Coptic Hospital, Kenya
Posters & Accepted Abstracts: J Neurol Disord
Statement of problem: Idiopathic intracranial hypertension (formerly benign intracranial hypertension or pseudo-tumor cerebri) is a serious disorder with therapeutic uncertainties. It may affect young obese women, with body mass index around 40 and presents with headache, visual obscurations, back pain and pulsatile tinnitus. One to four per one hundred thousand people may be affected every year. The condition endangers vision. There is a lack of uniform agreement concerning medical management with diuretics and there is a lack of guidelines concerning the necessity and timing of surgical interventions. In 2015 cochran review concluded that although the included RCT showed modest benefits for Acetazolamide for some outcomes, there is insufficient evidence to recommend or reject the efficacy of this intervention. Aim: To find any new evidence based results published since the cochrane database review of IIHT released in 2015 August. Methodology & Theoretical Orientations: Online research of MEDLINE, Cochrane Library and CENTRAL, MEDSCAPE, PLOS, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform. Findings: New results of one trial were published in multiple articles: Ô??Idiopathic Intracranial Hypertension Treatment TrialÔ?Ł. This was a randomized, double-masked, placebo-controlled study. 165 patients were enrolled with mild vision loss. 86 patients were randomized to Acetazolamide, 79 to placebo group. Quality of life questionnaire results reported improvement in visual field, and neck pain, pulsatile tinnitus, and dizziness/vertigo that outweighed the side effect of Acetazolamide. All 165 patients had lumbar puncture at enrollment, 85 at 6 month. There was an association between cerebro-spinal pressure (CSFp) and Frisen Papilla edema Grade (FPG) at baseline. At 6 months, Acetazolamide had similar effect on CSFp in subjects with high FPG and in subjects with low FPG. Only modest association was found between CSFp and FPG. In patients with IIH and mild visual loss the use of Acetazolamide with low-sodium weight -reduction diet compared with diet alone resulted in modest improvement in visual field function. The study found profound effect of weight loss on outcome. 89 (43 Acetazolamide, 46 placebo) of 165 subjects meet criteria to enroll to asses papilla edema to SD-OCT (spectral domain optical coherence tomography). Acetazolamide group had significantly greater reduction of retinal nerve fiber and total retinal thickness. Conclusions & Significance: In the light of new publications it is still not clear the medication or weight loss resulted in positive outcomes. Only mild cases were enrolled in the cited study. There are no data regarding drug adverse effects, neither explanations of high drop-out rate. No CSF studies results provided except changes in opening pressure. Further RCTs needed to provide conclusive evidences of interventions.
E-mail: [email protected]
Neurological Disorders received 937 citations as per Google Scholar report