Idiopathic intracranial hypertension (IIH) causes headaches, vision loss, and reduced quality of life. Sustained weight loss among patients with IIH is necessary to modify the disease and prevent relapse. Community weight management interventions (excluding very low-energy diets) have been associated with modest weight loss (approximately 5%). Bariatric surgery has been associated with sustained long-term weight loss (25%-30%) as well as positive cardiovascular and metabolic outcomes. Dr Alexandra J. Sinclair and his team conducted a study to compare the effectiveness of bariatric surgery with that of a community weight management (CWM) intervention for the treatment of patients with active IIH.

It was a 5-year randomized clinical trial (Idiopathic Intracranial Hypertension Weight Trial) of 66 women with active IIH and a body mass index of 35 or higher at 5 National Health Service hospitals in the UK between March 1, 2014, and May 25, 2017. The researchers randomized the women to either bariatric surgery (n = 33) or CWM intervention (Weight Watchers) (n = 33). The major outcome assessed was a change in intracranial pressure measured by lumbar puncture opening pressure at 12 months, as evaluated in an intention-to-treat analysis. The researchers also assessed the lumbar puncture opening pressure at 24 months as well as visual acuity, contrast sensitivity, perimetric mean deviation, and quality of life at 12 and 24 months.

Key findings of the study were:

• Upon analysis, the researchers found that intracranial pressure was significantly lower in the bariatric surgery arm at 12 months (adjusted mean [SE] difference, −6.0 [1.8] cm cerebrospinal fluid [CSF) and at 24 months (adjusted mean [SE] difference, −8.2 [2.0] cm CSF).
• In the per-protocol analysis, they found that intracranial pressure was significantly lower in the bariatric surgery arm at 12 months (adjusted mean [SE] difference, −7.2 [1.8] cm CSF) and at 24 months (adjusted mean [SE] difference, −8.7 [2.0] cm CSF).
• They noted that the weight was significantly lower in the bariatric surgery arm at 12 months (adjusted mean [SE] difference, −21.4 [5.4] kg) and at 24 months (adjusted mean [SE] difference, −26.6 [5.6] kg).
• They also noted significant improvement in the quality of life at 12 months (adjusted mean [SE] difference, 7.3 [3.6) and 24 months (adjusted mean [SE] difference, 10.4 [3.8) in the bariatric surgery arm.

The authors concluded, "In this randomized clinical trial, bariatric surgery was superior to a CWM intervention in lowering intracranial pressure. The continued improvement over the course of 2 years shows the impact of this intervention with regard to sustained disease remission."

For further information:

https://jamanetwork.com/journals/jamaneurology/fullarticle/2778650