The effect of CSF drainage on ambulatory center of mass movement in idiopathic normal pressure hydrocephalus

Abstract

Our results suggest that iNPH-associated gait disturbances could cause abnormal ambulatory COM movements and that these disturbances are mitigated by TT and SS.

Perceived and actual changes in gait balance after CSF shunting in idiopathic normal pressure hydrocephalus

“…Thus, improvements in symptomatic gait-balance function after CSF shunting may still be in progress for approximately 1 week after surgery. 4,18 However, despite such non-optimal conditions, the FGA can detect clinically significant changes in dynamic gait-balance function in patients with iNPH, including mildly affected patients. Therefore, In this study, each FGA item score, that is, item 7 (gait with narrow base of support) and item 8 (gait with eyes closed), tended to be lower both before and after CSF shunting in patients with iNPH, including mildly affected patients, although changes in these items after CSF shunt surgery were confirmed to be statistically significant in both groups.…”

“…The CSF TT generally involves the removal of 30-50 mL of CSF via lumbar puncture and is considered to be less invasive. 16 The exclusion criteria were: (1) TT negative according to the iNPH diagnostic criteria 16 ; (2) those who had previously undergone a CSF shunt surgery 4 ; (3) additional neurological, orthopedic disorders, or surgical pain interfering with gait 4 ; and (4) inability to walk unassisted for at least 15 m. 4 Ninety-nine patients with iNPH (age [mean ±standard deviation]: 77.6 ± 5.5 years; 64 men and 35 women) who met the inclusion criteria were included.…”

“…The patients with iNPH who showed positive CSF TT results underwent CSF shunt surgery at Osaka Medical College Hospital approximately 1 month after CSF TT. 4,17 Our first choice of surgical treatment was lumboperitoneal (LP) shunt surgery, whereas ventriculoperitoneal (VP) shunt surgery was selected when lumbar spinal deformity and spinal canal stenosis were observed. 4,17,18 The rates of surgery type were 72.7% for LP shunt and 27.3% for VP shunt.…”

“…4,17 Our first choice of surgical treatment was lumboperitoneal (LP) shunt surgery, whereas ventriculoperitoneal (VP) shunt surgery was selected when lumbar spinal deformity and spinal canal stenosis were observed. 4,17,18 The rates of surgery type were 72.7% for LP shunt and 27.3% for VP shunt. A Codman-Hakim programmable valve with a Siphon-Guard was implanted in all patients and initial pressure settings were determined according to the patient's height and weight in reference to Miyake's quick reference table.…”

“…Indeed, several studies have shown that the fall rate in patients with iNPH is approximately 50% to 80%. [2][3][4][5] In addition, a previous study has reported that even in the mild stage of iNPH, that is, mild gait disturbance characterized by a timed Up and Go (TUG) test time of less than 15 s, the fall rate is as high as 60%. 6 Regarding the fall risk assessment for iNPH, including mild cases, a previous study has shown that a dynamic balance assessment including vestibular function assessment, such as the Functional Gait Assessment (FGA), is more suitable than other assessments, such as the 10-meter walk test, TUG test, static balance test, or lower limb muscle strength for differentiating iNPH patients at high risk of falls from those with low risk of falls.…”