Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study

Abstract

OBJECTIVES - To assess the efficacy of topiramate in the treatment of idiopathic intracranial hypertension (IIH) and to compare it with acetazolamide. METHODS - Fourty patients diagnosed as IIH and randomly assigned to treatment with either acetazolamide or topiramate were assessed prospectively. Improvement in the visual fields at the end of third, sixth and twelfth months were taken into consideration. RESULTS - The demographic, clinical features and the cerebrospinal fluid (CSF) pressure of the two treatment groups were similar at the beginning of the study. When the follow-up visual field grades were compared with the visual field grades at the beginning of the study in each group a statistically significant improvement was detected with both drugs. When the results of the two treatment groups were compared with each other no statistically significant difference was present. Prominent weight loss was recorded in the topiramate group. CONCLUSIONS - Topiramate seems to be effective in the treatment of IIH. Weight reduction as well as the reduction of the CSF formation is the possible mechanism of action.

Rebound Intracranial Hypertension: A Complication of Epidural Blood Patching for Intracranial Hypotension

“…19 If patients cannot tolerate acetazolamide, we have used topiramate as an alternative because it also demonstrates carbonic anhydrase inhibitory effect and has been studied as an alternative to acetazolamide in cases of idiopathic intracranial hypertension. 20,21 Acetazolamide should be used cautiously in patients with sulfa allergy, though our experience is that it is well tolerated by most patients with a history of reaction to other sulfa drugs, a finding that agrees with previous reports of the use of acetazolamide in sulfa-allergic patients. 22 Other reported strategies for the treatment of RIH include the use of IV glycerol and the need for CSF shunting.…”

Primary stabbing headache: a new dural sinus stenosis-associated primary headache?

“…Acetazolamide inhibits carbonic anhydrase isoenzymes and is one of the few drugs with a known effect in ICP lowering [15]. Also indomethacin (reported as efficacy in PSH [16]) and topiramate (found efficacy in one of our cases not responding to indomethacin) share the same ICP lowering effect [17,18]. Based on these considerations, the high prevalence of sinus stenosis found in our series suggests that also PSH could be related to an overlooked ss-IHWOP.…”

Carbonic anhydrase inhibitory properties of novel sulfonamide derivatives of aminoindanes and aminotetralins

“…Most drugs contain this functional group in their structures 1 . A carbonic anhydrase (CA) inhibitor drug acetazolamide (diamox, 1) is used to treat glaucoma 2 and idiopathic intracranial hypertension 3 . A sulfonamide drug sultiame (sulthiame, 2) is an anticonvulsant that reported to be used in the treatment of epilepsy and West syndrome 4 .…”