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Bsteh G, Macher S, Krajnc N, Marik W, Michl M, Müller N, Zaic S, Harreiter J, Novak K, Wöber C, Pemp B. An interdisciplinary integrated specialized one-stop outpatient clinic for idiopathic intracranial hypertension - an assessment of sick leave, presenteeism, and health care utilization. J Headache Pain 2024; 25:73. [PMID: 38714920 PMCID: PMC11075215 DOI: 10.1186/s10194-024-01780-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Management of idiopathic intracranial hypertension (IIH) is complex requiring contributions from multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges. To meet those challenges, we established an interdisciplinary integrated outpatient clinic for IIH with a central coordination and a one-stop- concept. Here, we aimed to evaluate effects of this concept on sick leave, presenteeism, and health care utilization. METHODS In a retrospective cohort study, we compared the one-stop era with integrated care (IC, 1-JUL-2021 to 31-DEC-2022) to a reference group receiving standard care (SC, 1-JUL-2018 to 31-DEC-2019) regarding economic outcome parameters assessed over 6 months. Multivariate binary logistic regression models were used to adjust for confounders. RESULTS Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female: 90.6% vs. 90.1%; mean age: 33.6 vs. 32.8 years, educational level: ≥9 years of education 60.0% vs. 59.3%; located in Vienna 75.3% vs. 76.5%). Compared to SC, the IC group showed significantly fewer days with sick leave or presenteeism (-5 days/month), fewer unscheduled contacts for IIH-specific problems (-2.3/month), and fewer physician or hospital contacts in general (-4.1 contacts/month). Subgroup analyses of patients with migration background and language barrier consistently indicated stronger effects of the IC concept in these groups. CONCLUSIONS Interdisciplinary integrated management significantly improves the burden of IIH in terms of sick leave, presenteeism and healthcare consultations - particularly in socioeconomically underprivileged patient groups.
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Affiliation(s)
- Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria.
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Nina Müller
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Sina Zaic
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Division of Endocrinology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Novak
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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Yiangou A, Mollan SP, Sinclair AJ. Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms. Nat Rev Neurol 2023; 19:769-785. [PMID: 37957260 DOI: 10.1038/s41582-023-00893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
The understanding of idiopathic intracranial hypertension (IIH) has evolved over the past few years. Previously, IIH was considered a disease exclusively affecting the neuro-ophthalmic axis, characterized by raised intracranial pressure, headache and papilloedema, and resulting in the risk of severe and permanent visual loss and life-changing disabling headaches. Recent advances have begun to redefine IIH as a probable metabolic disease involving a range of systemic manifestations. More than 95% of individuals affected by the disease are women of reproductive age with obesity. The incidence is rapidly rising and parallels the escalating worldwide obesity rates. Contemporary insights identify associations with insulin resistance, type 2 diabetes and a twofold increased risk of cardiovascular disease in excess of that driven by obesity alone. Adipose distribution in people with IIH, like that in other metabolic diseases, is preferentially centripetal and is associated with changes in intracranial pressure. Evidence now demonstrates adipose tissue dysfunction in people with IIH, involving transcriptional and metabolic priming for lipogenesis and weight gain. Hormonal perturbations are also observed, including a unique phenotype of androgen excess that promotes cerebrospinal fluid secretion. Knowledge of these additional disease features is driving research into novel therapeutic targets and altering the approach to multidisciplinary care.
