Interventions for idiopathic intracranial hypertension

Abstract

Background: Idiopathic intracranial hypertension occurs throughout the world with an estimated incidence of one to three per 100,000 population per year. It occurs most commonly in obese young women but the cause is unknown. It presents a significant threat to sight and is associated with severe morbidity, in the form of headaches in most cases. Several different treatments have been proposed ranging from relatively conservative measures such as diuretic therapy to more invasive treatments such as optic nerve sheath fenestration, stenting of cerebral venous sinuses, or lumbo-peritoneal shunting.

Objectives: The objective of this review was to assess the effects of various forms of treatment for idiopathic intracranial hypertension with a view to producing an evidence-based treatment strategy.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Group Trials Register, on The Cochrane Library (Issue 4, 2004), MEDLINE (1966 to January 2005) and EMBASE (1980 to January 2005).

Selection criteria: We included only randomised controlled trials in which any intervention used to treat idiopathic intracranial hypertension had been compared to placebo or to another form of treatment in people with a clinical diagnosis of idiopathic intracranial hypertension.

Data collection and analysis: Both authors independently assessed the search results for trials to be included in the review. Discrepancies were resolved by discussion. Since no trials met our inclusion criteria, no assessment of quality or meta-analysis was undertaken.

Main results: No randomised controlled trials were found that met the inclusion criteria.

Authors' conclusions: There is insufficient information to generate an evidence-based management strategy for idiopathic intracranial hypertension. There is inadequate information regarding which treatments are truly beneficial and which are potentially harmful. Properly designed and executed trials are needed.