How do you determine when to wean patients with idiopathic intracranial hypertension (IIH) off of acetazolamide?  

As a neuro-ophthalmologist, my greatest concern is vision-threatening papilledema in IIH. So if there is no papilledema, that threat should be resolved for the time being, right? Not so fast. Accurate direct ophthalmoscopy has become an "optional" skill set for most neurologists. Subtle papilledema...

I am not aware of any published articles that specifically address this question. However, if patients remain asymptomatic for 6-12 months, I would consider gradually tapering off medical therapy. I would define asymptomatic as having headaches occurring less frequently, such as less than 10 days pe...