Pediatric Idiopathic Intracranial Hypertension and Extreme Childhood Obesity

Brara, Sonu M.; Koebnick, Corinna; Porter, Amy H.; Langer‐Gould, Annette

doi:10.1016/j.jpeds.2012.03.047

Cited by 94 publications

(87 citation statements)

References 22 publications

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“…Methods to assign race and ethnicity are described in detail elsewhere. 13 Race and ethnicity information were obtained from health plan administrative records and birth certificates. We categorized race/ethnicity as non-Hispanic white, Hispanic white, black (regardless of ethnicity), Asian or Pacific Islander, and other or multiple race/ethnicity.…”

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confidence: 99%

Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome

et al. 2013

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Objective: To determine whether childhood obesity is a risk factor for developing pediatric multiple sclerosis (MS) or clinically isolated syndrome (CIS).Methods: Cases were identified through the Kaiser Permanente Southern California (KPSC) Pediatric Acquired Demyelinating Diseases Cohort between 2004 and 2010. For cases, body mass index (BMI) was obtained prior to symptom onset, for the underlying cohort BMI was obtained through the KPSC Children's health study (n 5 913,097). Weight classes of normal weight, overweight, moderate obesity, and extreme obesity were assigned based on BMI specific for age and sex.Results: We identified 75 newly diagnosed pediatric cases of MS or CIS, the majority of which were in girls (n 5 41, 55%), age 11-18 (n 5 54, 72%). Obesity was associated with a significantly increased risk of MS/CIS in girls (p 5 0.005 for trend) but not in boys (p 5 0.93). The adjusted odds ratio and 95% confidence intervals for CIS/MS among girls was 1.58 (0.71-3.50) for overweight compared to normal weight (reference category), 1.78 (0.70-4.49) for moderately obese, and 3.76 (1.54-9.16) for extremely obese. Moderately and extremely obese cases were more likely to present with transverse myelitis compared with normal/overweight children (p 5 0.003). Conclusion:Our findings suggest the childhood obesity epidemic is likely to lead to increased morbidity from MS/CIS, particularly in adolescent girls. Once thought to be rare in children, multiple sclerosis (MS) and its potential precursor, clinically isolated syndrome (CIS), which encompasses optic neuritis (ON) and transverse myelitis (TM), are increasingly recognized. Pediatric MS/CIS most often affects teenage girls. While once thought to be more common in whites, one study showed that the incidence is higher in blacks compared with whites and Hispanics.1 Whether this represents increased exposure to environmental triggers that increase with age, black race, or female sex during childhood is unclear.Over the last 30 years, the prevalence of pediatric obesity has tripled. It is well-known that obesity is characterized by a low-grade inflammatory state, 2 raising the possibility that the increasing reports of pediatric MS/CIS may be due at least in part to this alarming epidemic. Yet whether obesity is a risk factor for pediatric MS/CIS is unknown. Even in adults, the relationship between obesity and MS risk is not well understood. Only 2 studies have examined this question, both of which suggest that moderate obesity at age 20 but not at other times in life double the risk of adult-onset MS in women 3,4 and men. 4 However, the studies are limited by retrospective self-report of body size, 3,4 selection bias, 3 use of volunteer controls, 4 small number of obese subjects, 3,4 and inability to examine the risk among extremely obese individuals. 3,4 The purpose of this study was to estimate the magnitude of the association between overweight, moderate, and extreme childhood obesity and the risk of pediatric MS/CIS in our population-based,

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confidence: 99%

Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome

et al. 2013

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“…Patients with IIH have normal levels of consciousness and functioning. (11) Patients who present with papilloedema and symptoms of raised intracranial pressure need urgent multidisciplinary assessment including neuroimaging, to rule out life threatening conditions. Where there is no apparent underlying cause for the raised intracranial pressure, patients are considered to have idiopathic intracranial hypertension (IIH).…”

Section: Diagnosismentioning

confidence: 99%

Optic Neuropathy in Idiopathic Intracranial Hypertension

Merticariu¹,

Baltă²,

Merticariu³

et al. 2017

JTMR

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Adult patients who present with papilloedema and symptoms of raised intracranial pressure need urgent multidisciplinary assessment including neuroimaging, to exclude life-threatening causes. Where there is no apparent underlying cause for the raised intracranial pressure, patients are considered to have idiopathic intracranial hypertension (IIH). Objectives: This review encompasses the newly revised diagnostic criteria for PTCS in adults and children and the role of obesity in the epidemiology, etiology, and management of IIH.Furthermore, this paper tries to offer a practical approach to assessing patients with papilloedema, the investigations and the subsequent management of patients with IIH. Methodology: PubMed was used to search for IIH and Pseudotumor Cerebri. The vast majority of the literature consisted of cohort studies, case control studies, systematic reviews and other narrative reviews. Conclusion: Idiopathic intracranial hypertension (IIH), also known as primary Pseudotumor Cerebri syndrome (PTCS), is a condition of unknown etiology which affects primarily overweight, reproductive-aged women and causes increased intracranial pressure (ICP). This review discusses the recently revised diagnostic criteria for IIH for adults and children and the controversial issues in its diagnosis and management.

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“…Bununla birlikte, bizim çalışmamızda yaş dağılımı ve kız/erkek oranı açısından İİH ve sekonder PTSS tanılı hastalar arasında fark saptanmadı. Çocukluk çağı İİH ve sekonder PTSS'nun obezite ile birlikteliği erişkin yaştakine göre daha düşük oranda bildirilmektedir (4,11,12). Bizim çalışmamızda obezite sıklığı sekonder PTSS tanılı çocuklarda %10, İİH tanılı çocuklarda %12,5 olarak bulundu.…”

Section: Introductionunclassified

“…Bizim çalışmamızda obezite sıklığı sekonder PTSS tanılı çocuklarda %10, İİH tanılı çocuklarda %12,5 olarak bulundu. Bu oranlar ön-ceki çalışmalardaki oranlardan daha düşük olmakla birlikte 6-12 yaş grubundaki sağlıklı Türk çocuklarındaki obezite sıklığı (%7,8) ile karşılaştırıldığında literatürde bildirildiği gibi ağırlık artışının İİH ve sekonder PTSS gelişimi için bir risk faktörü olduğu çıkarımını desteklemektedir (11,13). PTSS'da klinik bulgular değişkendir, bu da tanıda gecikmelere neden olabilmektedir.…”

Section: Introductionunclassified