Pseudotumor cerebri medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Medical Therapy
Medical treatment
Pharmacologic medical therapies for pseudotumor cerebri include:
1.Carbonic anhydrase inhibitors
Carbonic anhydrase inhibitors like acetazolamide reduce cerebrospinal fluid production and reduce the CSF pressure, papilledema and visual field loss.(3_16 uptodate darman). The starting dose is 500 mg twice a day for adults which we can increase to 2-4 gr a day. In young children we start with 25mg/kg and increase it to 100 mg/kg or 2 gr a day.(36) Another drug in this group is topiramate which is an antizeizure drug but can inhibit carbonic anhydrase activity too. Case reports suggest that topiramate can reduce symptoms and visual field loss in IIH patients.(45 ta 49)
2.Loop diuretics
In addition to acetazolamide we can use loop diuretics like furosemide with the start dose of 20 to 40 mg per day for adults and 1 to 2 mg/kg per day in children. Studies suggest that treatment with both acetazolamide and furosemide can rapidly reduce CSF pressure and papilledema(36-50)
3.Corticosteroids
In the past, prednisone was suggested for IIH patients but nowadays we avoid using them for long term treatment because of following reasons:
- Weight gain and worsening of symptoms
- Steroid withdrawal which is one of the IIH risk factors
- Systemic side effects(51)
4.Indomethacin
This drug is believed to reduce the CSF pressure by cerebral vasoconstriction and reducing blood flow(53)
5.Iron
Treatment of iron deficiency anemia can improve IIH patients symptoms(55)
6.analgesics
We can use analgesics to control headaches. Overusing of analgesics can cause rebound headaches which should be avoided.(56)
Non medical treatment
Weight loss with low soduim diet is helpful in IIH patients and can reduce CSF pressure, papilledema and disease symptoms.(3-25-28)