Intracranial Hypertension Recurrence Risk after Wean of Intracranial Pressure-lowering Medication

Abstract Background The proportion of children with recurrent signs and symptoms of intracranial hypertension after medication wean has been reported to be between 18-50%. Few studies have reported intracranial hypertension recurrence risk in children while adjusting for each individual's observed follow-up time after medication wean. Additionally, the role of intracranial hypertension etiology on the risk of disease recurrence has not been widely studied. Methods The medical charts of intracranial hypertension patients treated with intracranial pressure-lowering medication were analyzed retrospectively for disease recurrence. Baseline characteristics from diagnosis were recorded in addition to information regarding duration of therapy, medication wean, and recurrence. Survival analyses as well as Poisson regression models with time under observation as an offset were performed. Results One hundred and thirty-three patients were included in the study. The cumulative risk of intracranial hypertension recurrence increased rapidly within the first 6 months after medication wean and was 1.5% at 1 month, 9.5% at 3 months, and 20% at 6 months. This risk leveled off near 12-18 months. The presence of optic nerve edema and weaning medication due to intolerance were found to be risk factors for recurrence. The presence of headache at diagnosis was protective. Conclusions While the cumulative risk of intracranial hypertension recurrence increases most dramatically within the first 6 months after medication wean, it does not appear to taper off until 12-18 months. Given the possibility of delayed or asymptomatic recurrences, long-term follow-up is ideal, though patients can likely be seen less frequently after the first 12-18 months after medication wean.