The following article is a part of conference coverage from the 2021 meeting of the North American Neuro-Ophthalmology Society, being held virtually from February 20 to 23, 2021. The team at Ophthalmology Advisor will be reporting on the latest news and research conducted by these leading experts in neuro-ophthalmology. Check back for more from the NANOS 2021 Meeting.

 

Idiopathic intracranial hypertension (IIH), also called pseudotumor cerebri, requires a multidisciplinary management approach, including regular discussion and optimization of patient’s weight as well as screening for obstructive sleep apnea (OSA), according to research presented at the North American Neuro-Ophthalmology Society 2021 Annual Meeting, held virtually February 20 through 23, 2021.1


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Researchers conducted a retrospective review of consecutive cases to evaluate the current practices used in a neuro-ophthalmology clinic compared with the currently recommended expert consensus guidelines for idiopathic intracranial hypertension.2 Specifically, evaluated the recommendations surrounding recording measurements of body mass index (BMI), discussion of weight management, and referral to dietician services.2 

Additionally, the researchers aimed to report both the prevalence and severity of OSA in patients with IIH through a review of overnight home pulse oximetry results. 

The study cohort included 68 patients (63 women) with newly diagnosed IIH between 2018 and 2020. Median BMI at the time of index was 35.6 kg/m2 and median follow-up time was 222 days. Patients were categorized into 1 of 5 categories based on BMI: normal, overweight, and obesity class 1 through 3. 

In total, 82% of patients had a recorded BMI at each clinic visit (67%, 71%, 73%, 86%, and 91% in each group, respectively). Similar trends were noted for discussion of weight management or lifestyle modification, discussed with 0%, 50%, 73%, 79%, and 96% in each group, respectively. 

Referrals were made to a hospital or community dietician in 85% of cases, and 4% were referred to bariatric services. Overall, a net weight loss between 0.3% and 5% was noted in the overweight and obese groups, while a median weight gain of 23.3% was noted in patients with normal BMI at index. 

Within the cohort, 78% of patients were screened for OSA. Of the patients screened, 43% had varying degrees of OSA (17% mild, 11% moderate, 13% severe); 24.5% of those screened required continuous positive airway pressure (CPAP), automatic positive airway pressure (APAP), or mandibular devices. 

“This study highlights the importance of a multidisciplinary approach to IIH management, including optimization of weight, dietician input, and consideration of screening for obstructive sleep apnea,” the research shows. Investigators added that these management aspects should be emphasized for all patients regardless of BMI. 

“Further studies are required to investigate the utility in screening for OSA in [patients with IIH],” the report concludes.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures. 

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Reference

  1. Kok LT, Wong SH. Risk factor management in patients with idiopathic intracranial hypertension/pseudotumor cerebri. Presented at: North American Neuro-Ophthalmology Society (NANOS) 2021 Annual Meeting; February 20-23, 2021; Poster 100.
  2. Mollan SP, Davies B, Silver NC, et al. Idiopathic intracranial hypertension: Consensus guidelines on management.J Neurol Neurosurg Psychiatry. 2018;89(10):1088-1100.