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Affiliation(s)
- Andreas Yiangou
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Susan P Mollan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alexandra J Sinclair
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
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Abbott S, Chan F, Tahrani AA, Wong SH, Campbell FEJ, Parmar C, Pournaras DJ, Denton A, Sinclair AJ, Mollan SP. Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations. Neurology 2023; 101:e2138-e2150. [PMID: 37813577 PMCID: PMC10663033 DOI: 10.1212/wnl.0000000000207866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/15/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Idiopathic intracranial hypertension (IIH) is associated with obesity; however, there is a lack of clinical consensus on how to manage weight in IIH. The aim of this systematic review was to evaluate weight loss interventions in people with IIH to determine which intervention is superior in terms of weight loss, reduction in intracranial pressure (ICP), benefit to visual and headache outcomes, quality of life, and mental health. METHODS A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42023339569). MEDLINE and CINAHL were searched for relevant literature published from inception until December 15, 2022. Screening and quality appraisal was conducted by 2 independent reviewers. Recommendations were graded using Scottish Intercollegiate Guidelines Network methodology. RESULTS A total of 17 studies were included. Bariatric surgery resulted in 27.2-27.8 kg weight loss at 24 months (Level 1- to 1++). Lifestyle weight management interventions resulted in between 1.4 and 15.7 kg weight loss (Level 2+ to 1++). Bariatric surgery resulted in the greatest mean reduction in ICP (-11.9 cm H2O) at 24 months (Level 1++), followed by multicomponent lifestyle intervention + acetazolamide (-11.2 cm H2O) at 6 months (Level 1+) and then a very low-energy diet intervention (-8.0 cm H2O) at 3 months (Level 2++). The least ICP reduction was shown at 24 months after completing a 12-month multicomponent lifestyle intervention (-3.5 cm H2O) (Level 1++). Reduction in body weight was shown to be highly correlated with reduction in ICP (Level 2++ to 1++). DISCUSSION Bariatric surgery should be considered for women with IIH and a body mass index (BMI) ≥35 kg/m2 since this had the most robust evidence for sustained weight management (grade A). A multicomponent lifestyle intervention (diet + physical activity + behavior) had the most robust evidence for modest weight loss with a BMI <35 kg/m2 (grade B). Longer-term outcomes for weight management interventions in people with IIH are required to determine whether there is a superior weight loss intervention for IIH.
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Affiliation(s)
- Sally Abbott
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Fiona Chan
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Abd A Tahrani
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Sui Hsien Wong
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Fiona E J Campbell
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Chetan Parmar
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Dimitri J Pournaras
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Amanda Denton
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Alexandra Jean Sinclair
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Susan P Mollan
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom.
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Parker MT, Putinta KM, Carr BR. Successful Electroconvulsive Therapy in Idiopathic Intracranial Hypertension With Mood Disorder and Partial Empty Sella Syndrome. J ECT 2023; 39:202-203. [PMID: 36215412 PMCID: PMC10487363 DOI: 10.1097/yct.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/05/2022] [Indexed: 03/08/2023]
Abstract
ABSTRACT Patients with idiopathic intracranial hypertension (IIH) often experience significant burden from psychiatric comorbidities. Mood disorders are present in up to half of all patients with IIH, and they are often refractory to treatment by psychopharmacologic agents. Electroconvulsive therapy (ECT) is the criterion standard for treatment of patients with the most severe psychiatric burden but has relative contraindications in those possessing pathologies that raise intracranial pressure (ICP). There is a growing body of literature that a multidisciplinary care model would allow for patients with elevated ICP to receive ECT safely. Despite the high prevalence of mood disorders in patients with IIH, there are only 2 published case reports describing ECT delivery to patients from this cohort. We report our own case of a patient with IIH and major depressive disorder who received 38 bitemporal treatments with a positive response and no change in baseline ICP. Her positive response, along with the absence of elevation of ICP, aligns with the prior reports; however, her IIH symptoms have not responded as reported in the 2 cases-despite receiving more than 4 times the amount of treatments. Moreover, our patient possessed unique imaging for a partial empty sella syndrome, which has recently been found to be the only significant finding in patients who had a mood disorder before IIH diagnosis, versus a mood disorder developing after IIH diagnosis. This case serves to provide evidence of the safety and success of ECT in patients with IIH, relying on multidisciplinary care from psychiatry, neurology, and neuro-ophthalmology.
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Mollan SP, Fraser CL, Digre KB, Diener HC, Lipton RB, Juhler M, Miller NR, Pozo-Rosich P, Togha M, Brock K, Dinkin MJ, Chan CKM, Tassorelli C, Sinclair AJ, Terwindt GM, Jensen RH. Guidelines of the International Headache Society for Controlled Clinical Trials in Idiopathic Intracranial Hypertension. Cephalalgia 2023; 43:3331024231197118. [PMID: 37661711 DOI: 10.1177/03331024231197118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The quality of clinical trials is essential to advance treatment, inform regulatory decisions and meta-analysis. With the increased incidence of idiopathic intracranial hypertension and the emergence of clinical trials for novel therapies in this condition, the International Headache Society Guidelines for Controlled Clinical Trials in Idiopathic Intracranial Hypertension aims to establish guidelines for designing state-of-the-art controlled clinical trials for idiopathic intracranial hypertension.
