Normal Pressure Hydrocephalus and Parkinsonism: Preliminary Data on Neurosurgical and Neurological Treatment

Broggi, Morgan; Redaelli, Veronica; Tringali, Giovanni; Restelli, Francesco; Romito, Luigi; Schiavolin, Silvia; Tagliavini, Fabrizio; Broggi, Giovanni

doi:10.1016/j.wneu.2016.03.004

Cited by 38 publications

(48 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A study with fluorodopa PET in a patient with obstructive hydrocephalus who developed parkinsonism due to shunt dysfunction revealed reduced uptake in the caudate and putamen [ 27 ]. Further indications of a disturbance in the nigrostriatal pathway were provided in a recent study of 30 patients with NPH and parkinsonism where striatal dopaminergic deficit on dopamine transporter (DaT) scan was found in almost half of the patients [ 14 ]. Whether such disturbances are due to global or regionally reduced CBF [ 25 , 26 , 28 – 30 ] or other mechanisms is not fully clear.…”

Section: Discussionmentioning

confidence: 99%

“…A recent hospital-based study with 55 NPH patients who underwent a CSF tap test revealed a significant improvement of bradykinesia in upper and lower bodies, whereas tremor marginally improved and rigidity did not improve [ 15 ]. In a recent publication, oral dopaminergic therapy added a positive effect to shunt surgery in the improvement of the UPDRS-m score in patients with NPH and parkinsonism, indicating that the disturbance in the dopaminergic system might not be totally reversible [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Parkinsonian symptoms in normal pressure hydrocephalus: a population-based study

2017

View full text Add to dashboard Cite

It may be challenging to differentiate normal pressure hydrocephalus (NPH) from neurodegenerative disorders such as Parkinson’s disease. In this population-based study, we wanted to describe the frequency of parkinsonian symptoms among individuals with and without NPH, and whether the motor examination part of the Unified Parkinson’s Disease Rating Scale (UPDRS-m) score differs between these groups. Furthermore, we wanted to find out whether there was a relationship between UPDRS-m score, NPH symptoms, and radiological signs of NPH. A sample of 168 individuals over the age of 65 with and without self-reported symptoms of NPH underwent a computerized tomography of the brain and clinical examination, including UPDRS-m to grade parkinsonian symptoms. According to diagnostic guidelines, 38 fulfilled criteria for NPH, whereas 130 had unlikely NPH. Bradykinesia was significantly more common among those with NPH (79%) compared to those with unlikely NPH (32%) (p < 0.001). The corresponding figures for rigidity were 43 vs. 15% (p < 0.001), for postural instability 71 vs. 22% (p < 0.001), and for tremor at rest 5 vs. 6% (not significant). The total UPDRS-m score was significantly higher among individuals with NPH (median = 12) than without (median = 1) and correlated significantly with the degree of NPH symptoms (r = −0.72) and ventriculomegaly (r = 0.31). In this study, parkinsonian symptoms, except resting tremor, were frequent in individuals with NPH and correlated with the severity of NPH symptoms. Asymmetric symptoms were uncommon. We recommend a liberal use of neuroradiological imaging when investigating a patient with parkinsonian features.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Parkinsonian symptoms in normal pressure hydrocephalus: a population-based study

2017

View full text Add to dashboard Cite

show abstract

“…Some patients with iNPH are later diagnosed with comorbidities, such as parkinsonism or neurodegenerative dementia, or have evidence of "dual pathology" at the time of shunting [10,45,46]. For example, cerebral pathology with β-amyloid in patients undergoing shunt surgery for iNPH were linked with a poorer improvement after operation [47,48].…”

