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Interventions for idiopathic intracranial hypertension

  • Review
  • Intervention

Authors


Abstract

Background

Idiopathic intracranial hypertension occurs throughout the world with an estimated incidence of one to three per 100,000 population per year. It occurs most commonly in obese young women but the cause is unknown. It presents a significant threat to sight and is associated with severe morbidity, in the form of headaches in most cases. Several different treatments have been proposed ranging from relatively conservative measures such as diuretic therapy to more invasive treatments such as optic nerve sheath fenestration, stenting of cerebral venous sinuses, or lumbo-peritoneal shunting.

Objectives

The objective of this review was to assess the effects of various forms of treatment for idiopathic intracranial hypertension with a view to producing an evidence-based treatment strategy.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 4, 2008), MEDLINE (January 1950 to December 2008) and EMBASE (January 1980 to December 2008). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 10 December 2008.

Selection criteria

We included only randomised controlled trials in which any intervention used to treat idiopathic intracranial hypertension had been compared to placebo or to another form of treatment in people with a clinical diagnosis of idiopathic intracranial hypertension.

Data collection and analysis

Both authors independently assessed the search results for trials to be included in the review. Discrepancies were resolved by discussion. Since no trials met our inclusion criteria, no assessment of quality or meta-analysis was undertaken.

Main results

No randomised controlled trials were found that met the inclusion criteria.

Authors' conclusions

There is insufficient information to generate an evidence-based management strategy for idiopathic intracranial hypertension. There is inadequate information regarding which treatments are truly beneficial and which are potentially harmful. Properly designed and executed trials are needed.

摘要

背景

原發性顱內高壓的處置

原發性顱內高壓在全世界的發生率約每年一萬人有一到三人.最常發生在肥胖的年輕女性,但原因不明.它造成視力明顯傷害並且並有嚴重的病態, 在大部分的病人以頭痛表現. 數個不同的治療已被提出,從相對保守的處置如利尿劑到較有侵襲性的治療如視神經鞘穿孔術(optic nerve sheath fenestration), 大腦靜脈竇(cerebral venous sinuses)的支架,或腰椎腹腔引流手術(lumboperitoneal shunting).

目標

此回顧的目的是評估對原發性顱內高壓不同治療方式的效果來型成一個有證據基礎的治療策略.

搜尋策略

我們搜尋於Cochrane Library 的Cochrane Central Register of Controlled Trials (CENTRAL), 其中包含the Cochrane Eyes and Vision Group Trials Register(Issue 1, 2007), MEDLINE (1966 年至2007年一月) 和 EMBASE (1980年至2007年一月)及被選定的實驗報告的參考文獻.

選擇標準

我們包含只有任一處置用來治療原發性顱內高壓與安慰組或另一個型式來治療臨床診斷是原發性顱內高壓的病人.

資料收集與分析

兩位作者獨立評估那些被含括於此回顧的研究結果.不一致處以討論方式解決. 並沒有研究符合我們的含括標準,也沒有研究進行品質評估或綜合分析..

主要結論

沒有符合條件的隨機對照試驗.

作者結論

沒有足夠的的證據可以產生對原發性顱內高壓有證據基礎的的處置策略.並沒有足夠的訊息關於何種治療是真正有效及何種是可能有害的.需有適當的設計和施行的實驗.

翻譯人

本摘要由高雄榮民總醫院王曉萍翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠的證據關於治療原發性顱內高壓有效治療.原發性顱內高壓是沒有任何明顯原因造成腦內壓力增加的情況.這通常造成視神經盤(視神經與眼睛相遇處)的腫脹.至腫脹會造成可能的視力受損. 此現象最常發生於年輕肥胖的女性.有些治療已被提出. 此文獻並不能發現足夠的證據來指出最有效的治療方式.需要更多的研究.

Plain language summary

Interventions for idiopathic intracranial hypertension

Idiopathic intracranial hypertension is a condition in which there is increased pressure inside the head without any obvious cause. This generally results in swelling of the optic disc (the point where the optic nerve meets the eye). The swelling in turn causes a potential threat to sight. The condition occurs most commonly in young women who are obese. A number of treatments have been advocated. This review could not find enough evidence to indicate the best form of treatment. More research is needed.

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