Novel advances in monitoring and therapeutic approaches in idiopathic intracranial hypertension.

James L Mitchell,Vivek Vijay,Susan P Mollan,Alexandra J Sinclair

doi:10.1097/wco.0000000000000690

Abstract

Purpose of reviewThe current article appraises the recent developments in idiopathic intracranial hypertension (IIH), with particular attention to novel therapeutic avenues and advanced clinical assessment and monitoring with optical coherence tomography and telemetric intracranial pressure devices.Recent findingsThe incidence of IIH is increasing. The first consensus guidelines for IIH have been published detailing investigation and management algorithms for adult IIH. Improved understanding, clinical assessment and monitoring are emerging with the use of optical coherence tomography. Intracranial pressure telemetry is providing unique insights into the physiology of raised intracranial pressure in IIH. There are now an increasing number of ongoing clinical trials evaluating weight loss methods and novel targeted therapies, such as 11ß-HSD1 inhibition and Glucagon-like peptide 1 (GLP-1) receptor agonists.SummarySeveral studies are evaluating new therapies for IIH. Monitoring techniques are advancing, aiding diagnosis and allowing the clinician to accurately evaluate changes in papilloedema and intracranial pressure.

Highlights

Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure (ICP) with no identifiable cause
There was a 65% reduction in ICP 30 min post dose compared with baseline and a cumulative effect seen with reduction in the ICP to 79.3 and 72.5% of baseline values predose at days 2 and 4, respectively, of the experiment
The IIH Pressure Trial, ISRCTN12678718, is a double-blinded, placebo-controlled physiology study assessing the effects of exenatide, a GLP-1 receptor (GLP-1R) agonist, on ICP in a cohort with active IIH and is expected to report this year [39]

Summary

INTRODUCTION

Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure (ICP) with no identifiable cause. The diagnostic principles of the investigation of papilloedema are to find any underlying treatable cause in a timely manner, protect the vision and ensure timely re-examination when aMetabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, bDepartment of Neurology, University Hospitals Birmingham, cBirmingham Neuro-Ophthalmology, Queen Elizabeth Hospital and dCentre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.

KEY POINTS

CONCLUSION

Findings

Conflicts of interest