Elsevier

Translational Research

Volume 148, Issue 5, November 2006, Pages 215-222
Translational Research

Original article
Changes in weight, papilledema, headache, visual field, and life status in response to diet and metformin in women with idiopathic intracranial hypertension with and without concurrent polycystic ovary syndrome or hyperinsulinemia

https://doi.org/10.1016/j.trsl.2006.05.003Get rights and content

The authors hypothesized that a metformin (MET)-diet would improve symptoms of idiopathic intracranial hypertension (IIH) in women who also had polycystic ovary syndrome (PCOS) or hyperinsulinemia without PCOS. Changes in weight, papilledema, headache, visual fields, and overall life status were prospectively assessed in response to 6 to 14 months on 2.25 g/day MET-diet or diet alone in 36 women with IIH, 23 with PCOS, selected by baseline body mass index (BMI) ≥ 25, and no previous surgery for IIH. Overall life status was graded using a self-reported 1–5 scale (1 = well, normal activities; 2 = unwell, usual activities; 3 = poor, usual activities; 4 = poor, no usual activities; 5 = totally disabled). Conventional treatment for IIH was maintained unchanged during MET-diet intervention. The diet was hypocaloric (1500 calories/day), high protein (26% of calories), and low carbohydrate (44%). Of the 23 women with PCOS, 20 received MET-diet and 3 diet only (could not tolerate MET). Of the 13 women without PCOS, 7 were hyperinsulinemic and received MET-diet and 6 received diet alone. The 3 treatment groups (diet only [n = 9], PCOS-MET-diet [n = 20], and hyperinsulinemia-MET-diet [n = 7]) did not differ by median entry BMI (33.3, 37.6, and 35.7 kg/m2) or by duration of treatment (10.2, 11.4, and 10.9 months). Median percent weight loss was greatest in the PCOS-MET group (7.7%, P = 0.0015), was 3.3% in the diet only group, and 2.4% (P = 0.04) in the hyperinsulinemia-MET group. Papilledema significantly improved in the diet-alone group from 100% at baseline to 13% (P = 0.03), and in the PCOS-MET group from 95% to 30% (P = 0.002). If headache persisted on therapy, it was less intense–less frequent (P = 0.03) in the diet-only group and in the PCOS-MET group (P = 0.04). As many women with IIH have PCOS, and because weight loss is central to IIH treatment, diet-MET is a novel approach to treat IIH in women with concurrent PCOS or hyperinsulinemia without PCOS.

Section snippets

Patients

The Jewish Hospital Institutional Review Board approved this consecutive case study. Written informed consent was obtained from all women, and the study was carried out in accordance with the ethical standards for human experimentation established by the Declaration of Helsinki of 1975, revised in 1983.

Of 103 women in the previous studies on IIH,16, 17 36 met this study’s enrollment criteria,which included (1) a minimum of 6 months of follow-up on MET-diet combination or diet alone; (2)

Characteristics of patients and treatment groups

Overall, 34 women were Caucasian and 2 were African-American. Mean ± SD and median age was 35 ± 9 and 34 years, range 16 to 54 years. Mean ± SD and median BMI were 37.1 ± 6.1, and 37.0. As is common in IIH,2, 3, 13, 16, 17, 22 the cohort was predominantly obese27 and extremely obese.27 Overall, 20 women (56%) had a BMI ≥ 30 and < 40 (obese),27 13 (36%) had a BMI ≥ 40 (extremely obese),27 and 3 (8%) were overweight27 with a BMI ≥ 25 and < 30. The lowest BMI was 27.6, and the fifth and tenth

Discussion

As revealed in the current study, despite conventional7 therapy (acetazolamide, Topamax, furosemide), the signs and symptoms of IIH may persist over a mean follow-up of 10 to 11 months. This finding is congruent with previous studies of response of IIH to medical and surgical treatment.2, 3, 5, 7, 21, 24

As the cause(s) of IIH can be multifactorial 3, 9, 10, 11, 13, 16, 17, 18, 19, 20, 21, 28, 29, 55, 56, 57, 58, 59, 60, 61 or largely unknown,18 inadequate information exists regarding which

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    Supported in part by a Jewish Hospital Medical Research Council Grant and by the Lipoprotein Research Fund of the Jewish Hospital, Cincinnati, Ohio.

    This study followed a protocol approved by the Jewish Hospital Institutional Review Board, with signed informed consent.

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