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Comment & Response |

Treating Idiopathic Intracranial Hypertension—Reply

Michael Wall, MD1; Michael P. McDermott, PhD2; Karl D. Kieburtz, MD, MPH3; Mark J. Kupersmith, MD4
[+] Author Affiliations
1Department of Neurology, University of Iowa, Iowa City
2School of Medicine and Dentistry, University of Rochester, Rochester, New York
3Department of Neurology, University of Rochester Medical Center, Rochester, New York
4Division of Neuro-Ophthalmology, Roosevelt Hospital, New York, New York
JAMA Neurol. 2014;71(10):1327-1328. doi:10.1001/jamaneurol.2014.2363.
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In Reply We thank Mollan and colleagues for their interest in our treatment trial.1 We were aware of the pilot study by Ball and colleagues.2 We stated that treatment of idiopathic intracranial hypertension is based on anecdotal and uncontrolled data because there were no properly designed and executed clinical trials to guide therapy prior to ours. We did not cite the Ball et al2 pilot work because its results were inconclusive with respect to efficacy owing to the small sample size and consequent low power. Indeed, Ball et al stated in the article that “[t]his pilot study was not powered to detect a treatment effect.”2 Also, 12 of 25 patients in the acetazolamide group stopped taking the medication during the study, a discontinuation rate of nearly 50%. Dosing schedules for acetazolamide were at the discretion of the supervising clinician and did not reach more than 1500 mg per day. Twenty percent of the participants in the control group were eventually given acetazolamide. No conclusions could be drawn from their trial because of these study design issues.

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October 1, 2014
Susan P. Mollan, MB, cHB, FRCOphth; Michael A. Burdon, MB, cHB, MRCP, FRCOphth; Alex J. Sinclair, MB, cHB, MRCP, PhD
1Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, The Medical School, University of Birmingham, Birmingham, England2Birmingham Neuro-Ophthalmology Unit, Ophthalmology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England
2Birmingham Neuro-Ophthalmology Unit, Ophthalmology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England
1Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, The Medical School, University of Birmingham, Birmingham, England3Neurology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England
JAMA Neurol. 2014;71(10):1326-1327. doi:10.1001/jamaneurol.2014.2360.
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