- •Initial gait parameters are insufficient to identify shunt-responsive iNPH patients.
- •Most iNPH patients require several days of CSF drainage before symptoms improve.
- •Inclusion of urinary and cognitive changes increases lumbar drain predictive value.
- •The level of improvement after lumbar drain trial correlates with that after shunting.
Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait instability, urinary incontinence and cognitive dysfunction. These symptoms can be relieved by cerebrospinal fluid (CSF) drainage, but the time course and nature of the improvements are poorly characterized. Attempts to prospectively identify iNPH patients responsive to CSF drainage by evaluating presenting gait quality or via extended lumbar cerebrospinal fluid drainage (eLCD) trials are common, but the reliability of such approaches is unclear. Here we combine eLCD trials with computerized quantitative gait measurements to predict shunt responsiveness in patients undergoing evaluation for possible iNPH. In this prospective cohort study, 50 patients presenting with enlarged cerebral ventricles and gait, urinary, and/or cognitive difficulties were evaluated for iNPH using a computerized gait analysis system during a 3 day trial of eLCD. Gait speed, stride length, cadence, and the Timed Up and Go test were quantified before and during eLCD. Qualitative assessments of incontinence and cognition were obtained throughout the eLCD trial. Patients who improved after eLCD underwent ventriculoperitoneal shunt placement, and symptoms were reassessed serially over the next 3 to 15 months. There was no significant difference in presenting gait characteristics between patients who improved after drainage and those who did not. Gait improvement was not observed until 2 or more days of continuous drainage in most cases. Symptoms improved after eLCD in 60% of patients, and all patients who improved after eLCD also improved after shunt placement. The degree of improvement after eLCD correlated closely with that observed after shunt placement.
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- Signs, symptoms and course of normal pressure hydrocephalus in comparison with cerebral atrophy.Acta Neurochir (Wien). 1999; 141: 1039-1048
- The role of the neurologist in the longitudinal management of normal pressure hydrocephalus.Neurologist. 2010; 16: 238-248
- Noninvasive biomarkers in normal pressure hydrocephalus: evidence for the role of neuroimaging.J Neurosurg. 2009; 110: 837-851
- European iNPH Multicentre Study Group. The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus.J Neurol Neurosurg Psychiatry. 2013; 84: 562-568
- The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus.J Neurol Neurosurg Psychiatry. 2002; 72: 503-506
Published online: January 07, 2016
Accepted: November 29, 2015
Received: July 30, 2015
© 2015 Elsevier Ltd. All rights reserved.