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In Reply We stand by our statement that there were no properly designed and executed clinical trials to guide therapy in IIH prior to ours. The results of the study by Ball et al1 were inconclusive with respect to efficacy due to the small sample size and consequent low power. The authors stated in their report that “This pilot study was not powered to detect a treatment effect.”1 Also, 12 of 25 patients in the acetazolamide group stopped taking medication, a discontinuation rate of nearly 50%. Dosing schedules for acetazolamide were at the discretion of the supervising clinician and did not get above 1500 mg/d. Twenty percent of the patients in the control group were eventually given acetazolamide. Therefore, this trial should not be used to guide therapy in IIH.
Wall M, McDermott M, Kupersmith M. Idiopathic Intracranial Hypertension—Reply. JAMA. 2014;312(10):1060. doi:10.1001/jama.2014.8903