gms | German Medical Science

Introduction: In IIH therapy there are non-surgical (body weight reduction and pharmacological treatment: acetazolamide, topiramate) and surgical (lumbo- and ventricular-peritoneal shunt, ventriculotomy, optical nerve sheath fenestration) as well as nowadays also radiological-interventional (STENT implantation into cerebral sinus) options. All these therapeutic procedures can fail for different reasons.

Main part: However, first of all, the question must be answered which of these treatment options can be considered to be evidence-based. A meta-analysis (Piper et al., 2015) has looked for randomised, controlled trials in different large data banks and identified two published trials with 211 patients and two studies „under way“ with several treatment arms. The authors compared acetazolamide medication vs. placebo + weight reduction programs in both arms; there were slight advantages for the acetazolamide arm, which however failed significance level, so that the authors of the meta-analysis didn´t see high enough evidence to recommend or not-recommend pharmacological IIH treatment. The same was true for surgical treatment in case of medication failure. Evidence level analysis of radiological options was not possible because of a lack of randomised trials.

Besides, pharmacological therapies can fail principally because of side effects, lack of patients´ compliance or insufficient information of the patients.

Weight reduction programs are very often discontinued, especially, if patients are left alone with the recommendation „to reduce their body weight“.

The success of surgical and radiological-interventional procedures correlates with the degree of local experience.

Conclusions: It can be summarised that therapeutic failure can be avoided only or kept at low frequencies if there are evidence-based treatment options. Such options do not exist to date in IIH treatment. Thus, the most important step is to design multicenter, randomised , controlled studies with several arms to test the most frequnetly applied therapies. However, foreseeable problems should be taken into consideration which will be presented in the second part of this presentation.