In Reply: GLP-1 Receptor Agonists: Beyond Diabetes—What the Neurosurgeon Needs to Know

To the Editor: We read with great interest the letter by Patel et al1 in response to our recently published article, “GLP-1 Receptor Agonists: Beyond Diabetes—What the Neurosurgeon Needs to Know.”2 The authors highlight the potential for use of GLP-1 receptor agonists for weight loss in patients with idiopathic intracranial hypertension (IIH). This pathology can present unique challenges for neurosurgeons, sometimes necessitating neurosurgical intervention in cases of refractory to medical management, whether by temporary or permanent cerebrospinal diversion, or cerebral venous sinus stenting. The evidence cited by Patel et al currently presents a limited case-control study,3 as well as a phase II randomized controlled clinical trial showing significant reduction in intracranial pressure in patients with IIH.4 We look forward to future trials investigating this and other indications that remain in the early stages of research. In many of the conditions treated by neurosurgeons, not only does obesity contribute to increased surgical risks and morbid outcomes, but it may in fact play a critical role in the pathophysiology that leads to developing these conditions, such as IIH. As demonstrated in the studies cited by Patel et al on the role of weight loss and bariatric surgery on improved headaches in patients with IIH,5 it is reasonable to suspect that GLP-1 receptor agonists may have a positive effect in obese patients with IIH and can potentially become a promising option for medical treatment of this condition. We therefore continue to eagerly await future studies on the use of GLP-1 receptor agonists in the treatment of various neurological conditions, and hope that our systematic review provides an overview of the most promising aspects of this class of medications, and inspires further research endeavors that will benefit increasing numbers of patients.