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Affiliation(s)
- Susan P Mollan
- Neuro-ophthalmology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Clare L Fraser
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Kathleen B Digre
- Neuro-ophthalmology Division, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Hans-Christoph Diener
- Institut für Medizinische Informatik, Biometrie undEpidemiologie (IMIBE), Medizinische Fakultät der Universität Duisburg-Essen, Essen, Germany
| | - Richard B Lipton
- The Saul R. Korey Department of Neurology, and the Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Neil R Miller
- Wilmer Eye Institute and Departments of Ophthalmology, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mansoureh Togha
- Headache Department, Iranian Centre of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Headache Department, Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kristian Brock
- Cancer Research Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marc J Dinkin
- Department of Ophthalmology, Weill Cornell Medical College, NY Presbyterian Hospital, New York, New York, USA
- Department of Neurology, Weill Cornell Medical College, NY Presbyterian Hospital, New York, New York, USA
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Cristina Tassorelli
- Unit of Translational Neurovascular Research, IRCCS Mondino Foundation, 27100, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, 27100, Pavia, Italy
| | - Alex J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Mollan SP, Subramanian A, Perrins M, Nirantharakumar K, Adderley NJ, Sinclair AJ. Depression and anxiety in women with idiopathic intracranial hypertension compared to migraine: A matched controlled cohort study. Headache 2023; 63:290-298. [PMID: 36748660 PMCID: PMC10952318 DOI: 10.1111/head.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate mental health burden in women with idiopathic intracranial hypertension (IIH) compared to matched women with migraine and population controls. BACKGROUND Depression and anxiety are recognized comorbid conditions in those with IIH and lead to worse predicted medical outcomes. The mental health burden in IIH has not been previously evaluated in a large, matched cohort study. METHODS We performed a population-based matched, retrospective cohort study to explore mental health outcomes (depression and anxiety). We used data from IQVIA Medical Research Data, an anonymized, nationally representative primary care electronic medical records database in the United Kingdom, from January 1, 1995, to September 25, 2019. Women aged ≥16 years were eligible for inclusion. Women with IIH (exposure) were matched by age and body mass index with up to 10 control women without IIH but with migraine (migraine controls), and without IIH or migraine (population controls). RESULTS A total of 3411 women with IIH, 30,879 migraine controls and 33,495 population controls were included. Of these, 237, 2372 and 1695 women with IIH, migraine controls and population controls, respectively, developed depression during follow-up, and 179, 1826 and 1197, respectively, developed anxiety. There was a greater hazard of depression and anxiety in IIH compared to population controls (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 1.20-1.58; and aHR 1.40, 95% CI 1.19-1.64, respectively), while hazards were similar to migraine controls (aHR 0.98, 95% CI 0.86-1.13; and aHR 0.98, 95% CI 0.83-1.14, respectively). CONCLUSION Depression and anxiety burden in women with IIH is higher than in the general population, and comparable to that in matched women with migraine. This may indicate that presence of headache is a potential driver for comorbid depression and anxiety in IIH.
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Affiliation(s)
- Susan P. Mollan
- Translational Brain Science, Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
- Health Data Research UKBirminghamUK
- Birmingham Neuro‐OphthalmologyQueen Elizabeth HospitalBirminghamUK
| | | | - Mary Perrins
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | | | - Nicola J. Adderley
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Alexandra J. Sinclair
- Translational Brain Science, Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
- Birmingham Neuro‐OphthalmologyQueen Elizabeth HospitalBirminghamUK
- Department of NeurologyUniversity Hospitals Birmingham, Queen Elizabeth HospitalBirminghamUK
- Centre for Endocrinology, Diabetes, and MetabolismBirmingham Health PartnersBirminghamUK
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Adderley NJ, Subramanian A, Perrins M, Nirantharakumar K, Mollan SP, Sinclair AJ. Headache, Opiate Use, and Prescribing Trends in Women With Idiopathic Intracranial Hypertension: A Population-Based Matched Cohort Study. Neurology 2022; 99:e1968-e1978. [PMID: 35985824 PMCID: PMC9651462 DOI: 10.1212/wnl.0000000000201064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Physician prescribing habits for opiates and headache therapies have not been previously evaluated in a large, matched cohort study in idiopathic intracranial hypertension (IIH). Our objective was to evaluate opiate and headache medication prescribing habits in women with IIH compared with matched women with migraine and population controls. We also investigated the occurrence of new onset headache in IIH compared with population controls. METHODS We performed a population-based matched, retrospective cohort study to explore headache outcomes. Cross-sectional analyses were used to describe medication prescribing patterns. We used data from IQVIA Medical Research Data, an anonymized, nationally representative primary care electronic medical record database in the United Kingdom, from January 1, 1995, to September 25, 2019. Women aged 16 years and older were eligible for inclusion. Women with IIH (exposure) were matched by age and body mass index with up to 10 control women without IIH but with migraine (migraine controls), and without IIH or migraine (population controls). RESULTS A total of 3,411 women with IIH, 13,966 migraine controls, and 33,495 population controls were included. The adjusted hazard ratio for new onset headache in IIH compared with population controls was 3.09 (95% CI 2.78-3.43). In the first year after diagnosis, 58% of women with IIH were prescribed acetazolamide and 20% topiramate. In total, 20% of women with IIH were prescribed opiates within the first year of their diagnosis, reducing to 17% after 6 years, compared with 8% and 11% among those with migraine, respectively. Twice as many women with IIH were prescribed opiates compared with migraine controls, and 3 times as many women with IIH were prescribed opiates compared with population controls. Women with IIH were also prescribed more headache preventative medications compared with migraine controls. DISCUSSION Women with IIH were more likely to be prescribed opiate and simple analgesics compared with both migraine and population controls. Women with IIH trialed more preventative medications over their disease course suggesting that headaches in IIH may be more refractory to treatment.
