Abstract Details

Title Reasons for Discontinuation of Medical Management in Refractory Idiopathic Intracranial Hypertension

Topic Headache

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-007

Background Commonly employed medical management for IIH includes diuretics, anti-epileptics, and others. However, a large subset of IIH patients may experience intolerance or resistance to medical management, leading to low efficacy and quality of life.

Objective To evaluate the reasons for discontinuing medical management in patients with refractory idiopathic intracranial hypertension (IIH).

Design/Methods This is a retrospective chart review of medically refractory IIH patients with no relevant brain or spine surgical and no secondary etiology, who underwent venous manometry at Thomas Jefferson University Hospital between 1/2022 and 10/2023. History of medical management, including current and past medications, doses, and reasons for discontinuation and medication changes were collected in addition to demographic data.

Results The study included 48 female patients (22 Caucasians, and 21 African Americans) with a mean age of 38.9±9.9 years and a BMI of 36.8 ± 9.1 kg/m2. Commonly used preventive medications in this cohort, included 43 (89.5%) acetazolamide, 29 (60.4%) topiramate, 11 (22.9%) onabotulinumtoxinA, 9 (18.8%) rimegepant, 8 (16.7%) galcanezumab, 5 (10.4%) erenumab, 2 (4.1%) eptinezumab, and 2 (4.1%) fremanezumab. The pre-intervention mean dose of acetazolamide and topiramate was 962.5 ± 425 mg and 140 ± 102mg per day, respectively. 23 (53.4%) and 20 (68.9%) of acetazolamide and topiramate were discontinued. The main reasons for discontinuation of acetazolamide vs topiramate included adverse effects (17 [73.9%] vs. 17 [85.0%]), inadequate response (6 [26.1%] vs. 1 [5.0%]), and reasons unspecified (6 [26.1%] vs. 5 [25.0%]). One patient also developed a sickle cell crisis on acetazolamide.

Conclusions Our study results suggest that medical management available for IIH may not be suitable for all patients, and many may discontinue the medication due to adverse effects or no improvement in symptoms. IIH patients refractory to medical management are a challenging sub-group requiring invasive and surgical diagnostic and treatment modalities.

Authors/Disclosures
Jenny Chan PRESENTER	Ms. Chan has nothing to disclose.
Shreya Swaminathan	No disclosure on file
Isha P. Sharan	Miss Sharan has nothing to disclose.
Nivethitha Arunkumar	Ms. Arunkumar has nothing to disclose.
Areeba Nisar	No disclosure on file
Michael J. Marmura, MD, FAAN (Thomas Jefferson University)	Dr. Marmura has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Axsome. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Marmura has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Lilly. Dr. Marmura has stock in Curelator. The institution of Dr. Marmura has received research support from Teva. The institution of Dr. Marmura has received research support from AbbVie. Dr. Marmura has received publishing royalties from a publication relating to health care. Dr. Marmura has received publishing royalties from a publication relating to health care. Dr. Marmura has received publishing royalties from a publication relating to health care.
Simy K. Parikh, MD (Jefferson Hospital For Neuroscience Headache Center)	Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Parikh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Pain and Headache Reports. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Author with Medlink. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Faculty with Touch Independent Medical Education (touchIME) . Dr. Parikh has a non-compensated relationship as a Medical Advisory Board Member with Spinal CSF Leak Foundation that is relevant to AAN interests or activities.
Nicole M. Spare, DO (Jefferson Headache Center)	Dr. Spare has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AbbVie.
Reid Gooch	No disclosure on file
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center)	An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH.