Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations

Sally Abbott, Fiona Chan, Abd A. Tahrani, Sui Wong, Fiona E Campbell, Chetan Parmar, Dimitri Pournaras, Amanda Denton, Alexandra Jean Sinclair, Susan P Mollan

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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 is to evaluate weight loss interventions in people with IIH to determine which intervention is superior in terms of weight loss, reduction in intracranial pressure, benefit to visual and headache outcomes, quality of life, and mental health.

Methods A systematic review was carried out in accordance with PRISMA guidelines and registered with PROSPERO (CRD42023339569). MEDLINE and CINAHL were searched for relevant literature published from inception until 15th December 2022. Screening and quality appraisal was conducted by two independent reviewers. Recommendations were graded using Scottish Intercollegiate Guidelines Network (SIGN) methodology.

Results A total of 17 studies were included. Bariatric surgery resulted in 27.2-27.8kg weight loss at 24 months (Level 1- to 1++). Lifestyle weight management interventions resulted in between 1.4 to 15.7kg weight loss (Level 2+ to 1++). Bariatric surgery resulted in the greatest mean reduction in ICP (-11.9cm H2O) at 24 months (Level 1++), followed by multi-component lifestyle intervention + acetazolamide (-11.2cm H2O) at 6 months (Level 1+), and then a very low energy diet intervention (-8.0cm H2O) at 3 months (Level 2++). The least ICP reduction was shown at 24 months after completing a 12-month multi-component 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 BMI ≥35kg/m2 since this had the most robust evidence for sustained weight management (Grade A). A multi-component lifestyle intervention (diet + physical activity + behaviour) had the most robust evidence for modest weight loss with a BMI <35kg/m2 (Grade B). Longer term outcomes for weight management interventions in people with IIH are required, to determine if there is a superior weight loss intervention for IIH.
Original languageEnglish
Pages (from-to)(In-Press)
Number of pages36
JournalNeurology
Volume(In-Press)
Early online date9 Oct 2023
Publication statusE-pub ahead of print - 9 Oct 2023

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