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Affiliation(s)
- Nicola Jaime Adderley
- From the Institute of Applied Health Research (N.J.A., A.S., M.P., K.N.), University of Birmingham; Centre for Endocrinology, Diabetes, and Metabolism (K.N.), Birmingham Health Partners; Health Data Research UK (K.N.), Birmingham; Birmingham Neuro-Ophthalmology (S.P.M.), Queen Elizabeth Hospital; Metabolic Neurology (A.J.S.), Institute of Metabolism and Systems Research, University of Birmingham; and Department of Neurology (A.J.S.), University Hospitals Birmingham, Queen Elizabeth Hospital, United Kingdom
| | - Anuradhaa Subramanian
- From the Institute of Applied Health Research (N.J.A., A.S., M.P., K.N.), University of Birmingham; Centre for Endocrinology, Diabetes, and Metabolism (K.N.), Birmingham Health Partners; Health Data Research UK (K.N.), Birmingham; Birmingham Neuro-Ophthalmology (S.P.M.), Queen Elizabeth Hospital; Metabolic Neurology (A.J.S.), Institute of Metabolism and Systems Research, University of Birmingham; and Department of Neurology (A.J.S.), University Hospitals Birmingham, Queen Elizabeth Hospital, United Kingdom
| | - Mary Perrins
- From the Institute of Applied Health Research (N.J.A., A.S., M.P., K.N.), University of Birmingham; Centre for Endocrinology, Diabetes, and Metabolism (K.N.), Birmingham Health Partners; Health Data Research UK (K.N.), Birmingham; Birmingham Neuro-Ophthalmology (S.P.M.), Queen Elizabeth Hospital; Metabolic Neurology (A.J.S.), Institute of Metabolism and Systems Research, University of Birmingham; and Department of Neurology (A.J.S.), University Hospitals Birmingham, Queen Elizabeth Hospital, United Kingdom
| | - Krishnarajah Nirantharakumar
- From the Institute of Applied Health Research (N.J.A., A.S., M.P., K.N.), University of Birmingham; Centre for Endocrinology, Diabetes, and Metabolism (K.N.), Birmingham Health Partners; Health Data Research UK (K.N.), Birmingham; Birmingham Neuro-Ophthalmology (S.P.M.), Queen Elizabeth Hospital; Metabolic Neurology (A.J.S.), Institute of Metabolism and Systems Research, University of Birmingham; and Department of Neurology (A.J.S.), University Hospitals Birmingham, Queen Elizabeth Hospital, United Kingdom
| | - Susan P Mollan
- From the Institute of Applied Health Research (N.J.A., A.S., M.P., K.N.), University of Birmingham; Centre for Endocrinology, Diabetes, and Metabolism (K.N.), Birmingham Health Partners; Health Data Research UK (K.N.), Birmingham; Birmingham Neuro-Ophthalmology (S.P.M.), Queen Elizabeth Hospital; Metabolic Neurology (A.J.S.), Institute of Metabolism and Systems Research, University of Birmingham; and Department of Neurology (A.J.S.), University Hospitals Birmingham, Queen Elizabeth Hospital, United Kingdom
| | - Alexandra Jean Sinclair
- From the Institute of Applied Health Research (N.J.A., A.S., M.P., K.N.), University of Birmingham; Centre for Endocrinology, Diabetes, and Metabolism (K.N.), Birmingham Health Partners; Health Data Research UK (K.N.), Birmingham; Birmingham Neuro-Ophthalmology (S.P.M.), Queen Elizabeth Hospital; Metabolic Neurology (A.J.S.), Institute of Metabolism and Systems Research, University of Birmingham; and Department of Neurology (A.J.S.), University Hospitals Birmingham, Queen Elizabeth Hospital, United Kingdom.
