1
|
Piche E, Armand S, Allali G, Assal F. The contribution of cognitive reserve in explaining the dual-task walking performance in iNPH patients: comparison with other cognitive, functional, and socio-demographic variables. Aging Clin Exp Res 2024; 36:190. [PMID: 39259457 PMCID: PMC11390896 DOI: 10.1007/s40520-024-02829-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/05/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent neurological disorder, but its diagnosis remains challenging. Dual-task (DT) walking performance is a reliable indicator of iNPH but less is known about the role of cognitive reserve (CR) in predicting DT walking performance. AIMS The objective of this study was to evaluate the contribution of CR on DT walking in healthy controls (HC) and in iNPH patients (iNPH-P). METHODS 68 iNPH-P (77.2 +/- 6.7 years old) and 28 HC (74.5 +/- 5.7 years old) were evaluated on their single-task walking (Vsimple) and on 4 DT walking (walking and counting or counting backwards, naming animals, naming words beginning with the letter P) (Vcount, VcountB, Vanimals and Vletter respectively). The contribution of CR on the different DT walking speeds was compared between HC and iNPH-P. In iNPH-P, the contribution of CR on the walking speeds was compared with regard to other cognitive, functional, and socio-demographic variables. RESULTS Simple linear regression demonstrated a moderate influence of CR on single and DT walking speed in iNPH-P (β > 0.3, p < .001) but not in HC where the relation was not significant. In iNPH-P, results showed that CR played a major role in explaining each of the single and DT walking speeds with NPH-scale. CONCLUSION As CR could be improved through the life cycle, these results support the idea of developing and supporting physical activity programs that will enrich social, physical, and cognitive resources to protect against age-related functional decline, especially in iNPH-P patients where the age-related deficits are greater.
Collapse
Affiliation(s)
- Elodie Piche
- Université Côte d'Azur, LAMHESS, Nice, France.
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France.
| | - Stephane Armand
- Laboratory of Kinesiology, University Geneva Hospitals and University of Geneva, Geneva, Switzerland.
| | - Gilles Allali
- Leenaards Memory Center, Lausanne University Hospitals and University of Lausanne, Lausanne, Switzerland
| | - Frederic Assal
- Division of Neurology, Department of Clinical Neurosciences, University Geneva Hospitals, Geneva, Switzerland
| |
Collapse
|
2
|
Bendella Z, Purrer V, Haase R, Zülow S, Kindler C, Borger V, Banat M, Dorn F, Wüllner U, Radbruch A, Schmeel FC. Brain and Ventricle Volume Alterations in Idiopathic Normal Pressure Hydrocephalus Determined by Artificial Intelligence-Based MRI Volumetry. Diagnostics (Basel) 2024; 14:1422. [PMID: 39001312 PMCID: PMC11241572 DOI: 10.3390/diagnostics14131422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/25/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
The aim of this study was to employ artificial intelligence (AI)-based magnetic resonance imaging (MRI) brain volumetry to potentially distinguish between idiopathic normal pressure hydrocephalus (iNPH), Alzheimer's disease (AD), and age- and sex-matched healthy controls (CG) by evaluating cortical, subcortical, and ventricular volumes. Additionally, correlations between the measured brain and ventricle volumes and two established semi-quantitative radiologic markers for iNPH were examined. An IRB-approved retrospective analysis was conducted on 123 age- and sex-matched subjects (41 iNPH, 41 AD, and 41 controls), with all of the iNPH patients undergoing routine clinical brain MRI prior to ventriculoperitoneal shunt implantation. Automated AI-based determination of different cortical and subcortical brain and ventricular volumes in mL, as well as calculation of population-based normalized percentiles according to an embedded database, was performed; the CE-certified software mdbrain v4.4.1 or above was used with a standardized T1-weighted 3D magnetization-prepared rapid gradient echo (MPRAGE) sequence. Measured brain volumes and percentiles were analyzed for between-group differences and correlated with semi-quantitative measurements of the Evans' index and corpus callosal angle: iNPH patients exhibited ventricular enlargement and changes in gray and white matter compared to AD patients and controls, with the most significant differences observed in total ventricular volume (+67%) and the lateral (+68%), third (+38%), and fourth (+31%) ventricles compared to controls. Global ventriculomegaly and marked white matter reduction with concomitant preservation of gray matter compared to AD and CG were characteristic of iNPH, whereas global and frontoparietally accentuated gray matter reductions were characteristic of AD. Evans' index and corpus callosal angle differed significantly between the three groups and moderately correlated with the lateral ventricular volumes in iNPH patients [Evans' index (r > 0.83, p ≤ 0.001), corpus callosal angle (r < -0.74, p ≤ 0.001)]. AI-based MRI volumetry in iNPH patients revealed global ventricular enlargement and focal brain atrophy, which, in contrast to healthy controls and AD patients, primarily involved the supratentorial white matter and was marked temporomesially and in the midbrain, while largely preserving gray matter. Integrating AI volumetry in conjunction with traditional radiologic measures could enhance iNPH identification and differentiation, potentially improving patient management and therapy response assessment.
Collapse
Affiliation(s)
- Zeynep Bendella
- Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (Z.B.); (R.H.); (S.Z.); (F.D.); (A.R.)
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; (V.P.); (C.K.); (U.W.)
| | - Veronika Purrer
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; (V.P.); (C.K.); (U.W.)
- Department of Neurodegenerative Diseases, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Robert Haase
- Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (Z.B.); (R.H.); (S.Z.); (F.D.); (A.R.)
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; (V.P.); (C.K.); (U.W.)
| | - Stefan Zülow
- Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (Z.B.); (R.H.); (S.Z.); (F.D.); (A.R.)
| | - Christine Kindler
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; (V.P.); (C.K.); (U.W.)
- Department of Neurodegenerative Diseases, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Valerie Borger
- Department of Neurosurgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (V.B.); (M.B.)
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (V.B.); (M.B.)
| | - Franziska Dorn
- Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (Z.B.); (R.H.); (S.Z.); (F.D.); (A.R.)
| | - Ullrich Wüllner
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; (V.P.); (C.K.); (U.W.)
- Department of Neurodegenerative Diseases, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (Z.B.); (R.H.); (S.Z.); (F.D.); (A.R.)
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; (V.P.); (C.K.); (U.W.)
| | - Frederic Carsten Schmeel
- Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (Z.B.); (R.H.); (S.Z.); (F.D.); (A.R.)
- German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; (V.P.); (C.K.); (U.W.)
| |
Collapse
|
3
|
Bianconi A, Colonna S, Minardi M, Di Perna G, Ceroni L, Nico E, Garbossa D, Borgarello S, Cofano F. Prognostic Factors in Idiopathic Normal Pressure Hydrocephalus Patients After Ventriculo-Peritoneal Shunt: Results from a Single-Institution Observational Cohort Study with Long Term Follow-Up. World Neurosurg 2024; 187:e1089-e1096. [PMID: 38759789 DOI: 10.1016/j.wneu.2024.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE The aim of this study is to investigate long-term prognostic factors and clinical outcomes in patients with idiopathic normal pressure hydrocephalus (iNPH) treated with ventriculo-peritoneal shunt (VPS). METHODS This single-center retrospective observational study of prospectively collected data included patients with probable iNPH treated with VPS surgery. All patients underwent complete preoperative assessment, including past medical history and neurological examination, dynamic cerebrospinal fluid (CSF) flow brain magnetic resonance imaging (MRI), and preoperative CSF samplings. NPH-consistent brain MRI findings and favorable responses to CSF subtraction tests were the main factors considered for VPS surgery eligibility. All patients were subsequently followed up every six to twelve months (mean follow-up time 40 months, minimum to maximum interval 6-150 months). RESULTS A total of 238 patients with a diagnosis of probable iNPH treated with VPS were enrolled. Age, comorbidities, and response to CSF samplings were not significantly associated with a better long-term outcome after VPS surgery. The results of our retrospective analysis demonstrated a statistically significant association between the presence of preoperative aqueductal CSF flow acceleration on dynamic brain MRI and neurological outcomes at 12 and 18 months after VPS surgery. CONCLUSIONS Long-term outcomes of iNPH patients treated with VPS surgery do not appear to be directly influenced by preoperative comorbidities, age, or responses to CSF samplings. Alterations in preoperative brain MRI CSF dynamics were found to be related to long-term outcomes following VPS surgery, highlighting the role of radiological assessment as a prognostic factor in patients deemed suitable candidates for VPS surgery.
