Psychiatric disorders are a common prognostic marker for worse outcome in patients with idiopathic intracranial hypertension

Puustinen, Tero; Tervonen, Joona; Avellan, Cecilia; Jyrkkänen, Henna‐Kaisa; Paterno, Jussi J.; Hartikainen, Päivi; Vanhanen, Ulla; Leinonen, Ville; Lehto, Soili M.; Elomaa, Antti-Pekka; Huttunen, Terhi

doi:10.1016/j.clineuro.2019.105527

Cited by 24 publications

(25 citation statements)

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“…Depression has an estimated lifetime prevalence of 15-20 % and severe depression has been identified in 37 % of IIH patients [22,23]. An even higher rate of depression (56 %) was (self-) reported in our survey, with one third of the participants under an antidepressant medication.…”

Section: Discussionmentioning

confidence: 49%

The patients’ perspective on the burden of idiopathic intracranial hypertension

et al. 2021

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Background Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure without evidence of a tumor or any other underlying cause. Headache and visual disturbances are frequent complaints of IIH patients, but little is known about other symptoms. In this study, we evaluated the patients’ perspective on the burden of IIH. Methods For this cross-sectional study, we developed an online survey for patients with IIH containing standardized evaluations of headache (HIT-6), sleep (PROMIS Sleep Disturbance Scale) and depression (MDI) in relation to BMI, lumbar puncture opening pressure (LP OP) and treatment. Results Between December 2019 and February 2020, 306 patients completed the survey. 285 (93 %) were female, mean age was 36.6 years (± 10.8), mean BMI 34.2 (± 7.3) and mean LP OP at diagnosis was 37.8 cmH2O (± 9.5). 219 (72 %) of the participants were obese (BMI ≥ 30); 251 (82 %) reported severe impacting headaches, 140 (46 %) were suffering from sleep disturbances and 169 (56 %) from depression. Higher MDI scores correlated with higher BMI and increased sleep disturbances. Patients with a normalized LP opening pressure reported less headaches, less sleep disturbances and less depression than those with a constantly elevated opening pressure. Conclusions In addition to headaches and visual disturbances, sleep disturbances and depression are frequent symptoms in IIH and contribute to the patients’ burden. Structured questionnaires can help to identify IIH patients’ needs and can lead to personalized and better treatment.

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Section: Discussionmentioning

confidence: 49%

The patients’ perspective on the burden of idiopathic intracranial hypertension

et al. 2021

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“…Depression has an estimated lifetime prevalence of 15-20% and severe depression has been identi ed in 37% of IIH patients [20,21]. An even higher rate of depression (56%) was (self-) reported in our survey, with one third of the participants under an antidepressant medication.…”

Section: Discussionmentioning

confidence: 51%

The patients’ perspective on the burden of idiopathic intracranial hypertension

Witry

Kindler

Weller

et al. 2021

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Background: Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure without evidence of a tumor or any other underlying cause. Headache and visual disturbances are frequent complaints of IIH patients, but little is known about other symptoms. In this study, we evaluated the patients’ perspective on the burden of IIH. Methods: For this cross-sectional study, we developed an online survey for patients with IIH containing standardized evaluations of headache (HIT-6), sleep (PROMIS Sleep Disturbance Scale) and depression (MDI) in relation to BMI, lumbar puncture opening pressure (LP OP) and treatment. Results: Between December 2019 and February 2020, 306 patients completed the survey. 285 (93%) were female, mean age was 36.6 years (± 10.8), mean BMI 34.2 (± 7.3) and mean LP OP at diagnosis was 37.8 cmH2O (± 9.5). 219 (72%) of the participants were obese (BMI ≥ 30); 251 (82%) reported severe impacting headaches, 140 (46%) were suffering from sleep disturbances and 169 (56%) from depression. Higher MDI scores correlated with higher BMI and increased sleep disturbances. Patients with a normalized LP opening pressure reported less headaches, less sleep disturbances and less depression than those with a constantly elevated opening pressure. Conclusion: In addition to headaches and visual disturbances, sleep disturbances and depression are frequent symptoms in IIH and contribute to the patients’ burden. Structured questionnaires can help to identify IIH patients’ needs and can lead to personalized and better treatment.

