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Topiramate Versus Acetazolamide for Idiopathic Intracranial Hypertension. A Real-World Data-Based Multicenter
Mahmoud Mohamed Morsy1, Ahmed Yasser Azzam1,2, Muhammed Amir Essibayi2
1Department of Medicine, October 6 University Hospital, October 6 University, Giza, EGYPT.
Summary
Topiramate is more effective than acetazolamide for Idiopathic Intracranial Hypertension (IIH). It improved vision and reduced the need for surgery in IIH patients.
Area of Science:
- Neurology
- Ophthalmology
- Pharmacology
Background:
- Idiopathic Intracranial Hypertension (IIH) affects young, obese women, causing elevated intracranial pressure.
- Acetazolamide is standard but has limiting side effects.
- Topiramate, an anticonvulsant, shows promise due to its carbonic anhydrase inhibition and weight loss effects.
Purpose of the Study:
- Compare topiramate and acetazolamide efficacy and safety in managing IIH.
- Evaluate treatment outcomes over 24 months.
Main Methods:
- International, multicenter retrospective study of IIH patients (2009-2024).
- Propensity score matching for 16,654 patients (8,327 per group).
- Primary endpoints: papilledema resolution, headache control, visual outcomes, refractory IIH, and surgical interventions.
Main Results:
- Topiramate significantly reduced persistent papilledema (16.8% vs. 28.8%, p<0.0001).
- Topiramate improved headache control (61.2% vs. 71.3%, p<0.0001).
- Fewer patients on topiramate required surgery or developed refractory IIH (p<0.0001).
Conclusions:
- Topiramate shows superior efficacy over acetazolamide for IIH.
- Topiramate may be a more effective first-line therapy for IIH.
- Further randomized trials are needed to confirm findings and optimize treatment.