Collapse
Affiliation(s)
- Andrea Bianconi
- Departments of Neuroscience and Neurosurgery, University of Turin, Turin, Italy
| | - Stefano Colonna
- Departments of Neuroscience and Neurosurgery, University of Turin, Turin, Italy.
| | | | - Giuseppe Di Perna
- Departments of Neuroscience and Neurosurgery, University of Turin, Turin, Italy
| | - Luca Ceroni
- Department of Psychology, University of Turin, Turin, Italy
| | - Elsa Nico
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Diego Garbossa
- Departments of Neuroscience and Neurosurgery, University of Turin, Turin, Italy
| | - Silvana Borgarello
- Departments of Neuroscience and Neurosurgery, University of Turin, Turin, Italy
| | - Fabio Cofano
- Departments of Neuroscience and Neurosurgery, University of Turin, Turin, Italy
| |
Collapse
|
4
|
Rohatgi S, Dua A, Avesta A, Khalid RN, Diociasi A, Buch K, Ford JN, Gupta R. Predicting Gait Speed Improvement in Idiopathic Normal Pressure Hydrocephalus Patients: The Role of Evans Index and Ventricular Volume. Cureus 2024; 16:e61799. [PMID: 38975434 PMCID: PMC11227259 DOI: 10.7759/cureus.61799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Objective This study aims to investigate the association between specific imaging parameters, namely, the Evans index (EI) and ventricular volume (VV), and the variation in gait speed observed in patients with idiopathic normal pressure hydrocephalus (iNPH) before and after cerebrospinal fluid (CSF) removal/lumbar drain (LD). Furthermore, it seeks to identify which imaging parameters are the most reliable predictors for significant improvements in gait speed post procedure. Methods In this retrospective analysis, the study measured the gait speed of 35 patients diagnosed with idiopathic normal pressure hydrocephalus (iNPH) before and after they underwent CSF removal. Before lumbar drain (LD), brain images were segmented to calculate the Evans index and ventricular volume. The study explored the relationship between these imaging parameters (the Evans index and ventricular volume) and the improvement in gait speed following CSF removal. Patients were divided into two categories based on the degree of improvement in gait speed, and we compared the imaging parameters between these groups. Receiver operating characteristic (ROC) curve analysis was employed to determine the optimal imaging parameter thresholds predictive of gait speed enhancement. Finally, the study assessed the predictive accuracy of these thresholds for identifying patients likely to experience improved gait speed post-LD. Results Following CSF removal/lumbar drain, the participants significantly improved in gait speed, as indicated by a paired sample t-test (p-value = 0.0017). A moderate positive correlation was observed between the imaging parameters (EI and VV) and the improvement in gait speed post-LD. Significant differences were detected between the two patient groups regarding EI, VV, and a composite score (statistical test value = 3.1, 2.8, and 2.9, respectively; p-value < 0.01). Receiver operating characteristic (ROC) curve analysis identified the optimal thresholds for the EI and VV to be 0.39 and 110.78 cm³, respectively. The classification based on these thresholds yielded significant associations between patients displaying favorable imaging parameters and those demonstrating improved gait speed post-LD, with chi-square (χ²) values of 8.5 and 7.1, respectively, and p-values < 0.01. Furthermore, these imaging parameter thresholds had a 74% accuracy rate in predicting patients who would improve post-LD. Conclusion The study demonstrates that ventricle volume and the Evans index can significantly predict gait speed improvement after lumbar drain (LD) in patients with iNPH.
Collapse
Affiliation(s)
- Saurabh Rohatgi
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Amol Dua
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Arman Avesta
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Rehab Naeem Khalid
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Andrea Diociasi
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Karen Buch
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Jeremy N Ford
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Rajiv Gupta
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| |
Collapse
|
5
|
Rigamonti D, Yasar S, Vivas-Buitrago T, Rigamonti K. Letter to Our Colleagues Family Practitioners, Geriatricians, and Radiologists to Increase Awareness Regarding Idiopathic Normal Pressure Hydrocephalus. World Neurosurg 2024; 181:e291-e293. [PMID: 37832641 DOI: 10.1016/j.wneu.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) affects elderly individuals and is characterized by a progressive deterioration of gait, urinary continence, and cognition. In most cases, it is reversible with treatment. INPH is not uncommonly an unrecognized cause of dementia. We wish to raise awareness of iNPH among primary care providers who are seeing these patients first. METHODS We reviewed the current epidemiological data regarding iNPH as well as epidemiological data regarding Alzheimer disease. We searched for the most sensitive radiological screening test for iNPH. RESULTS Alzheimer disease comprises 60%-70% of all dementia cases, in 2023 is affecting 6.7 million Americans, about 10.7% of people 65 and older. Epidemiological data from the Scandinavian countries confirmed that 3.7% of people older than 65 have iNPH. Surgical studies confirmed the presence of early Alzheimer's pathology in about 25% of operated patients with iNPH. Useful radiological findings of iNPH include an Evans Index greater than 0.30, and a disproportionally enlarged subarachnoid space hydrocephalus (DESH). However, the callosal angle is thought to represent the best tool to discriminate iNPH from its mimics. CONCLUSIONS According to the available epidemiological data iNPH is underdiagnosed. We strongly encourage the primary care physicians and geriatricians to ask the radiologist to measure the callosal angle on the initial brain computed tomography (or magnetic resonance) image. If the callosal angle is ≤71°, it is appropriate to refer the patient to neurosurgery for further diagnostic work-up.
Collapse
Affiliation(s)
- Daniele Rigamonti
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; KHDR Consulting, Baltimore, Maryland, USA.
| | - Sevil Yasar
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | |
Collapse
|
6
|
Grasso G, Teresi G, Noto M, Torregrossa F. Invasive Preoperative Investigations in Idiopathic Normal Pressure Hydrocephalus: A Comprehensive Review. World Neurosurg 2024; 181:178-183. [PMID: 37939878 DOI: 10.1016/j.wneu.2023.10.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder characterized by the triad of gait disturbance, cognitive impairment, and urinary incontinence. The condition is diagnosed mainly in older adults and is associated with ventricular enlargement without an increase in cerebrospinal fluid pressure. The clinical assessment involves a detailed medical history, physical examination, and cognitive testing. Neuroimaging is an essential part of the diagnostic workup for iNPH. However, to determine the suitability of patients for shunt surgery, a range of invasive preoperative investigations are employed. This narrative review aims to provide a comprehensive analysis of the current literature on invasive preoperative investigations in iNPH, focusing primarily on the lumbar infusion test, cerebrospinal fluid drainage tests, and continuous intracranial pressure monitoring. The strengths and limitations of each method, as well as their potential impact on treatment outcomes, are discussed.
Collapse
Affiliation(s)
- Giovanni Grasso
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
| | - Gaia Teresi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Manfredi Noto
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Fabio Torregrossa
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| |
Collapse
|
7
|
Mehta NH, Greenberg ABW, Kahle KT. The Efficacy of Endoscopic Third Ventriculostomy for Idiopathic Normal Pressure Hydrocephalus. World Neurosurg 2023; 179:158-166. [PMID: 37625638 DOI: 10.1016/j.wneu.2023.08.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Recently, intervention with endoscopic third ventriculostomy (ETV) for patients with idiopathic normal pressure hydrocephalus (iNPH) has emerged as a potential minimally invasive alternative to traditional treatments (ventriculoperitoneal shunting). The clinical response to these interventions is variable and unclear. The objective of this review was to assess the efficacy of endoscopic third ventriculostomy in treating patients with iNPH. A systematic review of PubMed, Web of Science, and Google Scholar was conducted using search terms relevant to ETV and iNPH. Included studies met consistent, predetermined diagnostic criteria for iNPH, implemented ETV in subjects greater than 40 years of age, and assessed all 3 components of Hakim's triad (gait impairment, dementia, and incontinence). Data extraction included dichotomization of successful ETV clinical outcomes and a subgroup meta-analysis of ETV success rates across binarized age groups. Meta-analysis was conducted using a Mantel-Haenszel fixed-effects model. The outcomes presented include generalized ETV success rates across all 12 studies. Age-specific individual data was measured with odds ratios, with a pooled statistic measured using the Mantel-Haenszel test. Overall, 2294 studies were identified in this search, of which 12 were selected for inclusion in this systematic review. Of these, 3 studies were utilized for age-specific meta-analyses. Preliminary synthesis of ETV clinical outcomes across all 12 studies revealed a success rate of 60.2%. Additionally, meta-analysis revealed that iNPH patients younger than or equal to 65 years of age were significantly more likely to respond successfully to ETV intervention. Heterogeneity was inconsequential in this analysis.
Collapse
Affiliation(s)
- Neel H Mehta
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ana B W Greenberg
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kristopher T Kahle
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Broad institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Center for Hydrocephalus and Neurodevelopmental Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA.
| |
Collapse
|
8
|
Passaretti M, Maranzano A, Bluett B, Rajalingam R, Fasano A. Gait Analysis in Idiopathic Normal Pressure Hydrocephalus: A Meta-Analysis. Mov Disord Clin Pract 2023; 10:1574-1584. [PMID: 38026510 PMCID: PMC10654838 DOI: 10.1002/mdc3.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/19/2023] [Accepted: 05/30/2023] [Indexed: 12/01/2023] Open
Abstract
Background Gait analysis objectively quantifies gait impairment in idiopathic normal pressure hydrocephalus (iNPH), may improve diagnosis and evaluation for surgical candidacy. Objectives This meta-analysis aims to understand which objective gait parameters improve after tap-test (TT) and CSF shunt surgery (CSS), also comparing responders (R) with non-responders (NR) and to assess if gait restores within the range of healthy controls after procedures. Methods Studies enrolling iNPH with at least one instrumented gait measure were selected. Three time points of gait assessment were defined: PRE, POST-TT, and POST-CSS. Gait velocity, cadence, step length, stride length, and double limb support time were evaluated. Patients were categorized based on responsiveness to CSF diversion procedures. Results Seventeen studies including 527 patients were selected. iNPH improved significantly in almost all gait parameters POST-TT, and to a greater extent POST-CSS. Gait parameters consistently discriminated iNPH from healthy controls. Despite the aforementioned improvements, iNPH's gait did not completely normalize after CSF diversion procedures. Meta-regression analysis also revealed that TT's effect on gait velocity plateaus after 24-48 hr and returns to baseline in 90-100 hr. Conclusions Gait analysis is a reliable quantitative instrument to assess gait impairment in iNPH, demarking a net differentiation from healthy controls, according to the notion that the iNPH CSF dynamic alteration also leads to an irreversible damage. Specific gait parameters improve among TT-R, providing an opportunity to select patients that will respond to CSS. Future studies validating a standardized reporting method including criteria of responsiveness, specific gait parameters, and timeframe of assessment are needed.
