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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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Thaller M, Homer V, Hyder Y, Yiangou A, Liczkowski A, Fong AW, Virdee J, Piccus R, Roque M, Mollan SP, Sinclair AJ. The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes. J Neurol 2023; 270:851-863. [PMID: 36242625 PMCID: PMC9886634 DOI: 10.1007/s00415-022-11402-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are limited longitudinal data evaluating outcomes in idiopathic intracranial hypertension (IIH). We aimed to evaluate the long-term outcomes in a real-world cohort of patients with IIH and sought to establish the prognostic factors. METHODS A longitudinal prospective cohort study was conducted over 9 years (2012-2021). Data included demographics and disease status. All consenting patients with IIH were recruited. Visual outcomes included visual acuity, Humphrey visual field and optical coherence tomography (OCT) imaging measurements. Headache frequency, severity, and impact were noted. We analysed the key variables impacting visual and headache outcomes. RESULTS The cohort contained 490 patients with a confirmed IIH diagnosis. 98% were female with a mean body mass index (BMI) of 38 kg/m2. Those with the highest OCT retinal nerve fibre layer had the worst visual outcomes. We noted a delayed decline, in the visual field and OCT ganglion cell layer after 12 months. In the medically managed cohort (n = 426), we found that disease duration and change in BMI had the greatest influence on visual outcomes. There was a high burden of headache, with a daily headache at presentation and prior migraine history influencing long-term headache prognosis. CONCLUSIONS There is a delayed decline in visual outcomes in those with the most severe papilloedema. Disease duration and change in BMI were the key visual prognostic factors, therefore those with the more acute disease may require closer monitoring. Improving prognosis in IIH should focus on the potentially modifiable factor of weight management.
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Affiliation(s)
- Mark Thaller
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - Victoria Homer
- Cancer Research (UK) Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT, UK
| | - Yousef Hyder
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - Andreas Yiangou
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - Anthony Liczkowski
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK.,Emergency Medicine, Hull University Teaching Hospitals NHS Trust, Anlaby Rd, Hull, HU3 2JZ, UK
| | - Anthony W Fong
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.,Ophthalmology, School of Medicine, University of Queensland, Queensland, 4006, Australia
| | - Jasvir Virdee
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Rachel Piccus
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Marianne Roque
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Susan P Mollan
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Alexandra J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK. .,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK. .,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK.
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