Effect and tolerance of acetazolamide in patients with idiopathic intracranial hypertension

Abstract

Introduction: Acetazolamide is commonly used to treat idiopathic intracranial hypertension (IIH). The Idiopathic Intracranial Hypertension Treatment Trial showed a modest improvement in visual field function in patients using acetazolamide with a low-sodium weight-reduction diet compared with diet alone. There is still insufficient data to establish its use. Objectives: To describe acetazolamide effect in improving headache, visual acuity and papilloedema in patients with HII and assess patient’s tolerance to it Design. Retrospective analysis of 37 patients with IIH taking acetazolamide in a headache clinic of a tertiary medical center in São Paulo, Brazil. Results: The population analyzed was mostly female, with a mean age of 34.32 years, obese with a mean body mass index of 34.16, and were referred to the headache clinic from the emergency department. All 37 patients complained of headache and had increased cerebrospinal fluid opening pressure initially (mean 42.05). Improvement of headache was reported by 25 (67.56%) patients. Fundoscopy was described in the initial and last visit in 24 patients: 15 had papilloedema initially and 9 had a normal exam. At the last visit 9 patients improved (60%), 6 maintained papilloedema and 1 patient developed it. Visual acuity was described in the initial and last visit in 20 patients: 5 had normal visual acuity, 14 had low visual acuity and one patient was amaurotic. Of those with low visual acuity 2 (14.28%) got completely recovered, 5 (35.71%) recovered partially and 7 (50%) got worse. Two patients with the initial normal exam got worse during follow-up. Adverse effects were reported by 5 (13.51%) patients and led to discontinuation of acetazolamide — 3 of 5 reported paresthesias. Conclusion: Acetazolamide reduced headache in 67.56%, improved visual acuity in 50% and papilloedema in 60%, and was well tolerated by 86.48% of patients.