Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Commentary
5 (
4
); 387-388

Commentary

Department of Neurology and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
Address for correspondence: Dr. Hagen Kunte, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany. E-mail: hagen.kunte@charite.de

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

The report by Reddy describes the rather peculiar case of a young woman who developed pseudotumor cerebri syndrome in the context of weight gain and self medication.[1] The case highlights the potential dangers of over-the-counter self-medication practices in India. Both the drugs (dexamethasone, cyproheptadine) implicated in this incident of pseudotumor cerebri syndrome would not be available without a doctor's prescription in most of the developed nations. As India and other developing countries grapple with complex issues arising from large socio-economic and regional variations, it seems unlikely that they will simply emulate the Western model of relatively tight and rigorously enforced state regulation of most medicines. Importantly, self medication may take many forms including the sharing of pharmaceuticals with family and friends, using leftover medicines or resubmitting unused, old prescriptions to obtain a drug.[2] Therefore, special emphasis should be placed on educating the public on the benefits of proper diagnostic evaluation and treatment, if applicable, by a medical professional. It would also be helpful if the public could be made more aware of the fact that medicines are usually only approved for a limited number of indications. Furthermore, the health risks of self medication in special populations, such as children, elderly individuals, or women of child-bearing age, should be widely publicized.

There is hardly another disease in women in which the association with obesity or recent weight gain is as strong as in idiopathic intracranial hypertension (IIH). The percentage of overweight and obese individuals among IIH patients is estimated at roughly 90%. Conversely, obesity increases the risk of developing IIH by approximately 20 times. Most affected are women of child-bearing age. Despite the clear linkage between obesity and IIH, the underlying pathogenetic mechanisms remain largely unknown.[34]

The ‘Idiopathic Intracranial Hypertension Treatment Trial’, which is currently underway, seeks to more precisely elucidate the etiology of IIH. The study focuses especially on the contribution of genetic factors and vitamin A metabolism to IIH.[5]

Medications commonly associated with increased appetite and weight gain include the progesterone derivative megestrol acetate, the first-generation antihistamine cyproheptadine, dronabinol (synthetic THC), some antidepressants such as mirtazapine, as well as most atypical antipsychotics.[6] In certain clinical situations these compounds may be useful to facilitate weight gain. However, most of these uses would be “off-label”. In the case reported by Reddy,[1] symptoms of pseudotumor cerebri syndrome developed after withdrawal from the chronic corticosteroids. In principle, steroid withdrawal may precipitate pseudotumor cerebri syndrome.[4] However, the patient described by Reddy[1] only started to display symptoms at around two months after discontinuation of dexamethasone and cyproheptadine. This timing strongly argues against a direct link between the patient's symptoms and discontinuation of dexamethasone.

Since obesity is on the rise around the globe, a further significant increase in the prevalence of IIH is foreseen for the coming years. The clinical course of IIH is inherently variable. In many instances, the visual disturbances associated with IIH do not resolve completely. Persistent visual problems have been found in approximately 25% of the cases. Recurrences and chronic syndromes are not infrequent.[34] Accumulating evidence indicates that IIH patients also suffer from significant olfactory dysfunction. Indeed, the prevalence of absolute hyposmia reached 80% in a sample of acute IIH patients in a recent study.[7] In this context, it is also worth mentioning the morphological studies of olfactory bulb volume (OBV) in IIH. During periods of increased disease activity, OBV is significantly reduced, which nicely fits with the functional deficits demonstrated by olfactometry.[8] Considering that patients suffering from IIH may already have to cope with obesity, chronic headache and frequent visual disturbances, the additional olfactory dysfunction may present a major health disturbance.

References

  1. , . Over the counter self-medication leading to Intracranial Hypertension in a young lady. J Neurosci Rural Pract. 2014;4:384-386.
    [Google Scholar]
  2. , , , , , , . Perceptions and practices of self-medication among medical students in coastal South India. PLoS One. 2013;8:e72247.
    [Google Scholar]
  3. , , , . Update on the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry. 2012;83:488-94.
    [Google Scholar]
  4. , , , . Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159-65.
    [Google Scholar]
  5. , . Idiopathic intracranial hypertension and the idiopathic intracranial hypertension treatment trial. J Neuroophthalmol. 2013;33:1-3.
    [Google Scholar]
  6. , , , . Appetite stimulants in cystic fibrosis: A systematic review. J Hum Nutr Diet. 2007;20:526-37.
    [Google Scholar]
  7. , , , , , , . Olfactory dysfunction in patients with idiopathic intracranial hypertension. Neurology. 2013;81:379-82.
    [Google Scholar]
  8. , , , , , , . Structural olfactory nerve changes in patients suffering from idiopathic intracranial hypertension. PLoS One. 2012;7:e35221.
    [Google Scholar]

    Fulltext Views
    315

    PDF downloads
    175
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections