Octreotide: The IIH therapy beyond weight loss, carbonic anhydrase inhibitors, lumbar punctures and surgical/interventional treatments

Abstract

ObjectiveIdiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without a space-occupying cerebral lesion, venous sinus thrombosis or hydrocephalus and with normally composited cerebrospinal fluid (CSF). Main symptoms are headache, sight disturbances and potential visual impairment. Weight loss, carbonic anhydrase inhibitors, lumbar punctures with CSF drain, CSF shunting, optic nerve sheath fenestration, and venous sinus stenting are common IIH therapies. Octreotide, a synthetic somatostatin analogue, also effectively suspends IIH symptoms. Here, treatment with octreotide on five so far inefficiently treated IIH patients is presented and discussed. MethodsFive female patients with IIH and a history of failed therapy regimes were treated with octreotide, to be administered everyday subcutaneously for six months with identified doses high enough to suspend all clinical IIH symptoms. After tapering for two months, the further clinical course was to be monitored. ResultsAll patients were IIH symptom-free under octreotide. After tapering, one patient remained IIH symptom-free; one patient became IIH symptom-free under intramuscular octreotide after failure of former therapy regimes; one patient became IIH symptom-free on low-dose carbonic anhydrase inhibitors; one patient had an allergic reaction and paused octreotide, after successful desensitization, tooth ache developed, forcing octreotide tapering; one patient had another shunt revision alleviating IIH symptoms. ConclusionWe confirmed that a) clinical IIH symptoms are suspended during octreotide exposure; b) 6-month administration can sustainably abolish IIH symptoms; c) desensitization is possible for octreotide allergy. When IIH symptoms reoccur after limited-time octreotide administration, re-application of formerly ineffective carbonic anhydrase inhibitors can suspend IIH symptoms. Intramuscular octreotide is a promising long-term therapy option.