Collapse
Affiliation(s)
| | - Alessio Maranzano
- Department of Neurology and Laboratory of NeuroscienceIstituto Auxologico Italiano IRCCSMilanItaly
| | - Brent Bluett
- Central California Movement DisordersPismo BeachCaliforniaUSA
| | - Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
- Department of Parkinson's Disease and Movement Disorders RehabilitationMoriggia‐Pelascini Hospital–Gravedona ed UnitiComoItaly
| |
Collapse
|
9
|
Li H, Liu C, Tai H, Wei Y, Shen T, Yang Q, Zheng K, Xing Y. Comparison of cerebrospinal fluid space between probable normal pressure hydrocephalus and Alzheimer's disease. Front Aging Neurosci 2023; 15:1241237. [PMID: 37693646 PMCID: PMC10484096 DOI: 10.3389/fnagi.2023.1241237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Idiopathic normal pressure hydrocephalus (INPH) is a potentially reversible syndrome characterized by complex symptoms, difficulty in diagnosis and a lack of detailed clinical description, and it is difficult to distinguish from Alzheimer's disease (AD). The objective of this study was to design a method for measuring the actual amount of hydrocephalus in patients with INPH and to evaluate INPH. Methods All subjects underwent a 3D T1-weighted MRI. Statistical parametric mapping 12 was used for preprocessing images, statistical analysis, and voxel-based morphometric gray matter (GM) volume, white matter (WM) volume, and cerebrospinal fluid (CSF) volume analysis. The demographic and clinical characteristics of the groups were compared using a t-test for continuous variables and a chi-square test for categorical variables. Pearson's correlation analysis and Bonferroni's statistic-corrected one-way ANOVA were used to determine the relationship among demographic variables. Receiver operating characteristic (ROC) curves were used to assess the accuracy of the callosal angle (CA), WM ratio, and CSF ratio in distinguishing probable INPH from AD. Results The study included 42 patients with INPH, 32 patients with AD, and 24 healthy control subjects (HCs). There were no differences among the three groups in basic characteristics except for Mini-Mental State Examination (MMSE). There was a correlation between the intracranial CSF ratio and CA. The WM ratio and CSF ratio in patients with INPH and AD were statistically different. Furthermore, the combination of CA, WM ratio, and CSF ratio had a greater differential diagnostic value between INPH and AD patients than CA alone. Conclusion INPH can be accurately assessed by measuring intracranial CSF ratio, and the addition of WM ratio and CSF ratio significantly improved the differential diagnostic value of probable INPH from AD compared to CA alone.
Collapse
Affiliation(s)
- Hongliang Li
- Department of Neurology, Aviation General Hospital, Beijing, China
| | - Chunyan Liu
- Department of Neurology, Aviation General Hospital, Beijing, China
| | - Hong Tai
- Department of Medical Imaging, Aviation General Hospital, Beijing, China
| | - Youping Wei
- Department of Rehabilitation, Aviation General Hospital, Beijing, China
| | - Taizhong Shen
- Department of Rehabilitation, Aviation General Hospital, Beijing, China
| | - Qiong Yang
- Department of Neurology, Aviation General Hospital, Beijing, China
| | - Keyang Zheng
- Department of Cardiovascular Medicine, Capital Medical University Affiliated Anzhen Hospital, Beijing, China
| | - Yan Xing
- Department of Neurology, Aviation General Hospital, Beijing, China
| |
Collapse
|
10
|
Dias SF, Graf C, Jehli E, Oertel MF, Mahler J, Schmid Daners M, Stieglitz LH. Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus. Front Neurol 2023; 14:1126298. [PMID: 37082443 PMCID: PMC10110860 DOI: 10.3389/fneur.2023.1126298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/01/2023] [Indexed: 04/07/2023] Open
Abstract
BackgroundThe identification of patients with gait disturbance associated with idiopathic normal pressure hydrocephalus (iNPH) is challenging. This is due to the multifactorial causes of gait disturbance in elderly people and the single moment examination of laboratory tests.ObjectiveWe aimed to assess whether the use of gait sensors in a patient's home environment could help establish a reliable diagnostic tool to identify patients with iNPH by differentiating them from elderly healthy controls (EHC).MethodsFive wearable inertial measurement units were used in 11 patients with iNPH and 20 matched EHCs. Data were collected in the home environment for 72 h. Fifteen spatio-temporal gait parameters were analyzed. Patients were examined preoperatively and postoperatively. We performed an iNPH sub-group analysis to assess differences between responders vs. non-responders. We aimed to identify parameters that are able to predict a reliable response to VP-shunt placement.ResultsNine gait parameters significantly differ between EHC and patients with iNPH preoperatively. Postoperatively, patients with iNPH showed an improvement in the swing phase (p = 0.042), and compared to the EHC group, there was no significant difference regarding the cadence and traveled arm distance. Patients with a good VP-shunt response (NPH recovery rate of ≥5) significantly differ from the non-responders regarding cycle time, cycle time deviation, number of steps, gait velocity, straight length, stance phase, and stance to swing ratio. A receiver operating characteristic analysis showed good sensitivity for a preoperative stride length of ≥0.44 m and gait velocity of ≥0.39 m/s.ConclusionThere was a significant difference in 60% of the analyzed gait parameters between EHC and patients with iNPH, with a clear improvement toward the normalization of the cadence and traveled arm distance postoperatively, and a clear improvement of the swing phase. Patients with iNPH with a good response to VP-shunt significantly differ from the non-responders with an ameliorated gait pattern.
Collapse
Affiliation(s)
| | - Christina Graf
- Product Development Group Zurich, Department of Mechanical and Process Engineering, Eidgenoessische Technische Hochschule Zurich, Zurich, Switzerland
| | - Elisabeth Jehli
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Julia Mahler
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, Eidgenoessische Technische Hochschule Zurich, Zurich, Switzerland
- *Correspondence: Marianne Schmid Daners
| | | |
Collapse
|
11
|
Hoshi K, Kanno M, Goto A, Ugawa Y, Furukawa K, Arai H, Miyajima M, Takahashi K, Hattori K, Kan K, Saito T, Yamaguchi Y, Mitsufuji T, Araki N, Hashimoto Y. Brain-Derived Major Glycoproteins Are Possible Biomarkers for Altered Metabolism of Cerebrospinal Fluid in Neurological Diseases. Int J Mol Sci 2023; 24:ijms24076084. [PMID: 37047057 PMCID: PMC10094273 DOI: 10.3390/ijms24076084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
Cerebrospinal fluid (CSF) plays an important role in the homeostasis of the brain. We previously reported that CSF major glycoproteins are biosynthesized in the brain, i.e., lipocalin-type prostaglandin D2 synthase (L-PGDS) and transferrin isoforms carrying unique glycans. Although these glycoproteins are secreted from distinct cell types, their CSF levels have been found to be highly correlated with each other in cases of neurodegenerative disorders. The aim of this study was to examine these marker levels and their correlations in other neurological diseases, such as depression and schizophrenia, and disorders featuring abnormal CSF metabolism, including spontaneous intracranial hypotension (SIH) and idiopathic normal pressure hydrocephalus (iNPH). Brain-derived marker levels were found to be highly correlated with each other in the CSF of depression and schizophrenia patients. SIH is caused by CSF leakage, which is suspected to induce hypovolemia and a compensatory increase in CSF production. In SIH, the brain-derived markers were 2-3-fold higher than in other diseases, and, regardless of their diverse levels, they were found to be correlated with each other. Another abnormality of the CSF metabolism, iNPH, is possibly caused by the reduced absorption of CSF, which secondarily induces CSF accumulation in the ventricle; the excess CSF compresses the brain's parenchyma to induce dementia. One potential treatment is a "shunt operation" to bypass excess CSF from the ventricles to the peritoneal cavity, leading to the attenuation of dementia. After the shunt operation, marker levels began to increase within a week and then further increased by 2-2.5-fold at three, six, and twelve months post-operation, at which point symptoms had gradually attenuated. Notably, the marker levels were found to be correlated with each other in the post-operative period. In conclusion, the brain-derived major glycoprotein markers were highly correlated in the CSF of patients with different neurological diseases, and their correlations were maintained even after surgical intervention. These results suggest that brain-derived proteins could be biomarkers of CSF production.
