Idiopathic intracranial hypertension

Yeah.

So I'm here today because September is, um, the awareness month for a condition called IIH, which is idiopathic intracranial hypertension, and what that means is, idiopathic means unknown cause, intracranial is inside the head or skull, and hypertension is high pressure.

So it's a condition where the cerebral spinal fluid either doesn't drain properly from your brain or over-produces in the brain, and it's not very well understood in the medical community or the wider community.

So the point of September being the awareness month for it is to let more people know that this condition exists and also to let more people know about what people with this condition can experience, because I have it myself.

Uh, some people get spinal fluid leaks where they'll b- have a clear liquid running from their nose.

Um- But that's less common.

And when I s- talk about common, so IIH is considered a rare disorder, and in New Zealand, rare disorders are considered anything that's, uh, less common than one per 2,000 people.

And IIH, the diagnosis rate is somewhere between one and 13 per 100,000 people.

So the optic nerve comes up one more time here, but this time it's good news.

So there's a condition called idiopathic intracranial hypertension, or IIH, where the pressure of the fluid around your brain runs too high.

It mostly affects younger women with obesity, and it causes very severe headaches and can damage vision by squeezing the optic nerve.

In a small trial, 15 women with IIH had pressure monitors implanted and on exenatide, the pressure came down close to 20% within two and a half hours of a dose, which is far too fast for it to be a weight loss effect.

A larger database study found that IIH patients on GLP-1s needed fewer than half as many procedures as similar patients on standard treatment.

So if you have IIH, that's worth raising with your neurologist or your eye doctor.

With seizures, there's no sign that these drugs provoke them.

Two database studies this year in patients with diabetes actually showed fewer new seizures on GLP-1s, but that doesn't make GLP-1 an epilepsy treatment, to say the least.

It's a pleasure to be here.

Today's publication is titled The Effect of GLP-1 Receptor Axenatide on Idiopathic Intracranial Hypertension, a Randomized Clinical Trial by James Mitchell and Colleagues.

Dr. Mesner, can you share the different mechanism of action of a GLP-1 medication and how they're suspected to be helpful in patients with IIH?

Sure.

I think that really gets to the fundamental issue of the significance of this paper and perhaps where future therapeutic modalities go for the treatment of idiopathic intracranial hypertension.

The choroid plexus is replete with receptors for GLP-1.

And it's been shown in animal model studies that GLP-1 agonists significantly reduce intracranial pressure, specifically as it relates to the down regulation of CSF production.

They were able to measure intracranial pressure very, very accurately at periods of two and a half hours 24 hours, and then at three months.