Topiramate is more effective than acetazolamide at lowering intracranial pressure

Abstract

Background The management of idiopathic intracranial hypertension focuses on reducing intracranial pressure to preserve vision and reduce headaches. There is sparse evidence to support the use of some of the drugs commonly used to manage idiopathic intracranial hypertension, therefore we propose to evaluate the efficacy of these drugs at lowering intracranial pressure in healthy rats. Methods We measured intracranial pressure in female rats before and after subcutaneous administration of acetazolamide, topiramate, furosemide, amiloride and octreotide at clinical doses (equivalent to a single human dose) and high doses (equivalent to a human daily dose). In addition, we measured intracranial pressure after oral administration of acetazolamide and topiramate. Results At clinical and high doses, subcutaneous administration of topiramate lowered intracranial pressure by 32% ( p = 0.0009) and 21% ( p = 0.015) respectively. There was no significant reduction in intracranial pressure noted with acetazolamide, furosemide, amiloride or octreotide at any dose. Oral administration of topiramate significantly lowered intracranial pressure by 22% ( p = 0.018), compared to 5% reduction with acetazolamide ( p = >0.999). Conclusion Our in vivo studies demonstrated that both subcutaneous and oral administration of topiramate significantly lowers intracranial pressure. Other drugs tested, including acetazolamide, did not significantly reduce intracranial pressure. Future clinical trials evaluating the efficacy and side effects of topiramate in idiopathic intracranial hypertension patients would be of interest.

Cerebrospinal fluid dynamics modulation by diet and cytokines in rats

“…Treating elevated CSF secretion in IIH patients may be achieved through either serotonin to inhibit Na + -K + -ATPase pathway through the activation and phosphorylation of protein kinase C [33]; antisense thyroid transcription factor-1 oligodeoxynucleotide to reduce AQP1 mRNA and protein expression in the CP [34]; or acetazolamide and topiramate treatment [35] to decrease intracellular carbonic anhydrase CP epithelium [6]. However, reducing weight loss and inhibiting the actions of reproductive hormones as well as HC and may result in decreased CSF formation and ICP in IIH patients.…”

Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension

“…Although the carbonic anhydrase side effects are milder than with acetazolamide, it may cause cognitive slowing in a subset of patients. A recent study demonstrated topiramate to be more effective at lowering ICP than acetazolamide in healthy rodents 84 ; however, it is not known if this translates to humans.…”

<p>Exploring The Current Management Idiopathic Intracranial Hypertension, And Understanding The Role Of Dural Venous Sinus Stenting</p>

“…Compared to placebo, acetazolamide did not significantly lower ICP over the same study period. 24 Human physiological studies would be further informative in assessing ICP levels in response to the common medications used. On the horizon may be more medical options, including 11β-Hydroxysteroid Dehydrogenase Type 1 inhibitors.…”