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Octreotide: The IIH therapy beyond weight loss, carbonic anhydrase inhibitors, lumbar punctures and surgical/interventional treatments.
Clin Neurol Neurosurg. 2016 Nov; 150:181-184.CN

Abstract

OBJECTIVE

Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without a space-occupying cerebral lesion, venous sinus thrombosis or hydrocephalus and with normally composited cerebrospinal fluid (CSF). Main symptoms are headache, sight disturbances and potential visual impairment. Weight loss, carbonic anhydrase inhibitors, lumbar punctures with CSF drain, CSF shunting, optic nerve sheath fenestration, and venous sinus stenting are common IIH therapies. Octreotide, a synthetic somatostatin analogue, also effectively suspends IIH symptoms. Here, treatment with octreotide on five so far inefficiently treated IIH patients is presented and discussed.

METHODS

Five female patients with IIH and a history of failed therapy regimes were treated with octreotide, to be administered everyday subcutaneously for six months with identified doses high enough to suspend all clinical IIH symptoms. After tapering for two months, the further clinical course was to be monitored.

RESULTS

All patients were IIH symptom-free under octreotide. After tapering, one patient remained IIH symptom-free; one patient became IIH symptom-free under intramuscular octreotide after failure of former therapy regimes; one patient became IIH symptom-free on low-dose carbonic anhydrase inhibitors; one patient had an allergic reaction and paused octreotide, after successful desensitization, tooth ache developed, forcing octreotide tapering; one patient had another shunt revision alleviating IIH symptoms.

CONCLUSION

We confirmed that a) clinical IIH symptoms are suspended during octreotide exposure; b) 6-month administration can sustainably abolish IIH symptoms; c) desensitization is possible for octreotide allergy. When IIH symptoms reoccur after limited-time octreotide administration, re-application of formerly ineffective carbonic anhydrase inhibitors can suspend IIH symptoms. Intramuscular octreotide is a promising long-term therapy option.

Authors+Show Affiliations

Department of Neurology and Epileptology, Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Elisabeth-Flügge-Straβe 1, 22337 Hamburg, Germany. Electronic address: p.house@eka.alsterdorf.de.Department of Neurology and Epileptology, Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Elisabeth-Flügge-Straβe 1, 22337 Hamburg, Germany. Electronic address: s.stodieck@eka.alsterdorf.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27690252

Citation

House, Patrick M., and Stefan R G. Stodieck. "Octreotide: the IIH Therapy Beyond Weight Loss, Carbonic Anhydrase Inhibitors, Lumbar Punctures and Surgical/interventional Treatments." Clinical Neurology and Neurosurgery, vol. 150, 2016, pp. 181-184.
House PM, Stodieck SR. Octreotide: The IIH therapy beyond weight loss, carbonic anhydrase inhibitors, lumbar punctures and surgical/interventional treatments. Clin Neurol Neurosurg. 2016;150:181-184.
House, P. M., & Stodieck, S. R. (2016). Octreotide: The IIH therapy beyond weight loss, carbonic anhydrase inhibitors, lumbar punctures and surgical/interventional treatments. Clinical Neurology and Neurosurgery, 150, 181-184. https://doi.org/10.1016/j.clineuro.2016.09.016
House PM, Stodieck SR. Octreotide: the IIH Therapy Beyond Weight Loss, Carbonic Anhydrase Inhibitors, Lumbar Punctures and Surgical/interventional Treatments. Clin Neurol Neurosurg. 2016;150:181-184. PubMed PMID: 27690252.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Octreotide: The IIH therapy beyond weight loss, carbonic anhydrase inhibitors, lumbar punctures and surgical/interventional treatments. AU - House,Patrick M, AU - Stodieck,Stefan R G, Y1 - 2016/09/28/ PY - 2016/07/11/received PY - 2016/09/16/revised PY - 2016/09/23/accepted PY - 2016/10/1/pubmed PY - 2017/3/16/medline PY - 2016/10/1/entrez KW - IIH KW - Idiopathic intracranial hypertension KW - Octreotide KW - Pseudotumor cerebri SP - 181 EP - 184 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 150 N2 - OBJECTIVE: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without a space-occupying cerebral lesion, venous sinus thrombosis or hydrocephalus and with normally composited cerebrospinal fluid (CSF). Main symptoms are headache, sight disturbances and potential visual impairment. Weight loss, carbonic anhydrase inhibitors, lumbar punctures with CSF drain, CSF shunting, optic nerve sheath fenestration, and venous sinus stenting are common IIH therapies. Octreotide, a synthetic somatostatin analogue, also effectively suspends IIH symptoms. Here, treatment with octreotide on five so far inefficiently treated IIH patients is presented and discussed. METHODS: Five female patients with IIH and a history of failed therapy regimes were treated with octreotide, to be administered everyday subcutaneously for six months with identified doses high enough to suspend all clinical IIH symptoms. After tapering for two months, the further clinical course was to be monitored. RESULTS: All patients were IIH symptom-free under octreotide. After tapering, one patient remained IIH symptom-free; one patient became IIH symptom-free under intramuscular octreotide after failure of former therapy regimes; one patient became IIH symptom-free on low-dose carbonic anhydrase inhibitors; one patient had an allergic reaction and paused octreotide, after successful desensitization, tooth ache developed, forcing octreotide tapering; one patient had another shunt revision alleviating IIH symptoms. CONCLUSION: We confirmed that a) clinical IIH symptoms are suspended during octreotide exposure; b) 6-month administration can sustainably abolish IIH symptoms; c) desensitization is possible for octreotide allergy. When IIH symptoms reoccur after limited-time octreotide administration, re-application of formerly ineffective carbonic anhydrase inhibitors can suspend IIH symptoms. Intramuscular octreotide is a promising long-term therapy option. SN - 1872-6968 UR - https://www.unboundmedicine.com/medline/citation/27690252/Octreotide:_The_IIH_therapy_beyond_weight_loss_carbonic_anhydrase_inhibitors_lumbar_punctures_and_surgical/interventional_treatments_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0303-8467(16)30347-X DB - PRIME DP - Unbound Medicine ER -