Noninvasive prediction of shunt operation outcome in idiopathic normal pressure hydrocephalus

Aoki, Yasunori; Kazui, Hiroaki; Tanaka, Toshihisa; Ishii, Ryouhei; Wada, Tamiki; Ikeda, Shunichiro; Hata, Masahiro; Canuet, Leonides; Katsimichas, Themistoklis; Musha, Toshimitsu; Matsuzaki, Haruyasu; Imajo, Kaoru; Kanemoto, Hideki; Yoshida, Tetsuhiko; Nomura, Keiko; Yoshiyama, Kenji; Iwase, Masao; Takeda, Masatoshi

doi:10.1038/srep07775

Cited by 13 publications

(15 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, abnormalities in this frequency band have been closely associated with motor disorders 33,34 . Interestingly, in our previous study using NPV analysis with EEG data, differences in EEG oscillations in iNPH patients were also found in the beta band 29 . Consistent with the source location finding at the right convexity areas in this study, we have provided evidence using eLORETA-ICA indicating that the right ventral attention network was involved in gait speed recovery after CSF drainage 27 .…”

Section: Discussionmentioning

confidence: 79%

“…Most SPECT, PET and fMRI studies have failed to detect difference in cerebral blood flow between shunt responders and non-responders prior to shunt operation 1 . Similarly, traditional EEG power spectral analysis and eLORETA analysis have failed to discriminate shunt responders from non-responders 29 . Unlike these neuroimaging modalities, eLORETA-NPV analysis with EEG data could detect difference of cortical electrical activities related to shunt response at high-convexity areas.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Normalized power variance of eLORETA at high-convexity area predicts shunt response in idiopathic normal pressure hydrocephalus

Aoki

Kazui

Bruña

et al. 2020

Sci Rep

Self Cite

View full text Add to dashboard Cite

Idiopathic normal pressure hydrocephalus (iNPH) is a neuropsychiatric disease characterized by gait disturbance, cognitive deterioration and urinary incontinence associated with excessive accumulation of cerebrospinal fluid (CSF) in the brain ventricles. These symptoms, in particular gait disturbance, can be potentially improved by shunt operation in the early stage of the disease, and the intervention associates with a worse outcome when performed late during the course of the disease. Despite the variable outcome of shunt operation, noninvasive presurgical prediction methods of shunt response have not been established yet. In the present study, we used normalized power variance (NPV), a sensitive measure of the instability of cortical electrical activity, to analyze cortical electrical activity derived from EEG data using exact-low-resolution-electromagnetic-tomography (eLORETA) in 15 shunt responders and 19 non-responders. We found that shunt responders showed significantly higher NPV values at high-convexity areas in beta frequency band than non-responders. In addition, using this difference, we could discriminate shunt responders from non-responders with leave-one-subjectout cross-validation accuracy of 67.6% (23/34) [positive predictive value of 61.1% (11/18) and negative predictive value of 75.0% (12/16)]. Our findings indicate that eLORETA-NPV can be a useful tool for noninvasive prediction of clinical response to shunt operation in patients with iNPH. Idiopathic normal pressure hydrocephalus (iNPH) is a neuropsychiatric disorder characterized by symptoms of gait disturbance, cognitive deterioration and urinary incontinence without any preceding diseases. Brain imaging by Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) shows typical morphologic abnormalities such as ventriculomegaly, dilation of the Sylvian fissures and narrowing of the sulci and subarachnoid spaces over the high-convexity area of the brain, indicating excessive accumulation of cerebrospinal fluid (CSF) in the ventricles 1. This morphological feature was defined as disproportionately enlarged subarachnoid-space hydrocephalus (DESH) in Japanese diagnostic criteria for iNPH 1. The prevalence of possible iNPH was reported to be 1-2% in the elderly population by recent community or population-based studies 1-6. However, many elderly patients with iNPH remain undiagnosed and untreated.

show abstract

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Normalized power variance of eLORETA at high-convexity area predicts shunt response in idiopathic normal pressure hydrocephalus