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8
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Korsbæk JJ, Beier D, Hagen SM, Molander LD, Jensen RH. Psychiatric Comorbidities in Patients With Idiopathic Intracranial Hypertension: A Prospective Cohort Study. Neurology 2022; 99:e199-e208. [PMID: 35473759 DOI: 10.1212/wnl.0000000000200548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Psychiatric disease is a frequent comorbidity in idiopathic intracranial hypertension (IIH) and has been associated with a poor subjective outcome. No prospective studies have investigated psychiatric comorbidities in new-onset IIH. Our primary aim was to investigate disease severity in IIH depending on comorbid psychiatric disease. Important secondary outcomes were disease severity after 6 months and prevalence of psychiatric diseases in IIH. METHODS This prospective, observational cohort study consecutively included patients with clinically suspected, new-onset IIH from 2 headache centers. A standardized diagnostic workup was completed to confirm or exclude IIH according to the revised Friedman criteria: semi-structured interview, neurologic and neuro-ophthalmologic examination, lumbar puncture with opening pressure (OP), and neuroimaging. Exclusion criteria were known IIH, secondary intracranial hypertension, missing data, and pregnancy. Disease severity was evaluated based on papilledema, visual fields, OP, and headache in patients with IIH without psychiatric disease (IIH-P) compared with patients with IIH with psychiatric disease (IIH+P). A blinded neuro-ophthalmologist assessed visual outcomes. Age- and sex-matched prevalence rates of psychiatric diseases in the general population were found in national reports. RESULTS A total of 258 patients were screened; 69 were excluded. A total of 189 patients with clinically suspected IIH were then evaluated with the diagnostic workup and IIH was confirmed in 111 patients (58.7%). A total of 45% of patients with IIH had a psychiatric comorbidity. Visual fields were worse in patients with IIH+P at baseline (-8.0 vs -6.0 dB; p = 0.04) and after 6 months (-5.5 vs -4.0 dB; p < 0.01) compared with IIH-P. Highly prevalent psychiatric disorders were major depressive disorder (24.3%; n = 27), anxiety or stress-related disorders (24.3%; n = 27), and emotionally unstable personality disorder (6.3%; n = 7). Substance abuse (1.8%), schizophrenia (0.9%), and bipolar disorder (0.9%) were rare. In the general population, prevalence estimates of major depressive disorder and emotionally unstable personality disorder were 1.8%-3.3% and 2%, respectively. DISCUSSION Visual fields were significantly worse at baseline and 6 months in IIH+P compared with IIH-P. Psychiatric comorbidities, particularly depression and emotionally unstable personality disorder, were highly prevalent in IIH. Increased awareness of psychiatric disease as a marker for worse visual status may improve patient care.
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Affiliation(s)
- Johanne Juhl Korsbæk
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark
| | - Dagmar Beier
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark
| | - Snorre Malm Hagen
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark
| | - Laleh Dehghani Molander
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark
| | - Rigmor Højland Jensen
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark.
