Bariatric surgery lowered intracranial pressure (ICP) better than a community weight management (CWM) intervention in women with obesity and idiopathic intracranial hypertension (IIH), according to study findings published in JAMA Neurology.

Participants in this randomized clinical trial (ClinicalTrials.gov Identifier: NCT02124486) were recruited from 5 hospitals in the UK between 2014 and 2017. All patients were women (mean age, 32.0 years), had active IIH, and had a body mass index of 35 or greater.

The women were randomly assigned to undergo either bariatric surgery (n=33) or CWM intervention based on a Weight Watchers program (n=33). The study investigators assessed the change in intracranial pressure from baseline to 1 year by measuring lumbar puncture (LP) opening pressure. At time of diagnosis, the overall mean (standard deviation) LP opening pressure was 35.5 (7.0) cm cerebrospinal fluid (CSF).


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A total of 64 women remained in the clinical trial at 1 year, but 54 women completed the primary outcome and were included in this final analysis. Compared with the group that received the CWM intervention, those that underwent bariatric surgery had significantly lower intracranial pressure at 1 year (adjusted mean difference, -6.0 cm CSF; 95% CI, -9.5 to -2.4; P =.001) and at 2 years (adjusted mean difference, -8.2; 95% CI, -12.2 to -4.2; P <.001).

Similar findings were reported in the per protocol analysis: Patients who underwent bariatric surgery had significantly lower intracranial pressure at 1 year (adjusted mean difference, -7.2 cm CSF; 95% CI, -10.6 to -3.7; P <.001) and 2 years (adjusted mean difference, -8.7; 95% CI, -12.7 to -4.8; P <.001).

Participants in the bariatric surgery arm had lower weight at 1 year (adjusted mean difference, -21.4 kg; 95% CI, -32.1 to -10.7; P <.001) and 2 years (adjusted mean difference, -26.6 kg; 95% CI, -37.5 to -15.7 kg; P <.001). Bariatric surgery was associated with significantly greater improvements in quality of life at 1-year follow-up (adjusted mean difference, 7.3; 95% CI, 0.2-14.4; P =.04) and 2-year follow-up (adjusted mean difference, 10.4; 95% CI, 3.0-17.9; P =.006).

The investigators noted that because of the small number of women in this study, they could not recommend one type of bariatric procedure over another. The small sample size also prevented the assessment of patient-centered outcomes.

In spite of these limitations, the researchers suggest the findings “can be used to develop recommendations for health care strategies and to inform health policy decisions regarding bariatric surgery for individuals with active IIH.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Mollan SP, Mitchell JL, Ottridge RS, et al. Effectiveness of bariatric surgery vs community weight management intervention for the treatment of idiopathic intracranial hypertension: a randomized clinical trial. JAMA Neurol. 2021;78(6):678-686. doi:10.1001/jamaneurol.2021.0659