Aoki

Kazui

Bruña

et al. 2020

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…Second, we were not able to associate the present findings with the information regarding treatment of iNPH, such as responsiveness to a CSF tap test. Aoki et al ( 2013 , 2015 ) found that responders to a shunt operation showed higher variance in the power of beta-frequency electroencephalography oscillations in the right fronto-temporo-occipital region than non-responders. Because a CSF tapping test is an invasive procedure and carries some risks of adverse events, we agree that predicting the responsiveness to a CSF tap test beforehand is of clinical benefit.…”

Section: Discussionmentioning

confidence: 99%

Interhemispheric Resting-State Functional Connectivity Predicts Severity of Idiopathic Normal Pressure Hydrocephalus

et al. 2017

View full text Add to dashboard Cite

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by a clinical triad (gait disturbance, dementia, and urinary incontinence), and by radiological findings of enlarged ventricles reflecting disturbance of central spinal fluid circulation. A diagnosis of iNPH is sometimes challenging, and the pathophysiological mechanisms underlying the clinical symptoms of iNPH remain largely unknown. Here, we used an emerging MRI technique, resting-state functional connectivity MRI (rsfcMRI), to develop a subsidiary diagnostic technique and to explore the underlying pathophysiological mechanisms of iNPH. rsfcMRI data were obtained from 11 patients with iNPH and 11 age-matched healthy volunteers, yielding rsfcMRI-derived functional connectivity (FC) from both groups. A linear support vector machine classifier was trained to distinguish the patterns of FCs of the patients with iNPH from those of the healthy volunteers. After dimensional reduction, the support vector machine successfully classified the two groups with an accuracy of 80%. Moreover, we found that rsfcMRI-derived FC carried information to predict the severity of the triad in iNPH. FCs relevant to the classification of severity were mainly based on interhemispheric connectivity, suggesting that disruption of the corpus callosum fibers due to ventricular enlargement may explain the triad of iNPH. The present results support the usefulness of rsfcMRI as a tool to understand pathophysiology of iNPH, and also to help with its clinical diagnosis.

show abstract

“…arrested hydrocephalus) [10,33,37]. Proper diagnosis has an extremely important impact on further diagnostic and treatment procedures [3,7,9]. The treatment of choice in symptomatic NPH is surgical.…”

Section: Introductionmentioning

confidence: 99%

Levels of selected pro- and anti-inflammatory cytokines in cerebrospinal fluid in patients with hydrocephalus

Czubowicz¹,

Głowacki²,

Fersten³

et al. 2017

View full text Add to dashboard Cite

Cytokines are widely known mediators of inflammation accompanying many neurodegenerative disorders including normal pressure hydrocephalus (NPH). NPH is caused by impaired cerebrospinal fluid (CSF) absorption and treated by surgical shunt insertion. The early diagnosis of NPH is difficult because of various manifestations of the disease. One of the most promising research directions is biochemical CSF analysis. The aim of this study was to determine the CSF levels of cytokines. The levels of various cytokines (IL-6, IL-8, IL-12, IL-10 and TNF-α) were measured in patients with idiopathic active normal pressure hydrocephalus, arrested hydrocephalus and hydrocephalus with brain atrophy compared to controls. Our study showed that the concentrations of IL-6 and IL-8 were significantly elevated in the group with idiopathic active hydrocephalus compared to control patients. Moreover, we observed that the levels of IL-6 and IL-8 in the group with idiopathic active hydrocephalus were significantly higher compared to patients with arrested hydrocephalus and hydrocephalus with brain atrophy..

show abstract

Noninvasive prediction of shunt operation outcome in idiopathic normal pressure hydrocephalus

Cited by 13 publications

References 38 publications

Normalized power variance of eLORETA at high-convexity area predicts shunt response in idiopathic normal pressure hydrocephalus

Normalized power variance of eLORETA at high-convexity area predicts shunt response in idiopathic normal pressure hydrocephalus

Interhemispheric Resting-State Functional Connectivity Predicts Severity of Idiopathic Normal Pressure Hydrocephalus

Levels of selected pro- and anti-inflammatory cytokines in cerebrospinal fluid in patients with hydrocephalus

Contact Info

Product

Resources

About