Should Acetazolamide Be the First-Line Treatment for Patients With Idiopathic Intracranial Hypertension?

Kaufman, David I.; Friedman, Deborah I.

doi:10.1097/wno.0000000000000513

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…It remains the first-line treatment for patients with IIH. [22][23][24] Although rebound high-pressure headache following treatment of SIH generally is not a serious…”

Section: Discussionmentioning

confidence: 99%

Rebound high-pressure headache after treatment of spontaneous intracranial hypotension

et al. 2019

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BackgroundRebound high-pressure headaches may complicate treatment of spontaneous intracranial hypotension (SIH), but no comprehensive study of such patients has been reported and little is known about its frequency and risk factors. We therefore studied patients undergoing treatment for SIH and performed magnetic resonance venography (MRV) to assess for cerebral venous sinus stenosis, a risk factor for idiopathic intracranial hypertension.MethodsWe studied a consecutive group of patients who underwent treatment for SIH. Rebound high-pressure headache was defined as a reverse orthostatic headache responsive to acetazolamide. MRV was obtained in all patients and lateral sinus stenosis was scored according to the system published by Higgins et al., with 0 being normal and 4 signifying bilateral signal gaps.ResultsThe mean age of the 46 men and 67 women was 45.9 years (range 13–71 years) at the time of onset of SIH. Rebound high-pressure headache was diagnosed in 31 patients (27.4%); 14% of patients with an MRV score of 0, 24% with a score of 1, and 46% with a score of 2 or 3 (p = 0.0092). Also, compared to SIH patients who did not develop rebound high-pressure headaches (n = 82), those with rebound high-pressure headaches were younger, more often female, and more often had an extradural CSF collection on spinal imaging.ConclusionsRebound high-pressure headache occurs in about one-fourth of patients following treatment of SIH and is more common in those with restriction of cerebral venous outflow.

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“…It remains the first-line treatment for patients with IIH. [22][23][24] Although rebound high-pressure headache following treatment of SIH generally is not a serious…”

Section: Discussionmentioning

confidence: 99%

Rebound high-pressure headache after treatment of spontaneous intracranial hypotension

et al. 2019

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“…Reliable and stable ICP measurements in awake rats were observed seven days post-surgery. A daily single dose of AZE, equivalent to a clinically employed 1 g single dose in humans (12,15), was effective in lowering the ICP. Yet, the ICP returned to baseline within 10-12 h after the treatment.…”

Section: Discussionmentioning

confidence: 95%

“…However, it remained unresolved if such modulation of the CSF secretion rate is directly represented in a change in ICP and/or ventricular volume. The latter two parameters do not necessarily go hand in hand, as exemplified in idiopathic intracranial hypertension, in which the ICP is elevated without enlarged ventricles (12), and, in contrast, normal pressure hydrocephalus, in which the ventricles are enlarged, but an ICP elevation is absent or minor (68). The etiology of these diseases is not fully understood, but AZE treatment may still be employed to treat the symptoms in these patient groups (12,69), despite this approach being questioned by several clinical trials (8,9).…”

Section: Discussionmentioning

confidence: 99%

“…Notwithstanding, due to lack of alternatives, AZE remains a first-line treatment for certain ICP pathologies, e.g. idiopathic intracranial hypertension (12), irrespective of the unresolved mode of action by which the drug may confer relief of elevated ICP. Studies on experimental animals have remained equally inconclusive as AZE administration did (13,14) or did not (15) reduce the ICP.…”

Section: Introductionmentioning

confidence: 99%

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Acetazolamide modulates intracranial pressure directly by its action on the cerebrospinal fluid secretion apparatus

Barbuskaite

Oernbo

Wardman

et al. 2022

Preprint

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Elevated intracranial pressure (ICP) is observed in many neurological pathologies, e.g. hydrocephalus and stroke. This condition is routinely relieved with neurosurgical approaches, since effective and targeted pharmacological tools are still lacking. The carbonic anhydrase inhibitor, acetazolamide (AZE), may be employed to treat elevated ICP. However, its effectiveness is questioned, its location of action unresolved, and its tolerability low. Here, we employed in vivo and ex vivo approaches to reveal the efficacy and mode of action of AZE in the rat brain. The drug effectively reduced the ICP, irrespective of the mode of drug administration and level of anaesthesia. The effect occurred via a direct action on the choroid plexus and an associated decrease in cerebrospinal fluid secretion, and not indirectly via the systemic action of AZE on renal and vascular processes. Upon a single administration, the reduced ICP endured for approximately 10 h post-AZE delivery with no long-term changes of brain water content or choroidal transporter expression. However, a persistent reduction of ICP was secured with repeated AZE administrations throughout the day. Future specific targeting of choroidal carbonic anhydrases may limit the systemic side effects, and therefore enhance the treatment tolerability and effectiveness in select patient groups experiencing elevated ICP.

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“…Numerous experimental and clinical studies have shown reduction in CSF production after ACZ administration. Effective doses of acetazolamide, which penetrate the blood-brain barrier to reach the choroid plexus and depress CSF flow, are on the order of 20 mg/kg [2,6,11,[14][15][16][17][18]. However, there is no standard dose of acetazolamide; the starting dose is 500 mg two times daily and a maximum dose of 4 g twice daily [19].…”

Section: Acetazolamidementioning

confidence: 99%

Hydrocephaly: Medical Treatment

Gül¹,

Arslantaş²,

Kasapoğlu³

2018

Hydrocephalus - Water on the Brain

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Hydrocephaly is a prevalent condition in all age groups. At present, the most frequent strategies used to treat hydrocephaly are surgical shunting procedures, which are still associated with multiple complications. The main goal of the medical therapy for the lowering of high ventricular pressure is to avoid shunting or to reduce and decrease intracranial pressure (ICP) until shunt surgery. Medications affect cerebrospinal fluid dynamics by decreasing secretion or increasing reabsorption. Medical treatment for manipulation of water balance or cerebrospinal fluid (CSF) production reduces mortality in both infants and adults with neurological disorders. Medical treatment has an important role in the management of hydrocephaly especially in patients not suitable for shunt and in patients whom the shunt alone is not able to control the hydrocephaly. The treatment is used to delay surgical intervention but is not effective in the long treatment of chronic hydrocephaly.

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Should Acetazolamide Be the First-Line Treatment for Patients With Idiopathic Intracranial Hypertension?

Cited by 9 publications

References 27 publications

Rebound high-pressure headache after treatment of spontaneous intracranial hypotension

Rebound high-pressure headache after treatment of spontaneous intracranial hypotension

Acetazolamide modulates intracranial pressure directly by its action on the cerebrospinal fluid secretion apparatus

Hydrocephaly: Medical Treatment

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