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“…Previously, we have reported that psychiatric disorders are very common in IIH patients compared to general population [ 40 ]. In this cohort of IIH patients who had undergone CELDA investigation, almost half of them had pre-existing psychiatric diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…This was a retrospective study on patients with International Statistical Classification of Diseases and Related Health Problems (ICD-10) G93.2 diagnosis, collected between January 1, 2000, and December 31, 2020, and formed a part of “Phenotype, Pathophysiology and Prognostic Factors of IIH” study, of which has been previously published a different analysis from the psychiatric comorbidity point of view [ 40 ]. Friedman criteria were applied to determine eligibility for inclusion in the cohort [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…In selected cases, surgical interventions, such as shunting procedures, optic nerve sheath fenestration and sinus stenting may alleviate symptoms [ 3 , 31 ] and in severely obese patients, gastric bypass surgery can be considered as a viable treatment for the IIH [ 3 , 17 , 31 , 37 ]. IIH comorbidities, such as psychiatric disorders, are associated with worse subjective outcome of the treatments [ 40 ].…”

Section: Introductionmentioning

confidence: 99%

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Cerebrospinal fluid dynamics in idiopathic intracranial hypertension: a literature review and validation of contemporary findings

et al. 2021

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Background Idiopathic intracranial hypertension (IIH) is a rare disease of unknown aetiology related possibly to disturbed cerebrospinal fluid (CSF) dynamics and characterised by elevated intracranial pressure (ICP) causing optic nerve atrophy if not timely treated. We studied CSF dynamics of the IIH patients based on the available literature and our well-defined cohort. Method A literature review was performed from PubMed between 1980 and 2020 in compliance with the PRISMA guideline. Our study includes 59 patients with clinical, demographical, neuro-ophthalmological, radiological, outcome data, and lumbar CSF pressure measurements for suspicion of IIH; 39 patients had verified IIH while 20 patients did not according to Friedman’s criteria, hence referred to as symptomatic controls. Results The literature review yielded 19 suitable studies; 452 IIH patients and 264 controls had undergone intraventricular or lumbar CSF pressure measurements. In our study, the mean CSF pressure, pulse amplitudes, power of respiratory waves (RESP), and the pressure constant (P0) were higher in IIH than symptomatic controls (p < 0.01). The mean CSF pressure was higher in IIH patients with psychiatric comorbidity than without (p < 0.05). In IIH patients without acetazolamide treatment, the RAP index and power of slow waves were also higher (p < 0.05). IIH patients with excess CSF around the optic nerves had lower relative pulse pressure coefficient (RPPC) and RESP than those without (p < 0.05). Conclusions Our literature review revealed increased CSF pressure, resistance to CSF outflow and sagittal sinus pressure (SSP) as key findings in IIH. Our study confirmed significantly higher lumbar CSF pressure and increased CSF pressure waves and RAP index in IIH when excluding patients with acetazolamide treatment. In overall, the findings reflect decreased craniospinal compliance and potentially depleted cerebral autoregulation resulting from the increased CSF pressure in IIH. The increased slow waves in patients without acetazolamide may indicate issues in autoregulation, while increased P0 could reflect the increased SSP.

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Psychiatric disorders are a common prognostic marker for worse outcome in patients with idiopathic intracranial hypertension

Cited by 24 publications

References 30 publications

The patients’ perspective on the burden of idiopathic intracranial hypertension

The patients’ perspective on the burden of idiopathic intracranial hypertension

The patients’ perspective on the burden of idiopathic intracranial hypertension

Cerebrospinal fluid dynamics in idiopathic intracranial hypertension: a literature review and validation of contemporary findings

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