Collapse
Grants
- 16hm0102042h0001, 17hm0102042h0002, 18hm0102042h0003, 19dk0310099h0001, 20dk0310099h0002, 21dk0310099h0003, 20dm0307003h0003, 21dm0307003h0004 the Japan Agency for Medical Research and Development (AMED)
- 16hm0102042h0001, 17hm0102042h0002, 18hm0102042h0003, 19dk0310099h0001, 20dk0310099h0002, 21dk0310099h0003, 20dm0307003h0003, 21dm0307003h0004 the Japan Agency for Medical Research and Development (AMED)
Collapse
Affiliation(s)
- Kyoka Hoshi
- Department of Biochemistry, Fukushima Medical University, Fukushima City 960-1295, Fukushima, Japan
| | - Mayumi Kanno
- Department of Forensic Medicine, Fukushima Medical University, Fukushima City 960-1295, Fukushima, Japan
| | - Aya Goto
- Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima City 960-1295, Fukushima, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima City 960-1295, Fukushima, Japan
| | - Katsutoshi Furukawa
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Miyagi, Japan
| | - Hiroyuki Arai
- Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Miyagi, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo University, Bunkyo City 113-8421, Tokyo, Japan
| | - Koichi Takahashi
- Department of Neurosurgery, Sanno Hospital, Minato City 107-0052, Tokyo, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira 187-8502, Tokyo, Japan
| | - Keiichi Kan
- Department of Anesthesiology, Southern Tohoku General Hospital, Koriyama 963-8052, Fukushima, Japan
| | - Takashi Saito
- Department of Neurocognitive Science, Nagoya City University, Nagoya 467-8601, Aichi, Japan
| | - Yoshiki Yamaguchi
- Laboratory of Pharmaceutical Physical Chemistry, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Miyagi, Japan
| | - Takashi Mitsufuji
- Department of Neurology, Saitama Medical University Hospital, Koshigaya 350-0495, Saitama, Japan
| | - Nobuo Araki
- Department of Neurology, Saitama Medical University Hospital, Koshigaya 350-0495, Saitama, Japan
| | - Yasuhiro Hashimoto
- Department of Forensic Medicine, Fukushima Medical University, Fukushima City 960-1295, Fukushima, Japan
| |
Collapse
|
12
|
Torelli G, Severino R, Caggiano C, Torelli M, de Martino L, Russo G. Hydrocephalus As Possible Prodromal Manifestation of COVID-19: A Report of Two Cases. Cureus 2023; 15:e34371. [PMID: 36874689 PMCID: PMC9975901 DOI: 10.7759/cureus.34371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
Although the etiopathology of normal pressure hydrocephalus (NPH) is still not completely defined, several studies in recent years have highlighted the role of neuro-inflammation mediators in its development. During COVID-19, the infected host develops a multifaceted inflammatory syndrome, that may lead to an uncontrolled immune system response also localized in the host nervous system. In fact, the target of the viral Spike protein, the angiotensin-converting enzyme 2 (ACE2) receptors, is widely expressed in different areas of CNS such as the olfactory epithelium, and the choroid plexus. As for idiopathic NPH, the massive release of inflammatory mediators may result in altered CSF dynamics and consequent sudden clinical decompensation. We report the cases of two patients with a known iNPH condition, in which neurological symptoms suddenly worsened, requiring hospitalization, without any evident precipitating cause. Both patients tested positive for the COVID-19 virus shortly after the neurological impairment, which had occurred, therefore, during the incubation period of the infection. On the basis of our experience we advise, in cases of NPH patients with sudden neurological worsening, to perform a molecular COVID-19 swab at the moment of clinical impairment. We, therefore, recommend considering SARS-CoV-2 infection in the differential diagnosis of a sudden and otherwise unexplainable impairment of hydrocephalic patients. Furthermore, we believe clinicians should invite NPH patients to adopt adequate preventive measures to protect them from SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Giovanni Torelli
- Neurosurgery, Azienda Ospedaliera Universitaria (AOU) San Giovanni e Ruggi d'Aragona, Salerno, ITA
| | - Rocco Severino
- Neurosurgery, Azienda Ospedaliera Universitaria (AOU) San Giovanni e Ruggi d'Aragona, Salerno, ITA
| | - Chiara Caggiano
- Neurosurgery, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Naples, ITA
| | | | - Luca de Martino
- Neurosurgery, Azienda Ospedaliera Universitaria (AOU) San Giovanni e Ruggi d'Aragona, Salerno, ITA
| | - Giuseppe Russo
- Neurosurgery, Azienda Ospedaliera Universitaria (AOU) San Giovanni e Ruggi d'Aragona, Salerno, ITA
| |
Collapse
|
13
|
Verghese JP, Terry A, de Natale ER, Politis M. Research Evidence of the Role of the Glymphatic System and Its Potential Pharmacological Modulation in Neurodegenerative Diseases. J Clin Med 2022; 11:jcm11236964. [PMID: 36498538 PMCID: PMC9735716 DOI: 10.3390/jcm11236964] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The glymphatic system is a unique pathway that utilises end-feet Aquaporin 4 (AQP4) channels within perivascular astrocytes, which is believed to cause cerebrospinal fluid (CSF) inflow into perivascular space (PVS), providing nutrients and waste disposal of the brain parenchyma. It is theorised that the bulk flow of CSF within the PVS removes waste products, soluble proteins, and products of metabolic activity, such as amyloid-β (Aβ). In the experimental model, the glymphatic system is selectively active during slow-wave sleep, and its activity is affected by both sleep dysfunction and deprivation. Dysfunction of the glymphatic system has been proposed as a potential key driver of neurodegeneration. This hypothesis is indirectly supported by the close relationship between neurodegenerative diseases and sleep alterations, frequently occurring years before the clinical diagnosis. Therefore, a detailed characterisation of the function of the glymphatic system in human physiology and disease would shed light on its early stage pathophysiology. The study of the glymphatic system is also critical to identifying means for its pharmacological modulation, which may have the potential for disease modification. This review will critically outline the primary evidence from literature about the dysfunction of the glymphatic system in neurodegeneration and discuss the rationale and current knowledge about pharmacological modulation of the glymphatic system in the animal model and its potential clinical applications in human clinical trials.
Collapse
|
14
|
Möhwald K, Wuehr M, Decker J, Asch EM, Schenkel F, Illigens B, Schniepp R. Quantification of pathological gait parameter thresholds of idiopathic normal pressure hydrocephalus patients in clinical gait analysis. Sci Rep 2022; 12:18295. [PMID: 36316420 PMCID: PMC9622747 DOI: 10.1038/s41598-022-22692-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
The aim of the study was to distinguish the hypokinetic gait disorder in idiopathic normal pressure hydrocephalus (NPH) patients from the gait decline in the elderly population by quantifying pathological gait parameter thresholds utilizing a multiple condition gait assessment. 55 NPH patients and 55 age-matched healthy subjects underwent a standardized gait assessment with eight gait conditions. Spatiotemporal gait parameters were assessed through a pressure-sensitive carpet. Statistical analysis consisted of a binary logistic regression (BLR) model, logistic curve-fit evaluated by a Chi-square goodness-of-fit-test, receiver operating characteristic models with area under the curves (AUC), and inverse BLR. Most discriminative gait parameter thresholds were observed in pace, gait cycle, and support gait domains. The most distinct gait conditions were preferred walking speed and semantic dual task. During preferred walking speed, the most significant gait parameter thresholds were stride length ≤ 1.02 m (sensitivity 0.93/specificity 0.91/AUC 0.96), gait velocity ≤ 0.83 m/s (0.80/0.91/0.93), double support phase ≥ 27.0% (0.96/0.76/0.91), and stride length coefficient of variation ≥ 3.4% (0.93/0.72/0.90). In conclusion, the hypokinetic gait disorder in NPH can be quantitatively differentiated from gait patterns of the elderly population. In future studies, this approach may be useful to differentiate clinical entities with similar gait disorders utilizing instrumented gait analysis procedures.
Collapse
Affiliation(s)
- Ken Möhwald
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany ,grid.5252.00000 0004 1936 973XGerman Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany ,grid.440925.e0000 0000 9874 1261Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Max Wuehr
- grid.5252.00000 0004 1936 973XGerman Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Julian Decker
- grid.490431.b0000 0004 0581 7239Schoen Klinik Bad Aibling, Kolbermoorer Str. 72, 83043 Bad Aibling, Germany
| | - Eric-Manuel Asch
- grid.5252.00000 0004 1936 973XGerman Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Fabian Schenkel
- grid.5252.00000 0004 1936 973XGerman Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Ben Illigens
- grid.440925.e0000 0000 9874 1261Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany ,grid.38142.3c000000041936754XBeth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Roman Schniepp
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany ,grid.5252.00000 0004 1936 973XGerman Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| |
Collapse
|
15
|
Can preoperative brain imaging features predict shunt response in idiopathic normal pressure hydrocephalus? A PRISMA review. Neuroradiology 2022; 64:2119-2133. [DOI: 10.1007/s00234-022-03021-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
|
16
|
Sun Y, Liang S, Yu Y, Yang Y, Lu J, Wu J, Cheng Y, Wang Y, Wu J, Han J, Yu N. Plantar pressure-based temporal analysis of gait disturbance in idiopathic normal pressure hydrocephalus: Indications from a pilot longitudinal study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 217:106691. [PMID: 35176597 DOI: 10.1016/j.cmpb.2022.106691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/24/2022] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) is a common yet potentially reversible neurodegenerative disease, and gait disturbance is a major symptom. Lots of methodological and clinical work has been conducted on gait disturbance analysis for differential diagnosis, presurgical test, and postsurgery assessment of iNPH. Nevertheless, the verification analysis was mostly lacking for surgery response, and the temporal characteristics of ground reaction force has been rarely investigated. METHODS In this work, we propose that plantar pressure features fundamentally signifies iNPH gait disturbance and improvement after cerebrospinal fluid (CSF) drainage by lumbar puncture tap test as well as surgical shunt implantation. The plantar pressure signals of six iNPH patients and eight healthy controls were collected, and an online database of sixteen healthy controls were used. For patients, data were collected in five periods, which are the baseline before the tap test, 8, 24, and 72 hours after the tap test, and one month after the shunt implantation surgery, respectively. Fast dynamic time warping (DTW) with an improved DTW barycenter averaging (DBA) method was proposed for temporal analysis with the measured and online plantar pressure data. An plantar-pressure variation index (PPVI) was formulated to characterize the temporal dynamic stability of walking. RESULTS The PPVI based on temporal analysis of plantar pressure well discriminated the impaired gait (baseline, 24 and 72 hours after tap test) with the improved gait (8 hours after tap test and follow up after surgery) of the patients. Further, the PPVI was close for the improved gait of the patients and the healthy gait measured in our study as well as in the online database. CONCLUSIONS Plantar pressure-based temporal features are promisingly effective for clinical examination and treatment of iNPH.
