Lumboperitoneal shunt in idiopathic normal pressure hydrocephalus: a prospective controlled study

Todisco, Massimiliano; Picascia, Marta; Pisano, Patrizia; Zangaglia, Roberta; Minafra, Brigida; Vitali, Paolo; Rognone, Elisa; Pichiecchio, Anna; Ceravolo, Roberto; Vanacore, Nicola; Fasano, Alfonso; Pacchetti, Claudio

doi:10.1007/s00415-020-09844-x

Cited by 15 publications

(26 citation statements)

References 37 publications

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“…Subjects with a negative response to the tap test (14 patients) underwent an external lumbar drainage lasting 4 days and removing 100–150 mL of CSF per day. They all had a positive response as defined earlier 19 …”

Section: Methodsmentioning

confidence: 83%

“…A tap test (ie, large volume lumbar puncture) removing at least 40 mL of cerebrospinal fluid (CSF) was performed, also to ascertain that the CSF opening pressure was within the 70–245 mmH 2 O range 15 . A positive response was defined as at least 10% improvement of 10‐meter seconds or steps 5 hours after the tap test 19 . Subjects with a negative response to the tap test (14 patients) underwent an external lumbar drainage lasting 4 days and removing 100–150 mL of CSF per day.…”

Section: Methodsmentioning

confidence: 99%

“…A surgical CSF diversion was offered to all patients, and 12 subjects declined in favor of a “wait and see” approach given their mild impairment of activities of daily living and/or fear of surgery. All iNPH patients who underwent surgery had a sustained improvement of their condition; these subjects have been included in a recently published trial detailing shunt outcome 19 …”

Section: Methodsmentioning

confidence: 99%

“…All iNPH patients who underwent surgery had a sustained improvement of their condition; these subjects have been included in a recently published trial detailing shunt outcome. 19…”

Section: Clinical and Mri Assessmentmentioning

confidence: 99%

“…response was defined as at least 10% improvement of 10-meter seconds or steps 5 hours after the tap test. 19 Subjects with a negative response to the tap test (14 patients) underwent an external lumbar drainage lasting 4 days and removing 100-150 mL of CSF per day. They all had a positive response as defined earlier.…”

Section: Clinical and Mri Assessmentmentioning

confidence: 99%

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Striatal Dopamine Deficit and Motor Impairment in Idiopathic Normal Pressure Hydrocephalus

et al. 2020

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Background Idiopathic normal pressure hydrocephalus can present with parkinsonism. However, abnormalities of the striatal dopamine reuptake transporter are unclear. Objectives To explore presence and features of striatal dopaminergic deficit in subjects with idiopathic normal pressure hydrocephalus as compared to Parkinson's disease (PD) patients and healthy controls. Methods We investigated 50 subjects with idiopathic normal pressure hydrocephalus, 25 with PD, and 40 healthy controls. All participants underwent [123I]‐N‐ω‐fluoropropyl‐2β‐carbomethoxy‐3β‐(4‐iodophenyl)nortropane and single‐photon emission computed tomography to quantify the striatal dopamine reuptake transporter binding. All subjects with idiopathic normal pressure hydrocephalus underwent a levodopa (l‐dopa) challenge test and magnetic resonance imaging to evaluate ventriculomegaly and white matter changes. Gait, cognition, balance, and continence were assessed with the Idiopathic Normal Pressure Hydrocephalus Rating Scale, and parkinsonism with the motor section of the Movement Disorder Society‐Unified Parkinson's Disease Rating Scale. All patients completed a 2‐year follow‐up. Results A total of 62% of patients with idiopathic normal pressure hydrocephalus featured a reduced striatal dopamine reuptake transporter binding, which correlated with the severity of parkinsonism but not with features of ventriculomegaly or white matter changes. Unlike PD, this dopaminergic deficit in idiopathic normal pressure hydrocephalus was more symmetric and prominent in the caudate nucleus. Conclusions Subjects with idiopathic normal pressure hydrocephalus can present a reduction of striatal dopamine reuptake transporter binding, which is consistent with the severity of parkinsonism and qualitatively differs from that found in PD patients. Longitudinal interventional studies are needed to prove a role for striatal dopamine reuptake transporter deficit in the pathophysiology of idiopathic normal pressure hydrocephalus. © 2020 International Parkinson and Movement Disorder Society

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Section: Methodsmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…All iNPH patients who underwent surgery had a sustained improvement of their condition; these subjects have been included in a recently published trial detailing shunt outcome. 19…”

Section: Clinical and Mri Assessmentmentioning

confidence: 99%

Section: Clinical and Mri Assessmentmentioning

confidence: 99%

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Striatal Dopamine Deficit and Motor Impairment in Idiopathic Normal Pressure Hydrocephalus

et al. 2020

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Dynamic functional networks in idiopathic normal pressure hydrocephalus: Alterations and reversibility byCSFtap test

Griffa

Bommarito

Assal

et al. 2020

Human Brain Mapping

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Idiopathic Normal Pressure Hydrocephalus (iNPH)—the leading cause of reversible dementia in aging—is characterized by ventriculomegaly and gait, cognitive and urinary impairments. Despite its high prevalence estimated at 6% among the elderlies, iNPH remains underdiagnosed and undertreated due to the lack of iNPH‐specific diagnostic markers and limited understanding of pathophysiological mechanisms. INPH diagnosis is also complicated by the frequent occurrence of comorbidities, the most common one being Alzheimer's disease (AD). Here we investigate the resting‐state functional magnetic resonance imaging dynamics of 26 iNPH patients before and after a CSF tap test, and of 48 normal older adults. Alzheimer's pathology was evaluated by CSF biomarkers. We show that the interactions between the default mode, and the executive‐control, salience and attention networks are impaired in iNPH, explain gait and executive disturbances in patients, and are not driven by AD‐pathology. In particular, AD molecular biomarkers are associated with functional changes distinct from iNPH functional alterations. Finally, we demonstrate a partial normalization of brain dynamics 24 hr after a CSF tap test, indicating functional plasticity mechanisms. We conclude that functional changes involving the default mode cross‐network interactions reflect iNPH pathophysiological mechanisms and track treatment response, possibly contributing to iNPH differential diagnosis and better clinical management.

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Lumboperitoneal Shunt for iNPH

Nakajima,

Karagiozov

2023

Normal Pressure Hydrocephalus

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Lumboperitoneal shunt in idiopathic normal pressure hydrocephalus: a prospective controlled study

Cited by 15 publications

References 37 publications

Striatal Dopamine Deficit and Motor Impairment in Idiopathic Normal Pressure Hydrocephalus

Striatal Dopamine Deficit and Motor Impairment in Idiopathic Normal Pressure Hydrocephalus

Dynamic functional networks in idiopathic normal pressure hydrocephalus: Alterations and reversibility byCSFtap test

Lumboperitoneal Shunt for iNPH

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