Long-Term Outcomes of Bariatric Surgery in Idiopathic Intracranial Hypertension Patients

Hermes, Sam M.; Bharadwaj, Madhumithaa; Miller, Nick R; Waslo, Carin S.; Husain, Farah; Wolfe, Bruce M.; Tanne, Emanuel

doi:10.1097/nrl.0000000000000446

Cited by 3 publications

(10 citation statements)

References 35 publications

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“…In one study, a mean 1.0 kg weight gain observed 24 months postgastric band procedure (Level 1− 7 ). In other studies, excess weight loss was 64.1% at a mean of 20 months and a lesser 27.1% at a median of 108 months (Level 3 to 2− 22,23 ), although statistical significance was not reported for either study.…”

Section: Resultsmentioning

confidence: 69%

“…There were 6 studies 7,20,21,31-33 of randomized control trials (RCTs), 4 prospective nonrandomized interventional studies, 6,24,25,30 and 2 prospective 27,29 and 4 retrospective observational studies. 5,22,23,26,28 Prescribed concomitant IIH pharmacotherapy is presented in eTable 1 (links.lww.com/WNL/D149).…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies (n = 122 participants) reported on bariatric surgery interventions, including gastric band 7,20,22-24,34 (n = 6 studies), sleeve gastrectomy 7,20,22,27,28,34 (n = 6 studies), and gastric bypass 7,20,22,24,34 (n = 5 studies). Twelve studies reported on lifestyle weight management interventions (n = 374 participants), of which 4 studies 6,25,29,30 were dietary interventions alone, 7 studies 20,21,26,31-34 were multicomponent interventions (diet + physical activity + behavioral interventions), and in 1 study 5 patients independently sourced a weight management intervention of their choosing (eTable 1, links.lww.com/WNL/D149).…”

Section: Resultsmentioning

confidence: 99%

“…Sleeve gastrectomy (n = 42 participants) resulted in weight loss of 32.2–39.0 kg at 12–24 months (Level 3 to 1− 7,28 ). Excess weight loss ranged from 75.2% to 87.4% at 12 months (Level 3 27,28 ) and 40.2% excess weight loss at a median follow-up of 68 months (Level 2− 22 ); statistical significance was not reported. Weight loss outcomes after gastric banding (n = 27 participants) varied.…”

Section: Resultsmentioning

confidence: 99%

“…In studies where outcomes were pooled across bariatric surgery procedures (gastric band, gastric bypass, and sleeve gastrectomy), the mean weight loss was 27.2-27.8 kg at 24 months (Level 1− to 1++ 20,34 ) (Table 3). However, where weight loss outcomes were reported at the procedure level, the greatest weight loss was seen for gastric bypass procedures (n = 37 participants) with a significant weight reduction of 42.5-45.0 kg at 12-24 months and excess weight loss of 69.9%-71.0% at 24 months to a median of 91 months (Level 2− to 1− 7,22,24 ). Sleeve gastrectomy (n = 42 participants) The greatest weight loss with a lifestyle intervention was reported using a very low-energy diet (VLED) dietary intervention with a 15.7 kg at 3 months (Level 2+ 6 ).…”

Section: Weight Loss Outcomesmentioning

confidence: 99%

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Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension

Abbott,

Chan,

Tahrani

et al. 2023

Neurology

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Background and ObjectivesIdiopathic 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.MethodsA 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 15thDecember 2022. Screening and quality appraisal was conducted by two independent reviewers. Recommendations were graded using Scottish Intercollegiate Guidelines Network (SIGN) methodology.ResultsA 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++).DiscussionBariatric surgery should be considered for women with IIH and a BMI ≥35kg/m2since 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.

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Section: Resultsmentioning

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Weight Loss Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension

Abbott,

Chan,

Tahrani

et al. 2023

Neurology

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The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes

et al. 2022

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Background There are limited longitudinal data evaluating outcomes in idiopathic intracranial hypertension (IIH). We aimed to evaluate the long-term outcomes in a real-world cohort of patients with IIH and sought to establish the prognostic factors. Methods A longitudinal prospective cohort study was conducted over 9 years (2012–2021). Data included demographics and disease status. All consenting patients with IIH were recruited. Visual outcomes included visual acuity, Humphrey visual field and optical coherence tomography (OCT) imaging measurements. Headache frequency, severity, and impact were noted. We analysed the key variables impacting visual and headache outcomes. Results The cohort contained 490 patients with a confirmed IIH diagnosis. 98% were female with a mean body mass index (BMI) of 38 kg/m2. Those with the highest OCT retinal nerve fibre layer had the worst visual outcomes. We noted a delayed decline, in the visual field and OCT ganglion cell layer after 12 months. In the medically managed cohort (n = 426), we found that disease duration and change in BMI had the greatest influence on visual outcomes. There was a high burden of headache, with a daily headache at presentation and prior migraine history influencing long-term headache prognosis. Conclusions There is a delayed decline in visual outcomes in those with the most severe papilloedema. Disease duration and change in BMI were the key visual prognostic factors, therefore those with the more acute disease may require closer monitoring. Improving prognosis in IIH should focus on the potentially modifiable factor of weight management.

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Efficacy and Safety of Bariatric Surgery Versus Non-surgery in the Treatment of Idiopathic Intracranial Hypertension: a Systematic Review and Meta-analysis

Teng,

Wang,

Wang

et al. 2023

Preprint

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Background Idiopathic intracranial hypertension (IIH) is a debilitating disorder characterized by elevated intracranial pressure (ICP). Women, reproductive age, and obesity, especially weight gain in a short period, are major risk factors in the development of IIH. Weight loss has been widely recognized as a beneficial strategy of treatment. Methods Two researchers independently and systematically searched the National Library of Medicine (PubMed/MEDLINE), the Cochrane Library, EMBASE databases, and ClinicalTrials.gov to identify articles that met the eligibility criterion. The primary outcomes are ICP and IIH-related symptoms (number of patients with headache and visual defect), and secondary outcomes are weight, body mass index (BMI), ophthalmological examination, complications and mortality at the final follow-up. Results Eventually, 1 RCT, 6 retrospective studies and 17 case reports were included in the meta-analysis. The number of patients with headaches (P = 0.01) after surgery was significantly lower than that in the nonsurgery group. ICP (P = 0.005) was reduced significantly in the bariatric surgery group. Weight (P = 0.004) and BMI (P < 0.00001) were significantly lower in the bariatric surgery group. However, there was no significant difference in visual symptoms between the two groups. Overall, the probability of complications is not high. Conclusions Our research indicated that bariatric surgery is an effective and safe treatment for patients with IIH. Bariatric surgery can effectively reduce ICP and relieve headache, which is the major distress of patients.

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Long-Term Outcomes of Bariatric Surgery in Idiopathic Intracranial Hypertension Patients

Cited by 3 publications

References 35 publications

Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension

Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension

The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes

Efficacy and Safety of Bariatric Surgery Versus Non-surgery in the Treatment of Idiopathic Intracranial Hypertension: a Systematic Review and Meta-analysis

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