Collapse
Affiliation(s)
- Yubo Sun
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Yang Yu
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Yuchen Yang
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Jiewei Lu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Jingchao Wu
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Yuanyuan Cheng
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Yue Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China
| | - Jialing Wu
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China; Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China; Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin 300350, China.
| | - Jianda Han
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China.
| | - Ningbo Yu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China.
| |
Collapse
|
17
|
Aunan-Diop JS, Pedersen CB, Halle B, Jensen U, Munthe S, Harbo F, Johannsson B, Poulsen FR. Magnetic resonance elastography in normal pressure hydrocephalus-a scoping review. Neurosurg Rev 2022; 45:1157-1169. [PMID: 34687356 DOI: 10.1007/s10143-021-01669-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/05/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Magnetic resonance elastography (MRE) of the brain allows quantitative measurement of tissue mechanics. Multiple studies are exploring possible applications in normal pressure hydrocephalus (NPH) in clinical and paraclinical contexts. This is of great interest in neurological surgery due to challenges related to diagnosis and prediction of treatment effects. In this scoping review, we present a topical overview and discuss the current literature, with particular attention to clinical implications and current challenges. METHODS The protocol was based on the PRISMA extension for scoping reviews. After a systematic database search (PubMed, Embase, and Web of Science), the articles were screened for relevance. Thirty articles were subject to detailed screening, and key technical and clinical data items were extracted. The inclusion criteria included the use of MRE on human subjects with NPH. RESULTS Seven articles were included in the final study. These studies had various objectives including the role of MRE in the assessment of regional elastic changes in NPH, shunt effect, and evaluation of NPH symptoms. MRE revealed patterns of mechanical changes in NPH that differed from other dementias. Regional MRE changes were associated with specific NPH signs and symptoms. Neurosurgical shunting caused partial normalization in tissue scaffold parameters. The studies were highly heterogeneous in technical aspects and design. CONCLUSION MRE studies in NPH are still limited by few participants, variable cohorts, inconsistent methodologies, and technical challenges, but the approach shows great potential for future clinical application.
Collapse
Affiliation(s)
- Jan Saip Aunan-Diop
- Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, Entrance 44, 5000, Odense C, Denmark. .,University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Christian Bonde Pedersen
- Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, Entrance 44, 5000, Odense C, Denmark
| | - Bo Halle
- Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, Entrance 44, 5000, Odense C, Denmark
| | - Ulla Jensen
- Department of Radiology, Odense University Hospital, Kløvervænget 47, Entrance 27, 5000, Odense C, Denmark
| | - Sune Munthe
- Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, Entrance 44, 5000, Odense C, Denmark
| | - Fredrik Harbo
- Department of Radiology, Odense University Hospital, Kløvervænget 47, Entrance 27, 5000, Odense C, Denmark
| | - Bjarni Johannsson
- Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, Entrance 44, 5000, Odense C, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, Entrance 44, 5000, Odense C, Denmark.,University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| |
Collapse
|
18
|
Vasconcelos TDMF, Nóbrega PR, Ferreira GDM, de Souza MLP, Vanderlei AS, de Castro JDV, Braga-Neto P, Sobreira-Neto MA. Normal pressure hydrocephalus associated with COVID-19 infection: a case report. BMC Infect Dis 2022; 22:216. [PMID: 35241017 PMCID: PMC8892823 DOI: 10.1186/s12879-022-07184-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND COVID-19 is a pandemic disease responsible for many deaths worldwide. Many neurological manifestations have been described. We report a case of normal pressure hydrocephalus (NPH) 2 months after acute COVID19 infection, in a patient without other risk factors. CASE PRESENTATION A 45-year-old male patient presented an 8-month history of progressive gait disorder and cognitive impairment after being hospitalized for SARS-CoV-2 infection. Magnetic resonance imaging (MRI) was compatible with NPH. A spinal tap test was positive and there was progressive improvement after shunting, with complete resolution of symptoms. CONCLUSION Other infections such as syphilis, cryptococcosis and Lyme disease have been associated with NPH. Possible mechanisms for NPH after COVID include disruption of choroid plexus cells by direct viral invasion or as a result of neuroinflammation and cytokine release and hypercoagulability leading to venous congestion and abnormalities of CSF flow. Given the significance of NPH as a cause of reversible dementia, it is important to consider the possibility of a causal association with COVID19 and understand the mechanisms behind this association.
Collapse
Affiliation(s)
| | - Paulo Ribeiro Nóbrega
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil.,Department of Clinical Medicine, Neurology Section, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | - Moysés Loiola Ponte de Souza
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil.,Department of Clinical Medicine, Neurology Section, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | | | - Pedro Braga-Neto
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil. .,Department of Clinical Medicine, Neurology Section, Universidade Federal do Ceará, Fortaleza, Brazil. .,Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil. .,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.
| | - Manoel Alves Sobreira-Neto
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil.,Department of Clinical Medicine, Neurology Section, Universidade Federal do Ceará, Fortaleza, Brazil.,Unichristus University, Fortaleza, Brazil
| |
Collapse
|
19
|
Trungu S, Scollato A, Ricciardi L, Forcato S, Polli FM, Miscusi M, Raco A. Clinical Outcomes of Shunting in Normal Pressure Hydrocephalus: A Multicenter Prospective Observational Study. J Clin Med 2022; 11:jcm11051286. [PMID: 35268376 PMCID: PMC8911143 DOI: 10.3390/jcm11051286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Normal pressure hydrocephalus (NPH) is characterized by the triad of dementia, gait disturbance and urinary incontinence, all potentially reversible following a ventriculoperitoneal shunt (VPS). This study aims to evaluate the clinical outcomes of shunting in normal pressure hydrocephalus following a new standardized protocol. Methods: This study is designed according to the STROBE guidelines. Demographical, clinical, surgical and radiological data were collected from May 2015 to November 2019. Gait, balance and incontinence data based on the NPH European scale were collected before and after one, six and twelve months of treatment with a VPS. Clinical symptoms and changes of the stoke volume, measured on phase-contrast MRI, were used to evaluate improvement after VPS surgery. Results: One hundred and eighty-one consecutive patients met the inclusion criteria. The mean age was 73.1 years (59−86) and mean follow-up was 38.3 months (13−50). The gait (58.5 ± 14.3 to 70.1 ± 13.4, p < 0.001), the balance (66.7 ± 21.5 to 71.7 ± 22.1, p = 0.001), continence domain (69.9 ± 20.5 to 76 ± 20, p = 0.002) scores and neuropsychological scales showed a statistically significant improvement over the follow-up. The overall improvement after 12 months was present in 91.2% of patients. An overall complication rate of 8.8% and a reoperation rate of 9.4% were recorded, respectively. Conclusions: Surgical treatment by VPS for NPH improves symptoms in most patients, when accurately selected. A standardized protocol and a multidisciplinary team dedicated to this disorder is needed to achieve an early and correct diagnosis of NPH. Follow-up with stroke volume measurement is a valuable tool for the early diagnosis of shunt malfunction or the need for valve adjustment.
Collapse
Affiliation(s)
- Sokol Trungu
- Neurosurgery Unit, Card. G. Panico Hospital, 73039 Tricase, Italy; (A.S.); (S.F.)
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
- Correspondence:
| | - Antonio Scollato
- Neurosurgery Unit, Card. G. Panico Hospital, 73039 Tricase, Italy; (A.S.); (S.F.)
| | - Luca Ricciardi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
| | - Stefano Forcato
- Neurosurgery Unit, Card. G. Panico Hospital, 73039 Tricase, Italy; (A.S.); (S.F.)
| | | | - Massimo Miscusi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
| | - Antonino Raco
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
| |
Collapse
|
20
|
Youn J, Todisco M, Zappia M, Pacchetti C, Fasano A. Parkinsonism and cerebrospinal fluid disorders. J Neurol Sci 2021; 433:120019. [PMID: 34674853 DOI: 10.1016/j.jns.2021.120019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/25/2021] [Accepted: 09/29/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although various motor manifestations can be seen in patients with cerebrospinal fluid (CSF) disorders, such as hydrocephalus or intracranial hypotension, the clinical presentation with parkinsonism is not clearly elucidated. METHODS We searched the literature for studies describing the occurrence of parkinsonism in subjects with normal pressure hydrocephalus (NPH), obstructive hydrocephalus, and intracranial hypotension. We analyzed the clinical presentation (particularly with respect to bradykinesia, rigidity, rest tremor, and gait disturbance/postural instability) as well as the response to treatment. RESULTS Parkinsonism was most commonly reported in NPH patients. Although gait disturbance/postural instability is a well-known motor symptom of NPH, other cardinal signs include upper limb involvement or asymmetric presentation. As for obstructive hydrocephalus, parkinsonism was mainly observed in subjects with aqueductal stenosis and more often after shunt surgery. Patients with NPH or obstructive hydrocephalus rarely improved with levodopa therapy, while most subjects only improved with shunt surgery. Although the mechanism is still controversial, a functional involvement of nigrostriatal pathway has been hypothesized based on imaging studies and case reports. Brain imaging is also helpful for atypical cases of intracranial hypotension presenting with parkinsonism. Parkinsonism improved after treatment in such cases as well. CONCLUSIONS Studies exploring the relationship between CSF disorders and parkinsonism are mainly descriptive and their quality is generally poor. However, considering that these disorders can be treated, clinicians' awareness of the differential diagnosis is important and future studies better exploring the underlying pathophysiological mechanisms are warranted. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
Collapse
Affiliation(s)
- Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Massimiliano Todisco
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mario Zappia
- Department of Medical, Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', University of Catania, Catania, Italy
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada.
| |
Collapse
|
21
|
Kuruvithadam K, Menner M, Taylor WR, Zeilinger MN, Stieglitz L, Schmid Daners M. Data-Driven Investigation of Gait Patterns in Individuals Affected by Normal Pressure Hydrocephalus. SENSORS 2021; 21:s21196451. [PMID: 34640771 PMCID: PMC8512819 DOI: 10.3390/s21196451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
Normal pressure hydrocephalus (NPH) is a chronic and progressive disease that affects predominantly elderly subjects. The most prevalent symptoms are gait disorders, generally determined by visual observation or measurements taken in complex laboratory environments. However, controlled testing environments can have a significant influence on the way subjects walk and hinder the identification of natural walking characteristics. The study aimed to investigate the differences in walking patterns between a controlled environment (10 m walking test) and real-world environment (72 h recording) based on measurements taken via a wearable gait assessment device. We tested whether real-world environment measurements can be beneficial for the identification of gait disorders by performing a comparison of patients’ gait parameters with an aged-matched control group in both environments. Subsequently, we implemented four machine learning classifiers to inspect the individual strides’ profiles. Our results on twenty young subjects, twenty elderly subjects and twelve NPH patients indicate that patients exhibited a considerable difference between the two environments, in particular gait speed (p-value p=0.0073), stride length (p-value p=0.0073), foot clearance (p-value p=0.0117) and swing/stance ratio (p-value p=0.0098). Importantly, measurements taken in real-world environments yield a better discrimination of NPH patients compared to the controlled setting. Finally, the use of stride classifiers provides promise in the identification of strides affected by motion disorders.
