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Medscape
7 days ago
- Health
- Medscape
‘Clear Advantage' of GLP-1s for IIH vs Conventional Therapy
GLP-1 receptor agonists (RAs) are associated with fewer headaches and visual symptoms, reduced medication use, and less need for procedures — including bariatric surgery — compared with conventional therapies in patients with idiopathic intracranial hypertension (IIH), results of a retrospective multicenter study showed. These outcomes were achieved without a significant change in BMI, which suggests GLP-1 RAs have therapeutic benefits aside from weight loss alone. The results reflect 'clear advantages' of GLP-1 RAs over current IIH management strategies, including surgical interventions and medications like acetazolamide, study investigator Dennis J. Rivet II, MD, professor, Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, told Medscape Medical News . 'These therapies belong in the armamentarium of medications used in IIH, and they should be considered prior to surgery,' he said. The findings were published online on July 14, 2025, in JAMA Neurology . Unknown Mechanism IIH is characterized by elevated intracranial pressure (ICP) without an identifiable cause. Obesity is present in about 90% of IIH cases, with the highest incidence in women with overweight of childbearing age. The exact mechanism linking obesity to IIH is unknown, but weight loss appears to be beneficial. Bariatric surgery, such as a gastric bypass or sleeve gastrectomy, can be an effective means of weight loss, which then may reduce the risk for IIH. Other treatments of IIH include pharmacological agents such as acetazolamide or procedural interventions such as cerebrospinal fluid (CSF) diversion to increase CSF drainage, optic nerve sheath fenestration, and venous sinus stenting (VSS). GLP-1 RAs, which have been around for more than a decade now, are gaining popularity for weight loss as well as type 2 diabetes. However, they're proving beneficial in other 'less obvious' disease states, including heart failure with preserved ejection fraction and liver cirrhosis. Rivet noted there's also growing interest in exploring them for addiction. These agents are also under investigation for IIH, but efficacy data are limited. The retrospective study analyzed deidentified electronic health records (EHRs) from adults with IIH who had not used GLP-1 RAs, using data from 67 healthcare organizations in the TriNetX US Collaborative Network. Researchers established two cohorts: patients who initiated a GLP-1 RA within 6 months of an IIH diagnosis and a control group who started conventional therapies without GLP-1 RAs. After propensity score matching, each group included 555 patients. Baseline characteristics were well balanced (mean age, approximately 43 years; 86% women; 54% White; about two thirds with overweight or obesity), with comparable rates of symptoms, signs, and medication use. Outcomes included the use of medications other than GLP-1 RAs; symptoms and signs such as headache, visual disturbances or blindness, dizziness, papilledema, tinnitus, and optic atrophy; procedures, including spinal puncture, shunt placement, VSS, optic nerve decompression, and bariatric surgery; and mortality. Both groups had a median follow-up of 365 days. Patients in the GLP-1 RA group were significantly less likely to require any medication than those in the control group (29.7% vs 56.4%; P < .001). Notable reductions were observed in the use of tricyclic antidepressants (6.8% vs 12.3%; P = .002), topiramate (11.2% vs 19.6%; P < .001), furosemide (6.8% vs 14.4%; P < .001), and acetazolamide (8.6% vs 24.0%; P < .001). Use of valproate did not differ significantly between the groups (2.7% vs 3.4%; P = .49). The GLP-1 group also had fewer headache symptoms (12.3% vs 27.4%; P < .001), visual disturbances or blindness (7.0% vs 11.7%; P = .007), and papilledema (2.2% vs 11.5%; P < .001). In addition, GLP-1 RA users had fewer procedures overall (6.8% vs 15.7%; P < .001). Bariatric surgery (5.4% vs 10.1%; P = .004) and CSF shunt procedures (≤ 1.8% vs 5.2%; P = .002) were significantly less frequently performed in the GLP-1 RA group. Mortality was significantly lower in the GLP-1 RA group (≤ 2.0% vs 5.0%; P = .003). Statistical comparisons could not be made for tinnitus, optic atrophy, spinal puncture, and VSS because of small sample sizes. 