Section: Discussionmentioning

confidence: 99%

Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery

Chang

Tseng

Wang

et al. 2020

JCM

View full text Add to dashboard Cite

The diagnosis of idiopathic normal pressure hydrocephalus (iNPH) and the outcome of lumboperitoneal shunt treatment remains to be systematically explored. Here, we aim to evaluate whether the severity of dopaminergic degeneration and white matter small vessel disease could be predictors of outcome for iNPH patients subjected to lumboperitoneal shunt treatment. This is a single center retrospective study with 39 patients with probable iNPH undergoing programmable surgical lumboperitoneal shunt from June 2016 to March 2018 at Hualien Tzu Chi Hospital. In all patients, dopaminergic degeneration was determined with 99mTc- TRODAT-1 SPECT scan, while white matter small vessel disease (Fazekas scale) was assessed with Brain MRI. The iNPH grading scale (iNPHGS) score and Karnofsky Performance Score (KPS) pre- and post-operation (6-month follow-up) were available for all patients. Linear regression was used to correlate the severities of dopaminergic degeneration and small vessel disease with lumboperitoneal shunt treatment outcomes. Their iNPHGS score improved significantly after surgery (pre-operatively, 7.8 ± 2.6; post-operatively, 5.7 ± 2.6 (26.9% improvement) (p < 0.05)). Moreover, the KPS was also improved significantly after surgery, by a mean of 24.6% from the baseline score (p < 0.05). A significant correlation was observed between the severity of dopaminergic degeneration and a poorer improvement of iNPHGS score (p = 0.03). However, improvement of the iNPHGS score was not correlated with white matter small vessel disease. Dopaminergic degeneration comorbidity neutralized the degree of improvement after surgery. Although white matter small vessel disease was correlated with iNPH incidence, it may not be a prognostic factor for shunt operation. These findings have implications for the use of dopaminergic imaging, as they might help predict the surgical outcome of patients with iNPH, while vascular mechanisms seem to be involved in iNPH pathophysiology.

show abstract

“…Although Ouchi et al [4] reported that presynaptic dopaminergic depletion was not observed in patients with iNPH, not every iNPH patients showed normal DAT imaging in recent studies. According to reports of Broggi et al [5] and Allali et al [6], abnormal DAT losses were seen in 46.5% and 31% of iNPH patients, respectively.…”

Section: Introductionmentioning

confidence: 90%

Detailed visual assessment of striatal dopaminergic depletion in patients with idiopathic normal pressure hydrocephalus: Unremarkable or not?

Lee

Park

Lee

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Dopamine transporter (DAT) imaging may enable clinicians to discriminate idiopathic normal pressure hydrocephalus (iNPH) from other parkinsonian disorders. However, a specific pattern of dopaminergic loss in DAT imaging of iNPH patients remains to be further elucidated. Methods In this preliminary study, 11 patients with iNPH in our hospital between March 2017 and February 2019 were finally enrolled. A diagnosis of iNPH was made according to the two established criteria. For visual analysis of DAT imaging, a striatum was divided into five domains. A semi-quantitative visual assessment was performed with a consensus between a nuclear medicine specialist and an experienced neurologist who were blinded to the clinical diagnosis. Results Striatal dopaminergic deficits were abnormal in 90.9% (10/11) of patients with iNPH. The degree of dopaminergic reduction was mild and heterogeneous. However, a tendency of preferential striatal DAT loss in the caudate nucleus (90.9%, 10/11) than in the putamen (72.7%, 8/11) was observed, whereas ventral portion (9.1%, 1/11) was relatively preserved. Conclusion Striatal dopaminergic depletion might be mild and heterogeneous in patients with iNPH. These dopaminergic deficits were more common in the caudate nucleus than in the putamen, suggesting a pattern different from other degenerative parkinsonian disorders.

show abstract

Normal Pressure Hydrocephalus and Parkinsonism: Preliminary Data on Neurosurgical and Neurological Treatment

Cited by 38 publications

References 31 publications

Parkinsonian symptoms in normal pressure hydrocephalus: a population-based study

Parkinsonian symptoms in normal pressure hydrocephalus: a population-based study

Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery

Detailed visual assessment of striatal dopaminergic depletion in patients with idiopathic normal pressure hydrocephalus: Unremarkable or not?

Contact Info

Product

Resources

About