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Paediatric IIH: Are There Differences in Visual Outcomes and Recurrence Rates?
Jenna Rock1, Jacqueline K Shaia2,3, Jeffrey Chu1
1School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Insights
Paediatric idiopathic intracranial hypertension (IIH) in children shows distinct prepubertal and post-pubertal features. However, visual outcomes and papilledema recurrence rates are similar across these groups.
Area of Science:
- Pediatric Neurology
- Ophthalmology
Background:
- Idiopathic intracranial hypertension (IIH) is rare in children, with distinct prepubertal and post-pubertal presentations.
- Significant knowledge gaps exist regarding treatment, visual outcomes, and recurrence rates between these pediatric IIH populations.
Purpose of the Study:
- To compare prepubertal and post-pubertal pediatric IIH.
- To analyze demographic differences, treatment variations, visual outcomes, and papilledema recurrence risk.
Main Methods:
- Retrospective chart review of pediatric patients (0-18 years) diagnosed with IIH or papilledema between June 2012 and September 2023.
- Patients stratified by pubertal status (prepubertal vs. post-pubertal) and met revised Dandy criteria; secondary causes excluded.
- Data collected on demographics, treatment, and visual outcomes at baseline and 1-year follow-up; recurrence incidence analyzed.
Main Results:
- Of 128 pediatric IIH patients, 62% were post-pubertal and 38% prepubertal.
- Post-pubertal patients had higher rates of overweight/obesity and were more frequently female (p < .05).
- Poor visual outcomes (4.7%) and papilledema recurrence (24%) did not significantly differ between pubertal groups (p > .05).
Conclusions:
- While demographic and presenting features of pediatric IIH differ between prepubertal and post-pubertal children, visual outcomes and recurrence rates are comparable.
- Further research may explore underlying mechanisms for these observed demographic differences.
Abstract:
Paediatric IIH is a rare condition in children where prepubertal and post-pubertal disease appear distinct. There are major gaps in the literature regarding if these populations have different treatments, visual outcomes, or recurrence rates. The purpose of this study was to characterize the differences in prepubertal/post-pubertal disease while analysing the risk of papilloedema recurrence. Records at a single tertiary institution were screened between 1 June 2012 and September, 2023 for having an ICD code of IIH or papilloedema. All patients were between the ages of 0-18 and stratified by pubertal status. Patients met the revised Dandy diagnostic criteria and secondary causes of IIH were excluded. Demographics, treatment, and visual outcomes data was collected at baseline and 1 year after diagnosis. The incidence of papilloedema resolution and recurrence were collected. All data analysis was performed in R Studio and Excel with a p value of < .05 being significant. Of the 719 IIH patients, 128 (17%) were paediatric with 79 (62%) post-pubertal and 49 (38%) prepubertal at diagnosis. A higher percentage of post-pubertal patients were overweight/obese (77.2%) and female (77%) compared to prepubertal patients (p < .05). Overall, 6 (4.7%) patients had a poor visual outcome; however, this did not differ regarding pubertal status (p > .05). Papilloedema recurrence occurred in 24% of the population. There was no difference in recurrence rates between prepubertal and post-pubertal patients (p > .05). Although post-pubertal and prepubertal disease may differ in demographics and presenting features, there was no significant difference in visual outcomes and recurrence rates.