'Pleasantly Surprised' Rivet said he was 'pleasantly surprised' that the benefits of GLP-1 RAs were seen across the board. 'If you told me that it was only beneficial in reducing surgeries or only beneficial in reducing medications, that would still be important and it would be a victory, but it was beneficial for both,' he said. He was particularly encouraged by the reduction in symptoms among GLP-1 RA users. Patients are mostly concerned about feeling better and getting their headaches under control, he said. While it's too early to routinely recommend GLP-1 RAs for IIH without randomized controlled trials, as a surgeon Rivet said he would discuss these agents as a viable alternative to surgery with patients. Interestingly, mean BMI remained similar between treated and control groups, suggesting benefits beyond weight loss, which appears to suggest there are alternative mechanisms for GLP-1 RA therapy. Rivet referenced a pilot study showing a rapid reduction in ICP within 2.5 hours of GLP-1 RA administration, indicating mechanisms other than weight loss. Potential effects may include metabolic actions on the choroid plexus or hypothalamic appetite control. GLP-1 RAs have relatively milder side effects, mainly gastrointestinal effects, than bariatric surgery. Economically, GLP-1 RAs may be less costly upfront than surgery, and prices could decrease as newer medications emerge and older agents go off-label, he noted. Limitations of the study included potential diagnostic coding errors, lack of blinding, no differentiation among GLP-1 RA types or doses, and limited generalizability. Additionally, the study did not address whether patients discontinued GLP-1 RAs due to side effects. Need for Further Validation In an accompanying editorial, Nancy J. Newman, MD, of the Departments of Neurology and Neurological Surgery at Emory University School of Medicine in Atlanta, and colleagues described the findings as 'encouraging' but emphasized that well-designed studies are 'essential' given the limited data on GLP-1 RAs as monotherapy or in combination regimens for IIH. 'It is time for industry to recognize that the IIH patient population is unfortunately rapidly growing and a market worth testing with an appropriately designed clinical trial of GLP-1 RAs for IIH treatment,' they noted. IIH is particularly challenging to study retrospectively using EHR data because it is frequently misdiagnosed — especially in women with obesity and chronic headaches, the editorialist added. The 'extremely low' reported prevalence of papilledema among study participants raises concerns that a significant proportion of included patients may not have had true IIH. However, the editorialists acknowledged that this finding could also reflect the undercoding of papilledema, as well as IIH itself. They expressed similar concerns about the reporting of headaches and visual disturbances, noting that systematic or consistent documentation of such symptoms in EHR data is unlikely. The fact that participants experienced beneficial effects without a change in BMI is remarkable and supports the premise that GLP-1 RAs may offer greater therapeutic benefits beyond weight loss, Newman and colleagues noted. They also addressed cost considerations, noting that other medications used for IIH — as well as surgical procedures, many of which fail and require repetition — are often as expensive, if not more so, than GLP-1 RAs. Moreover, these alternatives generally carry a higher risk for serious complications, they wrote.
