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Abstract Details

Reasons for Discontinuation of Medical Management in Refractory Idiopathic Intracranial Hypertension
Headache
P3 - Poster Session 3 (5:30 PM-6:30 PM)
12-007
To evaluate the reasons for discontinuing medical management in patients with refractory idiopathic intracranial hypertension (IIH).
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.
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.
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.
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 Ms. Sharan has nothing to disclose.
Nivethitha Arunkumar Ms. Arunkumar has nothing to disclose.
Areeba Nisar Areeba Nisar has nothing to disclose.
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 AbbVie. The institution of Dr. Marmura has received research support from Teva. The institution of Dr. Marmura has received research support from AbbVie. The institution of Dr. Marmura has received research support from Axsome. The institution of Dr. Marmura has received research support from Pfizer. 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 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 好色先生 (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 Reid Gooch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stryker. Reid Gooch has stock in Sonorus NV.
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. 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 MedLink Neurology. 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 Cephalalgia. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. The institution of Dr. Yuan has received research support from Pfizer. Dr. Yuan has received publishing royalties from a publication relating to health care. 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. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Invited speaker with Chinese Stroke Association.