Collapse
Affiliation(s)
- Kiran Kuruvithadam
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland;
| | - Marcel Menner
- Institute for Dynamic Systems and Control, ETH Zurich, 8092 Zurich, Switzerland; (M.M.); (M.N.Z.)
| | - William R. Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland;
| | - Melanie N. Zeilinger
- Institute for Dynamic Systems and Control, ETH Zurich, 8092 Zurich, Switzerland; (M.M.); (M.N.Z.)
| | - Lennart Stieglitz
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland;
- Correspondence:
| |
Collapse
|
22
|
Acosta LMY, Stubblefield K, Conwell T, Espaillat K, Koons H, Konrad P, Fang J, Kirshner H, Davis T. Protocolizing the Workup for Idiopathic Normal Pressure Hydrocephalus Improves Outcomes. Neurol Clin Pract 2021; 11:e447-e453. [PMID: 34484943 DOI: 10.1212/cpj.0000000000001018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/22/2020] [Indexed: 11/15/2022]
Abstract
Background The workup for idiopathic normal pressure hydrocephalus (INPH) can be difficult to coordinate, and determining appropriate patients for ventriculoperitoneal shunting can be challenging. Therefore, we hypothesized that implementing a formalized protocol can improve patient selection for a shunt. In conjunction with neurology and neurosurgery, we instituted a standardized means of assessing patients whose presentation is concerning for INPH and compared their workup with similar patients seen without the Protocol (i.e., preprotocol [PP]) regarding baseline characteristics, assessment, and outcomes. Methods Twenty-six PP patients were compared with 40 Protocol patients on measures, including baseline deficits, workup, neurosurgical evaluation, and response to shunt. Results Average age was similar between groups, and the percentage of patients who had a decline in gait, cognition, and/or incontinence was not statistically different (p > 0.05). Significantly more Protocol patients underwent high-volume lumbar puncture (HVLP; 97.5%; PP, 61.5%; p < 0.001) and received formalized gait assessment with the Gait Scale (90%; PP, 0%, p < 0.001) and standardized cognitive testing (95%; PP, 38.5%; p < 0.001). Significantly more Protocol patients had no improvement after HVLP (33.3%; PP, 6.25%; p < 0.045); subsequently, fewer got shunted (57.5%; PP, 84.6%; p < 0.030). More Protocol patients who were shunted reported gait improvement (100%; PP, 72.7%; p = 0.009), although there was no difference in cognition (59.2%; PP, 82.6%; p = 0.108) or incontinence (18.2%; PP, 39.1%; p = 0.189). Conclusions Implementing an INPH Protocol leads to standardized and more extensive assessment and better patient selection for and subsequent outcomes from shunting, specifically regarding gait.
Collapse
Affiliation(s)
- Lealani Mae Y Acosta
- Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV
| | - Kassandra Stubblefield
- Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV
| | - Trisha Conwell
- Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV
| | - Kiersten Espaillat
- Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV
| | - Heather Koons
- Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV
| | - Peter Konrad
- Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV
| | - John Fang
- Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV
| | - Howard Kirshner
- Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV
| | - Thomas Davis
- Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV
| |
Collapse
|
23
|
Wu D, Moghekar A, Shi W, Blitz AM, Mori S. Systematic volumetric analysis predicts response to CSF drainage and outcome to shunt surgery in idiopathic normal pressure hydrocephalus. Eur Radiol 2021; 31:4972-4980. [PMID: 33389035 PMCID: PMC8213563 DOI: 10.1007/s00330-020-07531-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/05/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Idiopathic normal pressure hydrocephalus (INPH) is a neurodegenerative disorder characterized by excess cerebrospinal fluid (CSF) in the ventricles, which can be diagnosed by invasive CSF drainage test and treated by shunt placement. Here, we aim to investigate the diagnostic and prognostic power of systematic volumetric analysis based on brain structural MRI for INPH. METHODS We performed a retrospective study with a cohort of 104 probable INPH patients who underwent CSF drainage tests and another cohort of 41 INPH patients who had shunt placement. High-resolution T1-weighted images of the patients were segmented using an automated pipeline into 283 structures that are grouped into different granularity levels for volumetric analysis. Volumes at multi-granularity levels were used in a recursive feature elimination model to classify CSF drainage responders and non-responders. We then used pre-surgical brain volumes to predict Tinetti and MMSE scores after shunting, based on the least absolute shrinkage and selection operator. RESULTS The classification accuracy of differentiating the CSF drainage responders and non-responders increased as the granularity increased. The highest diagnostic accuracy was achieved at the finest segmentation with a sensitivity/specificity/precision/accuracy of 0.89/0.91/0.84/0.90 and an area under the curve of 0.94. The predicted post-surgical neurological scores showed high correlations with the ground truth, with r = 0.80 for Tinetti and r = 0.88 for MMSE. The anatomical features that played important roles in the diagnostic and prognostic tasks were also illustrated. CONCLUSIONS We demonstrated that volumetric analysis with fine segmentation could reliably differentiate CSF drainage responders from other INPH-like patients, and it could accurately predict the neurological outcomes after shunting. KEY POINTS • We performed a fully automated segmentation of brain MRI at multiple granularity levels for systematic volumetric analysis of idiopathic normal pressure hydrocephalus (INPH) patients. • We were able to differentiate patients that responded to CSF drainage test with an accuracy of 0.90 and area under the curve of 0.94 in a cohort of 104 probable INPH patients, as well as to predict the post-shunt gait and cognitive scores with a coefficient of 0.80 for Tinetti and 0.88 for MMSE. • Feature analysis showed the inferior lateral ventricle, bilateral hippocampus, and orbital cortex are positive indicators of CSF drainage responders, whereas the posterior deep white matter and parietal subcortical white matter were negative predictors.
Collapse
Affiliation(s)
- Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, Zhejiang, China
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Wen Shi
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, Zhejiang, China
| | - Ari M Blitz
- Department of Radiology, University Hospitals, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Susumu Mori
- Department of Radiology, University Hospitals, Case Western Reserve University, Cleveland, OH, 44106, USA.
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, 21205, USA.
| |
Collapse
|
24
|
Griffa A, Bommarito G, Assal F, Herrmann FR, Van De Ville D, Allali G. Dynamic functional networks in idiopathic normal pressure hydrocephalus: Alterations and reversibility by CSF tap test. Hum Brain Mapp 2020; 42:1485-1502. [PMID: 33296129 PMCID: PMC7927299 DOI: 10.1002/hbm.25308] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/02/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Alessandra Griffa
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute of Bioengineering, Center of Neuroprosthetics, École Polytechnique Fédérale De Lausanne (EPFL), Geneva, Switzerland
| | - Giulia Bommarito
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute of Bioengineering, Center of Neuroprosthetics, École Polytechnique Fédérale De Lausanne (EPFL), Geneva, Switzerland
| | - Frédéric Assal
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - François R Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Dimitri Van De Ville
- Institute of Bioengineering, Center of Neuroprosthetics, École Polytechnique Fédérale De Lausanne (EPFL), Geneva, Switzerland.,Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA
| |
Collapse
|
25
|
Lilja-Lund O, Kockum K, Hellström P, Söderström L, Nyberg L, Laurell K. Wide temporal horns are associated with cognitive dysfunction, as well as impaired gait and incontinence. Sci Rep 2020; 10:18203. [PMID: 33097796 PMCID: PMC7584644 DOI: 10.1038/s41598-020-75381-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022] Open
Abstract
The association between morphology of the brain and symptoms of suspected idiopathic normal pressure hydrocephalus (iNPH) is largely unknown. We investigated how ventricular expansion (width of the temporal horns [TH], callosal angle [CA], and Evans' index [EI]) related to symptom severity in suspected iNPH. Participants (n = 168; 74.9 years ± SD 6.7; 55% females) from the general population underwent neurological examination, computed tomography, and neuropsychological testing. Multiple linear regression analysis revealed that wide TH was independently associated with all examined iNPH symptoms (p < 0.01) except for fine-motor performance, whereas a narrow CA only was associated to specific motor and cognitive functions (p < 0.05). TH and EI correlated significantly with incontinence (rs 0.17 and rs 0.16; p < 0.05). In conclusion, wide TH was significantly associated with most iNPH-symptoms. This finding potentially reflects the complex nature of the hippocampus, however further studies are needed to demonstrate functional connectivity.
