Different Characteristics of Pre-Pubertal and Post-Pubertal Idiopathic Intracranial Hypertension: A Narrative Review
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Hannah S Lyons1,2,3, Sophie L P Mollan4, Grant T Liu5
1Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Insights
Idiopathic intracranial hypertension (IIH) presents differently in pre- and post-pubertal children. Post-pubertal children with IIH share similar traits with adults, highlighting the need for inclusive clinical trials.
Area of Science:
- Neurology
- Pediatrics
- Ophthalmology
Background:
- Idiopathic intracranial hypertension (IIH) affects both pediatric and adult populations.
- Currently, no clinical trials specifically target pediatric or adolescent IIH patients.
- Understanding IIH differences between pre- and post-pubertal children is crucial for effective management and research.
Purpose of the Study:
- To characterize the distinct clinical presentations of pre-pubertal versus post-pubertal IIH.
- To emphasize the necessity of inclusive clinical trial designs for pediatric and adolescent IIH patients.
- To identify limitations in current IIH research, particularly regarding pediatric populations.
Main Methods:
- A comprehensive narrative review of the scientific literature was conducted.
- Searches were performed on the PubMed database from inception until May 30, 2022.
- Inclusion criteria focused on English language papers, with abstracts and full texts independently assessed.
Main Results:
- Pre-pubertal IIH exhibits a more variable clinical presentation.
- Post-pubertal pediatric IIH cases resemble adult presentations, often dominated by headaches, with a higher prevalence in females and increased BMI.
- Significant heterogeneity in inclusion criteria and definitions of puberty across pediatric IIH studies complicates comparisons.
Conclusions:
- Adolescents with IIH share a similar phenotype to adults and should be considered for inclusion in clinical trials.
- Inconsistent definitions of puberty and the inclusion of secondary causes of intracranial hypertension in pediatric studies hinder accurate analysis.
- Future research and clinical trial planning must address these inconsistencies to improve understanding and treatment of IIH across all age groups.
Abstract:
Idiopathic intracranial hypertension (IIH) affects both children and adults. There are currently no clinical trials in IIH for those who are adolescents or children. The aims of this narrative review were to characterise the differences between pre- and post-pubertal IIH and to highlight the need to be more inclusive in clinical trial planning and recruitment. A detailed search of the scientific literature was performed using the PubMed database, from inception until 30 May 2022 using keywords. This included English language papers only. The abstracts and full texts were reviewed by two independent assessors. The literature revealed that the pre-pubertal group had a more variable presentation. The presenting features in the post-pubertal paediatric group were more akin to adults with headache as the dominant feature. They were also more likely to be female and have an increased body mass index. A clear limitation of the literature was that a number of paediatric studies had variable inclusion criteria, including secondary causes of raised intracranial pressure. Pre-pubertal children do not display the same predilection towards the female sex and obesity as post-pubertal children, who have a similar phenotype to the adult cohort. Inclusion of adolescents in clinical trials should be considered given the similar phenotype to adults. There is a lack of consistency in the definition of puberty, making the IIH literature difficult to compare. Inclusion of secondary causes of raised intracranial pressure has the potential to confound the accuracy of analysis and interpretation of the results.
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