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Lookup NU author(s): Menaka Paranathala, Patrick Mitchell, Dr Izzy Williams, Ian Coulter
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© 2024 Lippincott Williams and Wilkins. All rights reserved.Purpose of Review Idiopathic intracranial hypertension (IIH) is a chronic headache disorder with increasing prevalence. Although characterized by raised intracranial pressure causing papilledema with a risk of visual impairment, psychological symptoms such as depression, anxiety, and cognitive impairment are frequently seen but are understudied and under-reported. Together, these can negatively affect quality of life. These were explored through a systematic PRISMA scoping review. OVID, EMBASE, Cochrane, and PubMed databases were searched in April 2023, limited to those in English and published during January 2000–March 2023. PROSPERO ID CRD42023399410. Recent Findings From 454 identified studies, 24 relevant articles were identified from a range of countries including the United Kingdom, the United States, Israel, Egypt, Canada, Germany, and Brazil. Data on study design, participants, tests performed, and outcomes were collated. There is a considerable burden of psychiatric, affective, and cognitive conditions, as well as impaired quality of life, in adult patients with IIH. Notably, these were independently correlated with the presence of headache in a number of studies and with obesity in others. Summary Aside from optimizing symptom control, including reducing the severity of headaches and protecting visual function, clinicians should be mindful of the biopsychosocial difficulties and potential cognitive impairments patients with IIH face. Assistance may be required with managing concurrent depression and anxiety, as well as optimizing cognitive function. Incorporating neuropsychological assessment and individualized management strategies may be beneficial at the point of diagnosis and throughout the illness. Introduction Once termed “benign” intracranial hypertension, this term has fallen out of use in acknowledgment of the significant challenges patients diagnosed with idiopathic intracranial hypertension (IIH) often face. IIH is a chronic headache disorder characterized by raised intracranial pressure (ICP) in the absence of an identifiable cause and is associated with raised body mass index (BMI), especially acute weight gain and female sex.1 Treatment is predominantly medical, and in certain cases, surgical intervention may be considered, particularly if visual function is threatened.2 Treatment-refractory headaches, visual impairment, and the tribulations of surgical intervention can inevitably affect psychosocial functioning. The economic burden upon both the individual and society is substantial.2 As with many other chronic neurologic disorders, the quality of life (QoL) experienced by patients with IIH is reduced and is, therefore, increasingly becoming the focus of research.3 A potential link between psychological symptoms and IIH has been recognized since the early 2000s.4 Some hypotheses posit that IIH is a neurometabolic disorder5 with emerging evidence implicating the neuroendocrine axis dysfunction seen in IIH6 in the pathogenesis of mood symptoms. The morbidity associated with IIH and its potential coexistence with psychiatric and cognitive symptoms remain understudied and is of significance given the rising incidence and prevalence of IIH.2 Moreover, there are reports of increased rates of death by suicide in IIH when compared with the general population.7 The literature within these areas is often limited to one of these factors in isolation and unconnected to the other factors that may influence outcome in patients with IIH.8 We undertook a scoping review of psychological and cognitive comorbidity within IIH, along with studies examining QoL because these factors are interlinked and there are no studies that compare and contrast these. A scoping review methodology was undertaken because it provides a comprehensive overview of existing literature in an emerging field of literature.9 This approach enables exploration of and insight into the biopsychosocial factors within IIH and highlights areas for further investigation.
Author(s): Paranathala MP, Yoganathan KT, Mitchell P, Williams IA, Gourley L, Coulter IC
Publication type: Review
Publication status: Published
Journal: Neurology: Clinical Practice
Year: 2024
Volume: 14
Issue: 6
Online publication date: 16/08/2024
Acceptance date: 28/04/2024
ISSN (print): 2163-0402
ISSN (electronic): 2163-0933
Publisher: Lippincott Williams and Wilkins
URL: https://doi.org/10.1212/CPJ.0000000000200348
DOI: 10.1212/CPJ.0000000000200348