The Journal
09-07-2025
- The Journal
Reports of 'self-generated' child sexual abuse material online up 166% last year
THERE WAS A 55% increase in the level of child sexual abuse material (CSAM) reported to Ireland's national centre for combating illegal content online last year. According to the Irish Internet Hotline's annual report , it processed 44,955 reports of CSAM in 2024, up from the 29,197 reports handled the previous year. This included 11,505 reports involving self-generated CSAM, a 166% increase from 4,322 reports in 2023. These are images or videos that children appear to have taken themselves, typically using smartphone cameras or webcams, and often as a result of grooming or coercion. The term 'self-generated' does not apportion blame to the child who has been sexually exploited, and only indicates that an analyst has identified the material as most likely being created by the child. The IIH said self-generated content was the 'dominant form' of CSAM it identified last year, representing 'a fundamental shift requiring targeted prevention and education'. Forums were found to be the primary distribution channel of CSAM, making removal more complex due to their structure and the rapid restoration of content that is removed. Overall, the IIH received 53,441 reports in 2024, a 32% increase on the previous year. Of those reports, 85% were found to relate to illegal material. The IIH said that of the 20,647 CSAM reports where age could be clearly determined, 56% depicted children aged 4 to 12, while 43% depicted children aged 13 to 16. It said that 92% of the victims depicted were girls, 5% were boys and 3% of the material depicted both girls and boys. Advertisement The centre reported a 97% overall removal rate, with 99.6% of assessed CSAM removed at source. There were 519 reports of intimate image abuse in 2024, a decline compared with 2023. The IIH said this may be the result of early positive impact from awareness campaigns. Of the 241 reports involving confirmed sharing of intimate images, 234 cases involved publicly accessible content, while 20 cases involved sharing through encrypted or private communication channels. The IIH secured a 93% removal rate for publicly accessible intimate images. It referred 161 cases to Gardaí at the reporter's request. The centre received 908 reports of racism and xenophobia last year, a 600% increase on the previous year. Of those, 88% involved concerning content found exclusively on Twitter/X that was misidentified as hate speech, but was religious or occult-themed discussion, which the report states is not inherently illegal under Irish law. Some 11% contained potentially harmful content related to hate speech or similar material that violated platform policies, but did not meet the legal threshold for racism or xenophobia under Irish legislation. Just three cases contained content determined to be potentially illegal under Irish Law. These were forwarded to Gardaí. Justice Minister Jim O'Callaghan said many of the findings in the report 'make for worrying and stark reading'. 'It's easy to get overwhelmed by the figures, but crucial to recognise that behind these statistics are real people – and often children – who have suffered harm and have been victimised,' he said. 'Acknowledging that fact underscores the urgency and importance of our work in this space.' He said the government is 'firmly committed to making online safety a priority in our increasingly digital world'. 'While advances in technology have given rise to new and sophisticated methods of committing crimes online, we will not be found wanting in our responses – including our work with – to adapt and enhance how we protect and support vulnerable victims.' Readers like you are keeping these stories free for everyone... A mix of advertising and supporting contributions helps keep paywalls away from valuable information like this article. Over 5,000 readers like you have already stepped up and support us with a monthly payment or a once-off donation. Learn More Support The Journal
Irish Independent
09-07-2025
- Irish Independent
Reports of illegal and harmful online content including child sex abuse up 32pc in past year
The Irish Internet Hotline (IHH) received 53,411 reports last year, with the majority of those relating to illegal material found to include child sexual abuse material (CSAM). Members of the public can report suspected illegal and harmful online content – including CSAM, financial scams and racism – securely and anonymously to the organisation. The IIH works closely with gardaí and as part of a global network of internet hotline providers that handle reports from multiple jurisdictions to tackle CSAM. Chief executive Mick Moran said that while the figures revealed in its annual report may appear 'shocking or overwhelming', the rate of reports is also just 'an indication' of what exists online. Reports of self-generated CSAM surged by 166pc last year. It has been identified as the fastest-growing form of CSAM online, accounting for more than 25pc of all related reports last year. More than 90pc of victims depicted in this material were girls. Misunderstanding this term can lead to victim-blaming, which is deeply harmful The term 'self-generated', where a child appears to have taken the image or video themselves, is used by analysts to classify the origin of the material rather than the circumstances under which it was created. 'Misunderstanding this term can lead to victim-blaming, which is deeply harmful. Children who appear in such material are victims, regardless of how the content was created,' Mr Moran said. Online forums were identified as the dominant distribution channel of the material, with the IHH annual report noting that the removal of content from such platforms is 'more complex and urgent' as a result. Ireland continues to be among the lowest-ranking countries globally for the hosting of child sexual abuse material. The report also notes a 97pc removal rate for illegal content and a 99.6pc removal rate for cases of confirmed CSAM. ADVERTISEMENT The organisation has also identified a number of other online threats that are on the rise, including a 51pc increase in the number of financial scams that target Irish residents. It identified 134 fraudulent websites last year, with 79pc of such websites being removed. However, the rates of racism and xenophobia online 'remain concerning', with 908 reports received last year. In the report, to be launched today, Justice Minister Jim O'Callaghan said there is a need to ensure 'we never become hardened to the reality of these figures'. Mr Moran said the IIH is 'very proud to be part of the solution' to tackling the spread of harmful and illegal content online. 'There is no silver bullet, no panacea – just hard and sometimes gruelling work,' he said. 'I am proud of our small and growing team and the work we do, with partners, to make the internet a safer place for everyone, especially children.'
