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Symposium Idiopathic Intracranial Hypertension (Pseudotumor cerebri)

07.10.2017, Düsseldorf

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IIH therapy with octreotide

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  • Patrick Michael House - Hamburg

Symposium Idiopathic Intracranial Hypertension (Pseudotumor cerebri). Düsseldorf, 07.-07.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc17siih08

doi: 10.3205/17siih08, urn:nbn:de:0183-17siih082

This is the English version of the article.
The German version can be found at: http://www.egms.de/de/meetings/siih2017/17siih08.shtml

Published: November 30, 2017

© 2017 House.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Common IIH therapies are weight loss, carbonic anhydrase inhibitors like acetazolamide [1] and topiramate, lumbar punctures with CSF drain, and surgical and interventional treatments [2], [3] such as CSF shunting, venous sinus stenting, or optic nerve sheath fenestration. Octreotide represents an effective IIH therapy as well. It is, however, not approved in Germany.

Octreotide is a long-acting synthetic somatostatin analogue. The exact mechanism of action is still not known. As IIH symptoms were observed under treatment with recombinant GH or IGF-1 [4], the reversed idea of an IIH therapy with somatostatin or the longer-acting synthetic analogue octreotide emerged.

There are only 3 open studies (Panagopoulos et al., 2007 [5], [6], House et al., 2016 [7], Antaraki et al., 1993 [8]), which show a positive effect also on elevated CSF opening pressures, papilledema and sight disturbances, beyond the known analgetic effect [9] of octreotide.

Gastrointestinal side effects like moderate nausea and diarrhea diminish in most of the cases during treatment. Controls of laboratory (blood count, sodium, potassium, calcium, creatinine, GOT, GPT, Gamma-GT, alkaline phosphatase, TSH, glucose, HbA1c, and vitamin B12), electrocardiograms, and abdominal sonographies should be regularly performed.

On the basis of the acquired experience in treating IIH with octreotide in Hamburg (House et al., 2016 [7]), the following pragmatic IIH therapy management (no evidence) could be helpful: whenever weight loss (when applicable) and carbonic anhydrase inhibitors fail, a 6-month octreotide therapy followed by 2-months’ careful tapering could be considered. If clinical IIH symptoms reoccur after tapering, carbonic anhydrase inhibitors could be retried. If this fails, a long-term intramuscular octreotide therapy might be an option. Because of frequent complications and poor long-term efficacy [10], CSF shunting should be considered

the ultima ratio.

Outline

References

1.
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