Clinical comorbidities correlated with a response to the cerebrospinal fluid tap test in idiopathic normal-pressure hydrocephalus

Naito, Hiroyuki; Sugimoto, Takamichi; Kimoto, Kazuki; Abe, Tokiharu; Kawano, Tomohito; Matsuoka, Chika; Ohno, Narumi; Giga, Mayumi; Kono, Tomoyuki; Ueno, Hiroki; Nomura, Eiichi

doi:10.1016/j.jns.2021.120024

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…Many reports have assessed cognitive function in patients with iNPH before and after the spinal tap using the MMSE total score [39][40][41][42] and have suggested that the MMSE total score improved following the spinal tap. 39 However, the MMSE can be influenced by a learning effect 43 and may only evaluate limited cognitive domains.…”

Section: Discussionmentioning

confidence: 99%

Is there a spinal tap responder in progressive supranuclear palsy?: The first prospective study

Ohara,

Hattori,

Chen

et al. 2023

Preprint

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ObjectiveProgressive supranuclear palsy (PSP) is a progressive neurodegenerative disease, and sometimes shows idiopathic normal pressure hydrocephalus (iNPH)-like presentations. We aimed to evaluate spinal tap responsiveness in patients with PSP, including the effect of sham spinal tap.MethodsEleven patients with PSP, ten with probable/definite iNPH, and eight control patients were prospectively enrolled. All participants underwent sham spinal tap and spinal tap procedures. Gait was evaluated using wearable inertial sensors. We defined “tap responders” as individuals with a 10% or more improvement from baseline in any of the gait parameters (timed up-and-go test total time, stride length, and velocity during straight walking under single-task and cognitive dual-task conditions). We compared the ratio of tap responders in patients with PSP to patients with iNPH and controls.ResultsThe ratio of tap responders in patients with PSP was significantly higher than that in control patients, but not different from patients with iNPH. The ratio of sham tap responders was significantly higher in PSP patients than that in control patients, but not that in patients with iNPH. Notably, one patient with PSP responded to the spinal tap beyond the effect of sham spinal tap, and even to the shunt operation.InterpretationThis is the first prospective study to demonstrate tap and shunt responsiveness in patients with PSP while highlighting the placebo effects of the spinal tap in patients with PSP and iNPH. Our findings suggest that some PSP patients have impaired cerebrospinal fluid circulation, contributing to a distinct component of the clinical spectrum.

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Section: Discussionmentioning

confidence: 99%

Is there a spinal tap responder in progressive supranuclear palsy?: The first prospective study

Ohara,

Hattori,

Chen

et al. 2023

Preprint

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“…Idiopathic normal pressure hydrocephalus (iNPH) is a potentially treatable neurological disorder characterized by ventricular enlargement, gait and balance problems, cognitive dysfunction and urinary incontinence [1]. Comorbidities such as musculoskeletal disorders and subcortical vascular disease are seen in a large proportion of iNPH patients making diagnosis difficult [2]. The lack of good diagnostic tests and co-occurrence of neurodegenerative diseases, including Alzheimer's disease, are additional diagnostic challenges [3,4].…”

Section: Introductionmentioning

confidence: 99%

Prediction of shunt response in idiopathic normal pressure hydrocephalus by combined lumbar infusion test and preoperative imaging scoring

Hasselbalch,

Carlsen,

Alaouie

et al. 2023

Euro J of Neurology

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Background and purposeIdiopathic normal pressure hydrocephalus (iNPH) is a potentially treatable disorder, but prognostic tests or biomarkers are lacking. The aim was to study the predictive power of clinical, neuroimaging and lumbar infusion test parameters (resistance to outflow Rout, cardiac‐related pulse amplitude PA and the PA to intracranial pressure ICP ratio).MethodsIn all, 127 patients diagnosed with iNPH who had a lumbar infusion test, a subsequent ventriculo‐peritoneal shunt operation and at least 2 months of postoperative follow‐up were retrospectively included. Preoperative magnetic resonance images were visually scored for NPH features using the iNPH Radscale. Preoperative and postoperative assessment was performed using cognitive testing, as well as gait and incontinence scales.ResultsAt follow‐up (7.4 months, range 2–20 months), an overall positive response was seen in 82% of the patients. Gait was more severely impaired at baseline in responders compared to non‐responders. The iNPH Radscale score was borderline significantly higher in responders compared with non‐responders, whereas no significant differences in infusion test parameters were seen between responders and non‐responders. Infusion test parameters performed modestly with high positive (75%–92%) but low negative (17%–23%) predictive values. Although not significant, PA and PA/ICP seemed to perform better than Rout, and the odds ratio for shunt response seemed to increase in patients with higher PA/ICP, especially in patients with lower iNPH Radscale scores.ConclusionAlthough only indicative, lumbar infusion test results increased the likelihood of a positive shunt outcome. Pulse amplitude measures showed promising results that should be further explored in prospective studies.

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Prognosis and Outcomes

Skalický,

Bubeníková,

Vlasák

et al. 2023

Normal Pressure Hydrocephalus

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Clinical comorbidities correlated with a response to the cerebrospinal fluid tap test in idiopathic normal-pressure hydrocephalus

Cited by 5 publications

References 24 publications

Is there a spinal tap responder in progressive supranuclear palsy?: The first prospective study

Is there a spinal tap responder in progressive supranuclear palsy?: The first prospective study

Prediction of shunt response in idiopathic normal pressure hydrocephalus by combined lumbar infusion test and preoperative imaging scoring

Prognosis and Outcomes

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