Mark Thaller1,2,3, Victoria Homer4, Yousef Hyder1,2,3, Andreas Yiangou1,2,3, Anthony Liczkowski1,5, Anthony W Fong6,7, Jasvir Virdee6, Rachel Piccus6, Marianne Roque6, Susan P Mollan1,6, Alexandra J Sinclair8,9,10. 1. Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK. 2. Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK. 3. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK. 4. Cancer Research (UK) Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT, UK. 5. Emergency Medicine, Hull University Teaching Hospitals NHS Trust, Anlaby Rd, Hull, HU3 2JZ, UK. 6. Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK. 7. Ophthalmology, School of Medicine, University of Queensland, Queensland, 4006, Australia. 8. Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK. a.b.sinclair@bham.ac.uk. 9. Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK. a.b.sinclair@bham.ac.uk. 10. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK. a.b.sinclair@bham.ac.uk.
Abstract
BACKGROUND: There are limited longitudinal data evaluating outcomes in idiopathic intracranial hypertension (IIH). We aimed to evaluate the long-term outcomes in a real-world cohort of patients with IIH and sought to establish the prognostic factors. METHODS: A longitudinal prospective cohort study was conducted over 9 years (2012-2021). Data included demographics and disease status. All consenting patients with IIH were recruited. Visual outcomes included visual acuity, Humphrey visual field and optical coherence tomography (OCT) imaging measurements. Headache frequency, severity, and impact were noted. We analysed the key variables impacting visual and headache outcomes. RESULTS: The cohort contained 490 patients with a confirmed IIH diagnosis. 98% were female with a mean body mass index (BMI) of 38 kg/m2. Those with the highest OCT retinal nerve fibre layer had the worst visual outcomes. We noted a delayed decline, in the visual field and OCT ganglion cell layer after 12 months. In the medically managed cohort (n = 426), we found that disease duration and change in BMI had the greatest influence on visual outcomes. There was a high burden of headache, with a daily headache at presentation and prior migraine history influencing long-term headache prognosis. CONCLUSIONS: There is a delayed decline in visual outcomes in those with the most severe papilloedema. Disease duration and change in BMI were the key visual prognostic factors, therefore those with the more acute disease may require closer monitoring. Improving prognosis in IIH should focus on the potentially modifiable factor of weight management.
BACKGROUND: There are limited longitudinal data evaluating outcomes in idiopathic intracranial hypertension (IIH). We aimed to evaluate the long-term outcomes in a real-world cohort of patients with IIH and sought to establish the prognostic factors. METHODS: A longitudinal prospective cohort study was conducted over 9 years (2012-2021). Data included demographics and disease status. All consenting patients with IIH were recruited. Visual outcomes included visual acuity, Humphrey visual field and optical coherence tomography (OCT) imaging measurements. Headache frequency, severity, and impact were noted. We analysed the key variables impacting visual and headache outcomes. RESULTS: The cohort contained 490 patients with a confirmed IIH diagnosis. 98% were female with a mean body mass index (BMI) of 38 kg/m2. Those with the highest OCT retinal nerve fibre layer had the worst visual outcomes. We noted a delayed decline, in the visual field and OCT ganglion cell layer after 12 months. In the medically managed cohort (n = 426), we found that disease duration and change in BMI had the greatest influence on visual outcomes. There was a high burden of headache, with a daily headache at presentation and prior migraine history influencing long-term headache prognosis. CONCLUSIONS: There is a delayed decline in visual outcomes in those with the most severe papilloedema. Disease duration and change in BMI were the key visual prognostic factors, therefore those with the more acute disease may require closer monitoring. Improving prognosis in IIH should focus on the potentially modifiable factor of weight management.
Authors: Susan P Mollan; Olivia Grech; Zerin Alimajstorovic; Benjamin R Wakerley; Alexandra J Sinclair Journal: Br Med Bull Date: 2020-12-15 Impact factor: 4.291
Authors: Michael Wall; Julie Falardeau; William A Fletcher; Robert J Granadier; Byron L Lam; Reid A Longmuir; Anil D Patel; Beau B Bruce; Hua He; Michael P McDermott Journal: Neurology Date: 2015-08-05 Impact factor: 9.910
Authors: Olivia Grech; Andrew Clouter; James L Mitchell; Zerin Alimajstorovic; Ryan S Ottridge; Andreas Yiangou; Marianne Roque; Abd A Tahrani; Matthew Nicholls; Angela E Taylor; Fozia Shaheen; Wiebke Arlt; Gareth G Lavery; Kimron Shapiro; Susan P Mollan; Alexandra J Sinclair Journal: Brain Commun Date: 2021-09-02
Authors: Susan P Mollan; Brendan Davies; Nick C Silver; Simon Shaw; Conor L Mallucci; Benjamin R Wakerley; Anita Krishnan; Swarupsinh V Chavda; Satheesh Ramalingam; Julie Edwards; Krystal Hemmings; Michelle Williamson; Michael A Burdon; Ghaniah Hassan-Smith; Kathleen Digre; Grant T Liu; Rigmor Højland Jensen; Alexandra J Sinclair Journal: J Neurol Neurosurg Psychiatry Date: 2018-06-14 Impact factor: 10.154
Authors: Andreas Yiangou; James L Mitchell; Matthew Nicholls; Yu Jeat Chong; Vivek Vijay; Benjamin R Wakerley; Gareth G Lavery; Abd A Tahrani; Susan P Mollan; Alexandra J Sinclair Journal: J Neurol Date: 2021-08-22 Impact factor: 4.849