and jugular valve insufficiency in idiopathic intracranial hypertension

“…An animal study found an association between increased intraabdominal pressure and an intracranial pressure elevation [8]. Intracranial hypertension as a consequence of raised intra-abdominal pressure may explain why weight reduction is associated with clinical improvement, improvement of papilledema and lowering of CSF pressure [27,40,44]. Sugerman and co-workers [41] found a high rate of treatment success after surgical (bariatric) treatment of obesity.…”

Disease activity in idiopathic intracranial hypertension: a 3-month follow-up study

“…Evidence from clinical studies indicates that papilledema is more rapidly reversed or more easily controlled if weight-loss is achieved [4][5][6][7][8][9][10]. However, previous studies evaluated weight-loss in relation to resolution of papilledema, not in relation to CSF-pressure.…”

“…Studies suggest that papilledema can be more readily controlled if weight-loss is achieved, but the association between weight loss and ICP reduction has not been established [4][5][6][7][8][9][10].…”

Idiopathic intracranial hypertension is not benign: a long-term outcome study

“…IIH is closely associated with obesity, and weight reduction has been shown to improve the rate of recovery and prognosis in overweight patients [18,26,35,41,44]. At baseline patients entered a course of dietary recommendations and follow-up visits resulting in an overall initial weight loss [37].…”