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[Preprint]. 2024 Dec 13:2024.12.08.24318685.
doi: 10.1101/2024.12.08.24318685.

Epidemiological Patterns, Treatment Response, and Metabolic Correlations of Idiopathic Intracranial Hypertension: A US-Based Study From 1990 to 2024

Ahmed Y Azzam  1   2   3 , Mahmoud Nassar  4   5 , Mahmoud M Morsy  6   7 , Adham A Mohamed  8 , Jin Wu  9 , Muhammed Amir Essibayi  1   10 , David J Altschul  1   10
Affiliations

Epidemiological Patterns, Treatment Response, and Metabolic Correlations of Idiopathic Intracranial Hypertension: A US-Based Study From 1990 to 2024

Ahmed Y Azzam et al. medRxiv. .

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Abstract

Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United States (US).

Methods: We performed a retrospective analysis using the TriNetX US Collaborative Network database (1990-2024). We investigated demographic characteristics, time-based trends, geographic distribution, treatment pathways patterns, comorbidity profiles and associated risks with IIH. We used multivariate regression, Cox proportional hazards modeling, and standardized morbidity ratios to assess various outcomes and associations.

Results: Among 51,526 patients, we found a significant increase in adult IIH incidence from 16.0 to 127.0 per 100,000 (adjusted RR: 6.94, 95% CI: 6.71-7.17). Female predominance increased over time (female-to-male ratio: 3.29, 95% CI: 3.18-3.40). Southern regions showed the highest prevalence (43.0%, n=21,417). Initial medical management success rates varied between acetazolamide (42.3%) and topiramate (28.7%). Advanced interventional procedures showed 82.5% success rates in refractory cases. Cox modeling revealed significant associations between IIH and metabolic syndrome (HR: 2.14, 95% CI: 1.89-2.39) and cardiovascular complications (HR: 1.76, 95% CI: 1.58-1.94), independent of BMI.

Conclusions: Our findings highlight IIH as a systemic disorder with significant metabolic implications beyond its neurological manifestations. The marked regional disparities and rising incidence rates, especially among adults, suggest the need for targeted healthcare strategies. Early intervention success strongly predicts favorable outcomes, supporting prompt diagnosis and treatment initiation. These results advocate for an integrated approach combining traditional IIH management with broad metabolic screening care.

Keywords: Epidemiology; Headache; Idiopathic Intracranial Hypertension; Intracranial Pressure; Pesudotumor Cerebri.

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Conflict of interest statement

Conflicts of Interest: N/A.

Figures

Figure 1:
Figure 1:
Geographical Distribution of IIH In The United States From 1990 to 2024.
Figure 2:
Figure 2:
Longitudinal Treatment Patterns and Pathways for IIH Patients In Our Cohort.
Figure 3:
Figure 3:
IIH Incidence Time-Based Trends Over Gender, Age and Race Subgroups.
Figure 4:
Figure 4:
IIH Prevalence Time-Based Trends Over Gender, Age and Race Subgroups.
See this image and copyright information in PMC

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