Collapse
Affiliation(s)
- Otto Lilja-Lund
- Department of Clinical Science, Neuroscience, Umeå University, Östersunds sjukhus, 831 83, Östersund, Sweden.
| | - Karin Kockum
- Department of Clinical Science, Neuroscience, Umeå University, Östersunds sjukhus, 831 83, Östersund, Sweden
| | - Per Hellström
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Lars Söderström
- Unit of Research, Education and Development, Östersund Hospital, Region Jämtland Härjedalen, Östersund, Sweden
| | - Lars Nyberg
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | | |
Collapse
|
26
|
Griffa A, Van De Ville D, Herrmann FR, Allali G. Neural circuits of idiopathic Normal Pressure Hydrocephalus: A perspective review of brain connectivity and symptoms meta-analysis. Neurosci Biobehav Rev 2020; 112:452-471. [PMID: 32088348 DOI: 10.1016/j.neubiorev.2020.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent reversible neurological disorder characterized by impaired locomotion, cognition and urinary control with ventriculomegaly. Symptoms can be relieved with cerebrospinal fluid drainage, which makes iNPH the leading cause of reversible dementia. Because of a limited understanding of pathophysiological mechanisms, unspecific symptoms and the high prevalence of comorbidity (i.e. Alzheimer's disease), iNPH is largely underdiagnosed. For these reasons, there is an urgent need for developing noninvasive quantitative biomarkers for iNPH diagnosis and prognosis. Structural and functional changes of brain circuits in relation to symptoms and treatment response are expected to deliver major advances in this direction. We review structural and functional brain connectivity findings in iNPH and complement those findings with iNPH symptom meta-analyses in healthy populations. Our goal is to reinforce our conceptualization of iNPH as to brain network mechanisms and foster the development of new hypotheses for future research and treatment options.
Collapse
Affiliation(s)
- Alessandra Griffa
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center of Neuroprosthetics, Ecole Polytechnique Fédérale De Lausanne (EPFL), Lausanne, Switzerland.
| | - Dimitri Van De Ville
- Institute of Bioengineering, Center of Neuroprosthetics, Ecole Polytechnique Fédérale De Lausanne (EPFL), Lausanne, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
| | - François R Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
| |
Collapse
|
27
|
Renggli D, Graf C, Tachatos N, Singh N, Meboldt M, Taylor WR, Stieglitz L, Schmid Daners M. Wearable Inertial Measurement Units for Assessing Gait in Real-World Environments. Front Physiol 2020; 11:90. [PMID: 32153420 PMCID: PMC7044412 DOI: 10.3389/fphys.2020.00090] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background Walking patterns can provide important indications of a person’s health status and be beneficial in the early diagnosis of individuals with a potential walking disorder. For appropriate gait analysis, it is critical that natural functional walking characteristics are captured, rather than those experienced in artificial or observed settings. To better understand the extent to which setting influences gait patterns, and particularly whether observation plays a varying role on subjects of different ages, the current study investigates to what extent people walk differently in lab versus real-world environments and whether age dependencies exist. Methods The walking patterns of 20 young and 20 elderly healthy subjects were recorded with five wearable inertial measurement units (ZurichMOVE sensors) attached to both ankles, both wrists and the chest. An automated detection process based on dynamic time warping was developed to efficiently identify the relevant sequences. From the ZurichMOVE recordings, 15 spatio-temporal gait parameters were extracted, analyzed and compared between motion patterns captured in a controlled lab environment (10 m walking test) and the non-controlled ecologically valid real-world environment (72 h recording) in both groups. Results Several parameters (Cluster A) showed significant differences between the two environments for both groups, including an increased outward foot rotation, step width, number of steps per 180° turn, stance to swing ratio, and cycle time deviation in the real-world. A number of parameters (Cluster B) showed only significant differences between the two environments for elderly subjects, including a decreased gait velocity (p = 0.0072), decreased cadence (p = 0.0051) and increased cycle time (p = 0.0051) in real-world settings. Importantly, the real-world environment increased the differences in several parameters between the young and elderly groups. Conclusion Elderly test subjects walked differently in controlled lab settings compared to their real-world environments, which indicates the need to better understand natural walking patterns under ecologically valid conditions before clinically relevant conclusions can be drawn on a subject’s functional status. Moreover, the greater inter-group differences in real-world environments seem promising regarding the sensitive identification of subjects with indications of a walking disorder.
Collapse
Affiliation(s)
- David Renggli
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Christina Graf
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Nikolaos Tachatos
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Navrag Singh
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - William R Taylor
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Lennart Stieglitz
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
28
|
Tudor KI, Nemir J, Pavliša G, Mrak G, Bilić E, Borovečki F. Management of idiopathic normal pressure hydrocephalus (iNPH) - a retrospective study. Br J Neurosurg 2020; 34:316-320. [PMID: 32046512 DOI: 10.1080/02688697.2020.1726288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Normal pressure hydrocephalus (NPH) is communicating hydrocephalus characterised by normal intraventricular pressures. It presents with the triad of gait impairment, cognitive decline, and urinary incontinence. The term idiopathic normal pressure hydrocephalus (iNPH) is used in cases where the etiology is unknown. The aim of this study was to assess the prevalence and management of iNPH in our institution.Method: This was a retrospective study carried out at a tertiary health care center. Retrospective case series analysis was conducted using the existing electronic medical record data (2009-2017) on patients with hydrocephalus.Results: Forty-two (6.7%) patients with iNPH were identified, mean age 71.5 ± 8.8 years, 21 male (mean age 71.5 ± 9.3 years) and 21 female (mean age 71.5 ± 8.5 years). Ataxia was recorded in 39, symptoms of dementia in 31, and urinary incontinence in 29 patients. Forty patients were treated surgically by placing a ventriculoperitoneal (VP) shunt. One of the two patients treated by endoscopic third ventriculostomy (ETV) was subsequently treated by placing a VP shunt due to clinical deterioration. Significant improvements were noticed in cognitive and urinary symptoms, in the triad symptom sum score on the Japanese NPH scale, as well as in Evans' index and callosal angle (CA) on brain MRI (p < 0.05). Significant positive correlation was found between age and gait disturbance (Spearman's rho = 49.86% p = 0.0017), age and incontinence (Spearman's rho = 35.22%, p = 0.0351), age and triad symptom sum score (Spearman's rho = 44.67%, p = 0.0056), female gender and dementia (Spearman's rho = 34.94%, p = 0.0367), and among all three variables on the Japanese NPH scale (p < 0.0001).Conclusions: Treatment of iNPH with VP shunt showed significant improvement. A properly designed study is required to address the efficacy of ETV in the treatment of iNPH.
Collapse
Affiliation(s)
- Katarina Ivana Tudor
- Department of Neurology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jakob Nemir
- Department of Neurosurgery, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Goran Pavliša
- Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Goran Mrak
- Department of Neurosurgery, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ervina Bilić
- Department of Neurology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Fran Borovečki
- Department of Neurology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
29
|
Ferrari A, Milletti D, Giannini G, Cevoli S, Oppi F, Palandri G, Albini-Riccioli L, Mantovani P, Anderlucci L, Cortelli P, Chiari L. The effects of cerebrospinal fluid tap-test on idiopathic normal pressure hydrocephalus: an inertial sensors based assessment. J Neuroeng Rehabil 2020; 17:7. [PMID: 31948485 PMCID: PMC6966881 DOI: 10.1186/s12984-019-0638-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 12/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background Gait disturbances are typical of persons with idiopathic normal pressure hydrocephalus (iNPH) without signs distinctive from other neurodegenerative and vascular conditions. Cerebrospinal fluid tap-test (CSF-TT) is expected to improve the motor performance of iNPH patients and is a prognostic indicator in their surgical management. This observational prospective study aims to determine which spatio-temporal gait parameter(s), measured during instrumented motor tests, and clinical scale(s) may provide a relevant contribution in the evaluation of motor performance pre vs. post CSF-TT on iNPH patients with and without important vascular encephalopathy. Methods Seventy-six patients (20 with an associated vascular encephalopathy) were assessed before, and 24 and 72 h after the CSF-TT by a timed up and go test (TUG) and an 18 m walking test (18 mW) instrumented using inertial sensors. Tinetti Gait, Tinetti Balance, Gait Status Scale, and Grading Scale were fulfilled before and 72 h after the CSF-TT. Stride length, cadence and total time were selected as the outcome measures. Statistical models with mixed effects were implemented to determine the relevant contribution to response variables of each quantitative gait parameter and clinical scales. Results and conclusion From baseline to 72 h post CSF-TT patients improved significantly by increasing cadence in 18 mW and TUG (on average of 1.7 and 2.4 strides/min respectively) and stride length in 18 mW (on average of 3.1 cm). A significant reduction of gait apraxia was reflected by modifications in double support duration and in coordination index. Tinetti Gait, Tinetti Balance and Gait Status Scale were able to explain part of the variability of response variables not covered by instrumental data, especially in TUG. Grading Scale revealed the highest affinity with TUG total time and cadence when considering clinical scales alone. Patients with iNPH and an associated vascular encephalopathy showed worst performances compared to pure iNPH but without statistical significance. Gait improvement following CSF-TT was comparable in the two groups. Overall these results suggest that, in order to augment CSF-TT accuracy, is key to assess the gait pattern by analyzing the main spatio-temporal parameters and set post evaluation at 72 h. Trial registration Approved by ethics committee: CE 14131 23/02/2015.
Collapse
Affiliation(s)
- Alberto Ferrari
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - David Milletti
- Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Giannini
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federico Oppi
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giorgio Palandri
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Albini-Riccioli
- Unit of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Mantovani
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Laura Anderlucci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Pietro Cortelli
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Lorenzo Chiari
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| |
Collapse
|
30
|
Quantitative Gait Analysis and Cerebrospinal Fluid Tap Test for Idiopathic Normal-pressure Hydrocephalus. Sci Rep 2019; 9:16255. [PMID: 31700018 PMCID: PMC6838166 DOI: 10.1038/s41598-019-52448-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/14/2019] [Indexed: 11/08/2022] Open
Abstract
We investigated gait performance utilizing a quantitative gait analysis for 2 groups: (1) idiopathic normal-pressure hydrocephalus (INPH) patients who had a positive response to the cerebrospinal fluid tap test (CSFTT) and (2) healthy controls. The aims of the study were (1) to analyze the characteristics of gait features, (2) to characterize changes in gait parameters before and after the CSFTT, and (3) to determine whether there was any relationship between stride time and stride length variability and Frontal Assessment Battery (FAB) scores in INPH patients. Twenty-three INPH patients and 17 healthy controls were included in this study. Compared with healthy controls, the gait of INPH patients was characterized by lower velocity, shorter stride length, and more broad-based gait. Patients with INPH had a longer stance phase with increased double-limb support. Variability in stride time and stride length was increased in INPH patients. Stride time and stride length variability were correlated with FAB score. After the CSFTT, gait velocity, stride length, and step width significantly improved. There were significant decreases in stride time and stride length variability. These results suggest that the CSFTT for INPH patients might improve the so-called balance-related gait parameter (ie, step width) as well. Stride time and stride length variability also responded to the CSFTT. Association between FAB scores and both stride time and stride length variability suggests involvement of similar circuits producing gait variability and frontal lobe functions in INPH patients.
