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

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

doi:10.1212/WNL.0000000000207866

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

Neurology. 2023 Nov 21;101(21):e2138-e2150. doi: 10.1212/WNL.0000000000207866. Epub 2023 Oct 9.

Affiliations

¹ From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom.
² From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom. soozmollan@doctors.org.uk.

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

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42023339569). MEDLINE and CINAHL were searched for relevant literature published from inception until December 15, 2022. Screening and quality appraisal was conducted by 2 independent reviewers. Recommendations were graded using Scottish Intercollegiate Guidelines Network methodology.

Results: A total of 17 studies were included. Bariatric surgery resulted in 27.2-27.8 kg weight loss at 24 months (Level 1- to 1++). Lifestyle weight management interventions resulted in between 1.4 and 15.7 kg weight loss (Level 2+ to 1++). Bariatric surgery resulted in the greatest mean reduction in ICP (-11.9 cm H₂O) at 24 months (Level 1++), followed by multicomponent lifestyle intervention + acetazolamide (-11.2 cm H₂O) at 6 months (Level 1+) and then a very low-energy diet intervention (-8.0 cm H₂O) at 3 months (Level 2++). The least ICP reduction was shown at 24 months after completing a 12-month multicomponent 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 body mass index (BMI) ≥35 kg/m² since this had the most robust evidence for sustained weight management (grade A). A multicomponent lifestyle intervention (diet + physical activity + behavior) had the most robust evidence for modest weight loss with a BMI <35 kg/m² (grade B). Longer-term outcomes for weight management interventions in people with IIH are required to determine whether there is a superior weight loss intervention for IIH.

Publication types

Systematic Review

MeSH terms

Adult
Bariatric Surgery*
Female
Humans
Intracranial Hypertension* / complications
Obesity / complications
Obesity / therapy
Pseudotumor Cerebri* / complications
Pseudotumor Cerebri* / therapy
Quality of Life
Weight Loss