Bariatric surgery vs community weight management for idiopathic intracranial hypertension

1. At 12 and 24 months, bariatric surgery was superior to a community weight management program at decreasing intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH).

2. Patients in the bariatric surgery group had improved body weight and BMI compared to the weight management program.

Evidence Rating Level: 1 (Excellent)

Idiopathic intracranial hypertension (IIH) is characterized by heightened intracranial pressure (ICP), leading to chronic headaches, papilledema causing vision problems or loss, and overall reduced quality of life. IIH affects mostly women between the ages of 25 and 36, and weight gain is the main risk factor. A reduction in weight of between 3-15% has been correlated with IIH remission, and so interventions that prioritize weight loss may effectively treat IIH. This multicentre, randomized controlled trial compared bariatric surgery and a Weight Watchers community weight management program, to determine which would decrease ICP more, as measured by a lumbar puncture after 12 months. The study population consisted of 66 women with a BMI greater than 35, and a mean±SD age of 32.0±7.8. They were randomized evenly between the surgery and weight management groups. The mean±SD baseline opening pressure for the lumbar puncture was 35.5±7.0 cm CSF. The study found that for the surgery group, the opening pressure decreased from 34.8±5.8 to 26.4±8.7 cm CSF at 12 months, with a mean±SE difference of -8.7±1.3 cm CSF (95% CI -11.3 to -6.1 cm CSF, p < 0.001). For the weight management group, the opening pressure decreased from 34.6±5.6 to 32.0±5.2 cm CSF, with a difference of -2.5±1.4 cm CSF (95% CI -5.2 to 0.3 cm CSF, p = 0.08). The difference in ICP was more pronounced in the surgery group than the weight management group, and was not significantly different in the weight management group. From 12 to 24 months, the disparity between the groups widened, with a difference of -8.2±2.0 cm CSF (95% CI -12.2 to -4.2 cm CSF, p < 0.001). Furthermore, the bariatric surgery group had greater improvements in body weight and BMI, at both 12 and 24 months. Overall, this study demonstrated that bariatric surgery is superior to a community weight management program for the purposes of decreasing ICP in patients with IIH, by reducing body weight.

Click to read the study in JAMA Neurology

Image: PD

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