RTÉ News
08-07-2025
- RTÉ News
Rise in 'self-generated' child sex abuse material online
There was a big increase last year in the levels of "self-generated" child sexual abuse material (CSAM) appearing online, according to the annual report of the Irish Internet Hotline (IIH). These are images or videos that children appeared to have taken themselves. The IIH said the term "self-generated" does not imply consent, intent, blame or awareness of the consequences, and is used by analysts to describe the apparent origin of the material, not the circumstances under which it was created. It added that there was a 166% increase in cases of self-generated child sexual abuse material in 2024. The centre analysed 11,505 cases of self-generated CSAM, up from 4,322 in 2023, making it the fastest-growing form of CSAM and now accounting for 25.6% of all CSAM reports. In these cases, 92% of victims depicted were girls. The centre said that forums are the dominant distribution channel making removal more complex and urgent. The Irish Internet Hotline is Ireland's national reporting centre where members of the public can report suspected illegal and harmful online content in a secure and anonymous way, particularly child sexual abuse material. Overall, in 2024, the IIH received 53,411 reports, representing a 32% year-on-year increase. Of these reports, 85% were found to relate to illegal material, primarily CSAM. The report reveals a 97% overall removal rate, and a 99.6% removal rate for confirmed CSAM. Financial scams targeting Irish residents increased by 51%, leading to 134 fraudulent websites being identified, 79% of which were removed. Intimate image abuse reports saw a decline which the IIH said suggested the early impact of deterrent campaigns. There was a 91% removal rate for confirmed cases of intimate image abuse. The centre said that racism and xenophobia online remain concerning, with 908 reports received in 2024. "The online realities reflect the society we live in, and we must face the troubling parts of that in a systematic and collaborative way," Irish Internet Hotline CEO Mick Moran said. "There is no silver bullet, no panacea, just hard, and sometimes gruelling work," Mr Moran said. In his foreword in the annual report, Minister for Justice Jim O'Callaghan acknowledged the work carried out by the IIH. "It's easy to get overwhelmed by the figures, but crucial to recognise that behind these statistics are real people - and often children - who have suffered harm and have been victimised," Mr O'Callaghan said.
Los Angeles Times
23-06-2025
- Health
- Los Angeles Times
Why Weight Loss is the First Treatment for Idiopathic Intracranial Hypertension
Idiopathic Intracranial Hypertension (IIH) is a puzzling but increasingly common neurological condition that mimics the signs of a brain tumor—without one actually being present. IIH is also known as benign intracranial hypertension and pseudotumor cerebri (called pseudotumor cerebri). It is defined by increased intracranial pressure (ICP) without a known cause, different from others like portal hypertension. Characterized by elevated intracranial pressure (ICP) and symptoms like persistent headaches, visual changes, and pulsatile tinnitus, IIH mostly affects women of childbearing age who are overweight or obese. These groups are at higher risk, and risk factors include obesity and recent weight gain. Vision problems are among the most important clinical features of IIH. While the exact cause remains elusive, the condition is idiopathic, meaning there is no known cause, despite the presence of risk factors and a clear clinical presentation. One thing is clear: weight loss isn't just helpful—it's essential. It's the only intervention proven to modify the disease course, offering relief from symptoms and a protective effect against vision loss [1] [4]. At its core, IIH is defined by increased pressure inside the skull without a detectable cause, such as a mass or hydrocephalus. Diagnostic criteria for IIH include clinical features, brain imaging to rule out an intracranial mass, and measurement of cerebrospinal fluid pressure via lumbar puncture (spinal tap). Patients often present with: Other symptoms can include neck or back pain, dizziness, and cognitive changes. Though the mechanisms aren't fully understood, there's a well-established link between IIH and obesity. The theory is that excess body weight may impair