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Bariatric Surgery Superior to Community Weight Management Intervention in Reducing Intracranial Pressure

Bariatric surgery was more effective than a community weight management program for lowering intracranial pressure in women with idiopathic intracranial hypertension, and the effect of the treatment was sustained for two years, according to a randomized clinical trial published online on April 26 in JAMA Neurology.

The incidence of idiopathic intracranial hypertension is rising and has been linked with rising obesity rates globally, noted the researchers.

Women who underwent bariatric surgery had significantly lower intracranial pressure compared with those who had participated in a  community weight management intervention (Weight Watchers). The one-year adjusted mean difference was −6.0 cm cerebrospinal fluid (CSF) (p=0.001)  and a −8.2 cm CSF for a two-year adjusted mean difference (p<0.001), noted Susan P. Mollan, MBcHB, of the Queen Elizabeth Hospital in Birmingham, United Kingdom, and colleagues.

Prior research has found that  community weight management interventions were linked with modest weight loss. Other findings have shown that bariatric surgery has been linked with positive metabolic and cardiovascular outcomes as well as sustained weight loss, the researchers noted.

“These results can be used to develop recommendations for health care strategies and to inform health policy decisions regarding bariatric surgery for individuals with active idiopathic intracranial hypertension," wrote Dr. Mollan's group.

Dr. Mollan and colleagues assessed 66 females across five National Health Service medical facilities in the United Kingdom. Mean age was 32 years. Thirty-three patients participated in the weight management group and 33 in the bariatric surgery arm.

The women had a body mass index (BMS+I) of 35 or greater or active idiopathic intracranial hypertension.

Women who underwent bariatric surgery had significantly lower weight than those who did the weight management program at both one year (p<0.001) and two years (p<0.001).

In the bariatric surgery group, quality of life was significantly better at one year (adjusted mean difference 7.3; p=0.04) and two years (adjusted mean difference 10.4; p=0.006).

Notably, all measures of improvement in BMI, weight and decrease in excess body were greater in the surgery cohort than the weight management group.

Some limitations of the study include that applying the findings to a larger group of participants with idiopathic intracranial hypertension is limited given study's inclusion criteria and that the trial was unable to assess patient-centered outcomes given the small cohort needed to power the investigation for its primary endpoint, the researchers noted.

Another limitation of the trial was that the kind of bariatric operation was not predetermined for the surgical group as a result, the limited number of participants in the trial hindered the researchers ability to recommend one surgical procedure over another, they added.

“Future clinical trials should investigate which type of bariatric surgical procedure is superior for patients with idiopathic intracranial hypertension," the researchers concluded.

Disclosures

Dr. Mollan disclosed receiving personal compensation from Santhera Pharmaceuticals, Novartis, Heidelberg Engineering, Roche, Santen Pharmaceutical, Allergan, Chiesi Farmaceutici, and Neurodiem.

Link Up for More Information

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; Epub 2021 Apr 26.