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9
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Donaldson L, Dezard V, Chen M, Margolin E. Depression and generalized anxiety symptoms in idiopathic intracranial hypertension: Prevalence, under-reporting and effect on visual outcome. J Neurol Sci 2021; 434:120120. [PMID: 34992042 DOI: 10.1016/j.jns.2021.120120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with idiopathic intracranial hypertension (IIH) have been reported to have high prevalence of co-existent mood disorders. We investigated the frequency of symptoms of depression and anxiety in a large cohort of patients with IIH without a known psychiatric diagnosis and compared it with the age- and gender-matched control group. We also studied whether the presence and severity of co-existing mood disorder was related to visual outcome in patients with IIH. METHODS The Patient Health Questionnaire-8 (PHQ-8) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire for symptoms of generalized anxiety were administered via telephone survey to 100 patients with known diagnosis of IIH and 100 control subjects (matched for age and gender) who did not report a history of anxiety or depression during their prior in-person consultations. All participants were also asked whether they had ever been previously diagnosed with a mood disorder during this telephone assessment. Administered questionnaire results were correlated with final visual outcome in IIH cohort. RESULTS 34 IIH patients and 36 controls self-reported anxiety and/or depression when specifically asked if they had ever been diagnosed with these conditions although this was not reported on clinic intake questionnaires. Mean PHQ-8 depression scale score was 6.5 ± 0.6 in control group and 7.6 ± 0.6 in IIH group (p = 0.18). Mean GAD-7 score was 6.3 ± 0.5 in control group and 7.7 ± 0.6 in the IIH group (p = 0.06). In multivariable regression, scores on both scales were correlated with higher body mass index (BMI), younger age and presence of headache, but not with IIH diagnosis. In the IIH cohort, visual outcomes were not related to GAD-7 or PHQ-8 scores but were predicted by mean deviation on visual fields at presentation. CONCLUSIONS Pre-existing diagnosis of anxiety and depression are highly under-reported. Symptoms of anxiety and depression are very common in young women with elevated BMI and headache, however, there was no statistical difference in frequency of these symptoms between IIH and control groups. Presence and severity of mood disorder symptoms did not correlate with the final visual outcome in patients with IIH.
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Affiliation(s)
- Laura Donaldson
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Michael Chen
- University of Western Ontario, London, Ontario, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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10
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Kaipainen AL, Martoma E, Puustinen T, Tervonen J, Jyrkkänen HK, Paterno JJ, Kotkansalo A, Rantala S, Vanhanen U, Leinonen V, Lehto SM, Iso-Mustajärvi M, Elomaa AP, Qvarlander S, Huuskonen TJ. Cerebrospinal fluid dynamics in idiopathic intracranial hypertension: a literature review and validation of contemporary findings. Acta Neurochir (Wien) 2021; 163:3353-3368. [PMID: 34453214 PMCID: PMC8599224 DOI: 10.1007/s00701-021-04940-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
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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Affiliation(s)
- Aku L Kaipainen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
- Institute of Clinical Medicine / Neurology, University of Eastern Finland, Kuopio, Finland.
| | - Erik Martoma
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tero Puustinen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Joona Tervonen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Henna-Kaisa Jyrkkänen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi J Paterno
- Opthalmology KUH, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anna Kotkansalo
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Susanna Rantala
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ulla Vanhanen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Soili M Lehto
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | | | - Antti-Pekka Elomaa
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Eastern Finland Microsurgery Center, Kuopio University Hospital, Kuopio, Finland
| | - Sara Qvarlander
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Terhi J Huuskonen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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11
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Grech O, Clouter A, Mitchell JL, Alimajstorovic Z, Ottridge RS, Yiangou A, Roque M, Tahrani AA, Nicholls M, Taylor AE, Shaheen F, Arlt W, Lavery GG, Shapiro K, Mollan SP, Sinclair AJ. Cognitive performance in idiopathic intracranial hypertension and relevance of intracranial pressure. Brain Commun 2021; 3:fcab202. [PMID: 34704028 PMCID: PMC8421706 DOI: 10.1093/braincomms/fcab202] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 12/03/2022] Open
Abstract
Cognitive impairments have been reported in idiopathic intracranial hypertension; however, evidence supporting these deficits is scarce and contributing factors have not been defined. Using a case-control prospective study, we identified multiple domains of deficiency in a cohort of 66 female adult idiopathic intracranial hypertension patients. We identified significantly impaired attention networks (executive function) and sustained attention compared to a body mass index and age matched control group of 25 healthy female participants. We aimed to investigate how cognitive function changed over time and demonstrated that deficits were not permanent. Participants exhibited improvement in several domains including executive function, sustained attention and verbal short-term memory over 12-month follow-up. Improved cognition over time was associated with reduction in intracranial pressure but not body weight. We then evaluated cognition before and after a lumbar puncture with acute reduction in intracranial pressure and noted significant improvement in sustained attention to response task performance. The impact of comorbidities (headache, depression, adiposity and obstructive sleep apnoea) was also explored. We observed that body mass index and the obesity associated cytokine interleukin-6 (serum and cerebrospinal fluid) were not associated with cognitive performance. Headache severity during cognitive testing, co-morbid depression and markers of obstructive sleep apnoea were adversely associated with cognitive performance. Dysregulation of the cortisol generating enzyme 11β hydroxysteroid dehydrogenase type 1 has been observed in idiopathic intracranial hypertension. Elevated cortisol has been associated with impaired cognition. Here, we utilized liquid chromatography-tandem mass spectrometry for multi-steroid profiling in serum and cerebrospinal fluid in idiopathic intracranial hypertension patients. We noted that reduction in the serum cortisol:cortisone ratio in those undergoing bariatric surgery at 12 months was associated with improving verbal working memory. The clinical relevance of cognitive deficits was noted in their significant association with impaired reliability to perform visual field tests, the cornerstone of monitoring vision in idiopathic intracranial hypertension. Our findings propose that cognitive impairment should be accepted as a clinical manifestation of idiopathic intracranial hypertension and impairs the ability to perform visual field testing reliably. Importantly, cognitive deficits can improve over time and with reduction of intracranial pressure. Treating comorbid depression, obstructive sleep apnoea and headache could improve cognitive performance in idiopathic intracranial hypertension.