venous drainage from the brain, leading to cerebrospinal fluid (called cerebrospinal fluid) buildup around the brain and spinal cord. Venous sinus stenosis and abnormal venous pressure may contribute to increased intracranial pressure in IIH. This connection is why weight reduction remains the foundation of treatment [1] [4]. IIH occurs most often in women of childbearing age, but can affect others as well. The 2018 Consensus Guidelines published in the Journal of Neurology, Neurosurgery & Psychiatry make it unequivocally clear: weight loss is the most effective strategy for managing IIH [1] [4]. Even a modest reduction in weight—just 5% to 10% of a person's total body weight—has been shown to significantly decrease intracranial pressure, relieve headaches, and improve vision [5]. Women who are more than 20% above their ideal body weight are at increased risk for IIH, so losing weight to reach or approach ideal body weight is a key goal in management. Weight loss isn't a one-size-fits-all recommendation. It's a structured, multidisciplinary effort that often involves: For patients with a BMI over 30 kg/m², early intervention is critical. Experts recommend a compassionate, consistent approach that respects the psychosocial complexities of weight and body image [1]. Acetazolamide is typically the first drug prescribed. It works by inhibiting carbonic anhydrase, which reduces the production of CSF. Topiramate offers a double advantage. It not only lowers CSF production but also helps with weight loss—a bonus in IIH management. Surgery is usually a last resort, reserved for patients who have: Surgical options include: Each of these procedures carries potential risks, so decisions should be made in consultation with neurology, neurosurgery, and ophthalmology teams. Repeated lumbar punctures are now rarely used as a long-term treatment due to rapid reaccumulation of CSF. Some individuals have all the classic symptoms of IIH—especially headaches—but without any optic nerve swelling. This subtype, known as IIH without papilledema (IIHWOP), demands a slightly different treatment approach [2]. Consistent, structured follow-up is essential in IIH management. Most patients require: These assessments guide decisions about medication adjustment, weight loss effectiveness, and the need for escalated care. Ongoing collaboration between neurology and ophthalmology is vital to protecting long-term vision. Pediatric ophthalmology plays a crucial role in monitoring and managing IIH in children, ensuring early detection and specialized care for pediatric patients. While lowering ICP can help reduce headaches, it's not always enough. Many patients continue to experience migraines or tension-type headaches, even after their pressure normalizes. Treatment may include: Idiopathic Intracranial Hypertension can feel overwhelming for patients and providers alike, but there's good news: for most, sustainable weight loss truly changes the game. Combined with medical therapy and ongoing monitoring, lifestyle changes offer a tangible path to better health, fewer symptoms, and long-term vision preservation. While surgery plays a role in some cases, it's weight management that remains the beating heart of effective IIH care. [1] Mollan, S. P., Davies, B., Silver, N. C., Shaw, S., Mallucci, C. L., Wakerley, B. R., Krishnan, A., Chavda, S. V., Ramalingam, S., Edwards, J., Hemmings, K., Williamson, M., Burdon, M. A., Hassan-Smith, G., Digre, K., Liu, G. T., Jensen, R. H., & Sinclair, A. J. (2018). Idiopathic intracranial hypertension: consensus guidelines on management. Journal of neurology, neurosurgery, and psychiatry, 89(10), 1088–1100. [2] Thurtell M. J. (2019). Idiopathic Intracranial Hypertension. Continuum (Minneapolis, Minn.), 25(5), 1289–1309. [3] Ko M. W. (2011). Idiopathic intracranial hypertension. Current treatment options in neurology, 13(1), 101–108. [4] Kanagalingam, S., & Subramanian, P. S. (2018). Update on Idiopathic Intracranial Hypertension. Current treatment options in neurology, 20(7), 24. [5] Celebisoy, N., Gökçay, F., Sirin, H., & Akyürekli, O. (2007). Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Acta neurologica Scandinavica, 116(5), 322–327. [6] Piper, R. J., Kalyvas, A. V., Young, A. M., Hughes, M. A., Jamjoom, A. A., & Fouyas, I. P. (2015). Interventions for idiopathic intracranial hypertension. The Cochrane database of systematic reviews, 2015(8), CD003434.