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Affiliation(s)
- Olivia Grech
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston B15 2TT, UK
| | - Andrew Clouter
- Department of Psychology, Nottingham Trent University, Nottingham NG1 5LT, UK
| | - James L Mitchell
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston B15 2TT, UK
| | - Zerin Alimajstorovic
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston B15 2TT, UK
| | - Ryan S Ottridge
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Andreas Yiangou
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston B15 2TT, UK
| | - Marianne Roque
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Abd A Tahrani
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Matthew Nicholls
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Angela E Taylor
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Fozia Shaheen
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Wiebke Arlt
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Gareth G Lavery
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Kimron Shapiro
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston B15 2TT, UK
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12
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Objective Audible Bruit in Idiopathic Intracranial Hypertension Resolved After Stenting. Can J Neurol Sci 2021; 49:603-605. [PMID: 34402423 DOI: 10.1017/cjn.2021.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Witry M, Kindler C, Weller J, Linder A, Wüllner U. The patients' perspective on the burden of idiopathic intracranial hypertension. J Headache Pain 2021; 22:67. [PMID: 34238219 PMCID: PMC8268504 DOI: 10.1186/s10194-021-01283-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/25/2021] [Indexed: 12/27/2022] Open
Abstract
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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Affiliation(s)
- Max Witry
- Department of Neurology, University Hospital Bonn, Venusberg-Campus, 1, 53127, Bonn, Germany.
| | - Christine Kindler
- Department of Neurology, University Hospital Bonn, Venusberg-Campus, 1, 53127, Bonn, Germany
| | - Johannes Weller
- Department of Neurology, University Hospital Bonn, Venusberg-Campus, 1, 53127, Bonn, Germany
| | - Andreas Linder
- German Society of Intracranial Hypertension, Bad Honnef, Germany
| | - Ullrich Wüllner
- Department of Neurology, University Hospital Bonn, Venusberg-Campus, 1, 53127, Bonn, Germany
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Lin Y, Zhang Z, Wang S, Cai J, Guo J. Hypothalamus-pituitary-adrenal Axis in Glucolipid metabolic disorders. Rev Endocr Metab Disord 2020; 21:421-429. [PMID: 32889666 DOI: 10.1007/s11154-020-09586-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
With the change of life style, glucolipid metabolic disorders (GLMD) has become one of the major chronic disorders causing public health and clinical problems worldwide. Previous studies on GLMD pay more attention to peripheral tissues. In fact, the central nervous system (CNS) plays an important role in controlling the overall metabolic balance. With the development of technology and the in-depth understanding of the CNS, the relationship between neuro-endocrine-immunoregulatory (NEI) network and metabolism had been gradually illustrated. As the hub of NEI network, hypothalamus-pituitary-adrenal (HPA) axis is important for maintaining the balance of internal environment in the body. The relationship between HPA axis and GLMD needs to be further studied. This review focuses on the role of HPA axis in GLMD and reviews the research progress on drugs for GLMD, with the hope to provide the direction for exploring new drugs to treat GLMD by taking the HPA axis as the target and improve the level of prevention and control of GLMD.
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Affiliation(s)
- Yanduan Lin
- Guangdong Metabolic Diseases Research Centre of Integrated Chinese and Western Medicine, Guangdong Pharmaceutical University, Guangzhou, 510006, People's Republic of China
| | - Ziwei Zhang
- Guangdong Metabolic Diseases Research Centre of Integrated Chinese and Western Medicine, Guangdong Pharmaceutical University, Guangzhou, 510006, People's Republic of China
| | - Siyu Wang
- Center for Drug Research and Development, Guangdong Pharmaceutical University, Guangzhou, 510006, People's Republic of China
| | - Jinyan Cai
- Center for Drug Research and Development, Guangdong Pharmaceutical University, Guangzhou, 510006, People's Republic of China.
| | - Jiao Guo
- Guangdong Metabolic Diseases Research Centre of Integrated Chinese and Western Medicine, Guangdong Pharmaceutical University, Guangzhou, 510006, People's Republic of China.
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Abstract
Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unknown cause that most often occurs in women of childbearing age. Most patients are overweight or obese with a history of recent weight gain. Following a brief review of the symptoms and signs, we discuss the approach to assessment and monitoring of this condition. We then present a practical approach to treatment. Because patients frequently struggle with weight loss and can also have refractory headaches and coexisting psychosocial issues, we emphasize the importance of a multidisciplinary approach to the management of this common condition.
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Affiliation(s)
- Matthew J Thurtell
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA 52242, USA; Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
| | - Aki Kawasaki
- University of Lausanne, Hôpital Ophtalmique Jules Gonin, Avenue de France 15, Lausanne 1004, Switzerland.
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An update on idiopathic intracranial hypertension in adults: a look at pathophysiology, diagnostic approach and management. J Neurol 2020; 268:3249-3268. [PMID: 32462350 DOI: 10.1007/s00415-020-09943-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
Idiopathic intracranial hypertension is a neurological syndrome determined by a rise in intracranial pressure without a detectable cause. Course and prognosis may be changeable, requiring a multidisciplinary approach for its diagnosis and management. Although its precise pathogenesis is still unknown, many studies have been carried out to define the possible causal and associated factors, such as retinoids, steroid hormones, body mass index and recent weight gains, cytokines and adipokines levels. The clinical presentation can be variable including chronic headache, disturbance of vision, diplopia and tinnitus. Even if papilloedema is considered the most specific sign, it could not be observed in more than 5% of patients during the evaluation of the fundus oculi. Neuroradiological signs acquire greater importance in patients who do not present papilloedema and may suggest the diagnosis of idiopathic intracranial hypertension. Other assessments can be useful in the diagnostic process, such as optical coherence tomography, visual evoked potentials, ocular ultrasonography and fundus fluorescein angiography and autofluorescence. Nonetheless, cerebrospinal fluid pressure measurement is required to establish a definite diagnosis. Management may be different, since surgical procedures or lumbar punctures are often required when symptoms develop rapidly leading to a loss of visual function. Apart from these cases, patients can be treated with a pharmacological approach and low-calorie diet, but they also need to be monitored over time since relapses years later are not uncommon.
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Psychiatric symptoms are frequent in idiopathic intracranial hypertension patients. Neurosurg Rev 2020; 44:1183-1189. [PMID: 32458276 DOI: 10.1007/s10143-020-01321-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/10/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a rare disease with an incidence rate of 0.5-2.0/100,000/year. Characteristic symptoms are headache and several degrees of visual impairment. Psychiatric symptoms in association with IIH are usually poorly described and underestimated. In this study, we evaluated IIH subjects to determine the association with psychiatric symptoms. We evaluated thirty consecutive patients with IIH submitted to neurosurgery from January 2017 to January 2020 in two Brazilian tertiary hospitals. They underwent clinical evaluation, obtaining medical history, comorbidities, body mass index (BMI-kg/m2), and applying Neuropsychiatric Inventory Questionnaire (NPI-Q). There were 28 females and 2 males. Ages ranged from 18 to 66 years old, with mean age of 37.97 ± 12.78. Twenty-five (83%) presented comorbidities, being obese and having arterial hypertension the most frequent. Body mass index ranged from 25 to 35 kg/m2 and mean value was 31 ± 3.42. After application of Neuropsychiatric Interview, 26 of 30 presented psychiatric symptoms (86%). Depression-anxiety syndromes were reported in 25 patients (83%). Nighttime disturbances were reported by 14 subjects (46%). Appetite and eating disorders were described by 23 (76%). Psychiatric symptoms in association with IIH are usually poorly described and underestimated. In our sample, twenty-six out of 30 (86%) reported psychiatric symptoms. We highlight the high prevalence of psychiatric symptoms among IIH patients and the need of managing these patients with a multidisciplinary team, including psychiatrists.
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