Collapse
|
31
|
Giannini G, Palandri G, Ferrari A, Oppi F, Milletti D, Albini-Riccioli L, Mantovani P, Magnoni S, Chiari L, Cortelli P, Cevoli S, Agati R, Calandra-Buonaura G, Capellari S, Parchi P, Stanzani-Maserati M, Marliani AF, Merola M, Piserchia VA, Sambati L, Sturiale C, Supino A, Nicola M, Urli T. A prospective evaluation of clinical and instrumental features before and after ventriculo-peritoneal shunt in patients with idiopathic Normal pressure hydrocephalus: The Bologna PRO-Hydro study. Parkinsonism Relat Disord 2019; 66:117-124. [DOI: 10.1016/j.parkreldis.2019.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
|
32
|
Gholampour S, Bahmani M, Shariati A. Comparing the Efficiency of Two Treatment Methods of Hydrocephalus: Shunt Implantation and Endoscopic Third Ventriculostomy. Basic Clin Neurosci 2019; 10:185-198. [PMID: 31462974 PMCID: PMC6712634 DOI: 10.32598/bcn.9.10.285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/28/2018] [Accepted: 08/26/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction: Hydrocephalus is one of the most common diseases in children, and its treatment requires brain operation. However, the pathophysiology of the disease is very complicated and still unknown. Methods: Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS) implantation are among the common treatments of hydrocephalus. In this study, Cerebrospinal Fluid (CSF) hydrodynamic parameters and efficiency of the treatment methods were compared with numerical simulation and clinical follow-up of the treated patients. Results: Studies have shown that in patients under 19 years of age suffering from hydrocephalus related to a Posterior Fossa Brain Tumor (PFBT), the cumulative failure rate was 21% and 29% in ETV and VPS operation, respectively. At first, the ETV survival curve shows a sharp decrease and after two months it gets fixed while VPS curve makes a gradual decrease and reaches to a level lower than ETV curve after 5.7 months. Post-operative complications in ETV and VPS methods are 17% and 31%, respectively. In infants younger than 12 months with hydrocephalus due to congenital Aqueduct Stenosis (AS), and also in the elderly patients suffering from Normal Pressure Hydrocephalus (NPH), ETV is a better treatment option. Computer simulations show that the maximum CSF pressure is the most reliable hydrodynamic index for the evaluation of the treatment efficacy in these patients. After treatment by ETV and shunt methods, CSF pressure decreases about 9 and 5.3 times, respectively and 2.5 years after shunt implantation, this number returns to normal range. Conclusion: In infants with hydrocephalus, initial treatment by ETV was more reasonable than implanting the shunt. In adult with hydrocephalus, the initial failure in ETV occurred sooner compared to shunt therapy; however, ETV was more efficient.
Collapse
Affiliation(s)
- Seifollah Gholampour
- Department of Biomedical Engineering, Faculty of Electrical & Computer Engineering, Tehran North Branch, Islamic Azad University, Tehran, Iran
| | - Mehrnoush Bahmani
- Department of Biomedical Engineering, Faculty of Electrical & Computer Engineering, Tehran North Branch, Islamic Azad University, Tehran, Iran
| | - Azadeh Shariati
- Department of Biomedical Engineering, Faculty of Electrical & Computer Engineering, Tehran North Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
33
|
Abstract
Neurodegenerative diseases are sporadic and rare hereditary disorders of the central nervous system, which cause a slowly progressive loss of function of specific neuron populations and their connections. Severe impairments and care dependency can be the sequelae. Neurodegenerative disorders are diseases of older people; therefore, the demographic shift leads to an increase in the number of affected patients. Radiologists will also become more involved. For this reason important neurodegenerative diseases are presented in this article. In addition to Alzheimer's and Parkinson's diseases these also include frontotemporal lobar degeneration, Lewy body dementia, vascular dementia, Creutzfeldt-Jakob disease and Huntington's chorea. The clinical symptoms and diagnostics are described, whereby the focus lies on typical results of morphological imaging.
Collapse
|
34
|
Colella F, Speciali D, Bernal M, de Godoy W, Politti F, Lucareli PRG. Are we supererestimating gait assessments of patients with idiopathic normal-pressure hydrocephalus? Gait Posture 2019; 72:12-15. [PMID: 31129388 DOI: 10.1016/j.gaitpost.2019.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/19/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by a triad composed of cognitive alteration, urinary incontinence, and gait impairment associated with ventricular enlargement and normal cerebrospinal fluid pressure. Gait impairment is among the earliest symptoms; however, the reliability of the evaluation is not well-established and no consensus has been reaching regarding variables that should be analyzed and which parameters should be considered to accurately assess post-intervention improvement. RESEARCH QUESTION Are the degree of repeatability, standard error of measurement, and minimum detectable change considered to detect changes in gait variables in iNPH patients? METHODS A total of 84 iNPH patients with a mean age of 77.1 (±6.4) years were analyzed. Gait deviation index (GDI), speed, cadence, cycle time, stride length, single support, and first and second double support were chosen as the variables to be analyzed. Statistical analysis was performed by an independent evaluator, with gait repeatability assessed by the intraclass correlation coefficient (ICC) and the standard error of measure (SEM). RESULTS ICC values were 0.76-0.85 with excellent repeatability, while SEM demonstrated that the variables with best repeatability were the GDI (mean, 4.94; 95% confidence interval (CI), 4.63-5.43), representing a 7.65% mean relative error of the measurement (mean, 0.05 m; 95% CI, 0.05-0.06), and stride length (mean 0.05 m; 95% CI, 0.05-0.06), with a 7.69% mean relative error. SIGNIFICANCE We concluded that GDI and stride length were the variables with the best repeatability and lower variability in the gait of iNPH patients.
Collapse
Affiliation(s)
- Fernanda Colella
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Danielli Speciali
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil
| | - Milena Bernal
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil
| | - Wagner de Godoy
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil
| | - Fabiano Politti
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil.
| |
Collapse
|
35
|
Morel E, Armand S, Assal F, Allali G. Is frontal gait a myth in normal pressure hydrocephalus? J Neurol Sci 2019; 402:175-179. [PMID: 31158556 DOI: 10.1016/j.jns.2019.05.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/06/2019] [Accepted: 05/25/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with idiopathic normal pressure hydrocephalus (iNPH) are considered to present a magnetic, slow, wide-based gait, also called frontal gait. However, this gait profile is not specific for iNPH and encountered in patients with other neurological conditions mimicking iNPH (i.e. iNPH mimics), such as vascular dementia. We aimed to characterize the gait profiles in iNPH and their mimics and to compare the prevalence of clinical gait abnormalities between both groups. METHODS This retrospective study included 140 patients suspected of iNPH (76.3 ± 6.8 yo; 30.7% female). Eighty patients (57.1%) were diagnosed with iNPH according to the NPH consensus guidelines criteria; the remaining sixty patients were classified as mimics (23 neurodegenerative conditions, 12 multifactorial conditions, 9 vascular dementia, 7 mixed dementias, 6 toxic conditions, 2 psychiatric conditions, and 1 stroke). Two independent diagnosis-blinded clinicians (kappa, 0.73) evaluated gait according to four categories: frontal gait, parkinsonian gait, other clinical gait abnormalities, and normal gait. RESULTS iNPH patients and mimics shared similar clinical characteristics. Frontal gait occurred in only 26% of patients (with a similar prevalence for the mimics). Parkinsonian gait was significantly more prevalent among the mimics (32% versus 15%; p-value: 0.032). This association between parkinsonian gait and mimics remained significant after adjusting for age, gender, comorbidities and white matter changes (OR: 2.404; 95% CI: [1.03-5.64]; p value: 0.044). CONCLUSION Frontal gait is not the most prevalent gait abnormality in iNPH and does not discriminate iNPH from its mimics. Parkinsonian gait is more prevalent among the mimics.
Collapse
Affiliation(s)
- Eric Morel
- Department of Internal Medicine, Regionalspital Emmental AG, Burgdorf, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Stéphane Armand
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Willy Taillard Laboratory of Kinesiology, University Geneva Hospitals, Geneva, Switzerland
| | - Frédéric Assal
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Clinical Neurosciences, Division of Neurology, University Geneva Hospitals, Geneva, Switzerland
| | - Gilles Allali
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Clinical Neurosciences, Division of Neurology, University Geneva Hospitals, Geneva, Switzerland; Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA
| |
Collapse
|
36
|
Song M, Lieberman A, Fife T, Nielsen M, Hayden S, Sabbagh M, Shi J. A prospective study on gait dominant normal pressure hydrocephalus. Acta Neurol Scand 2019; 139:389-394. [PMID: 30676642 DOI: 10.1111/ane.13064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/19/2018] [Accepted: 01/09/2019] [Indexed: 11/27/2022]
Abstract
OBJECT We characterize idiopathic normal pressure hydrocephalus (NPH) following treatment with lumbar puncture (LP) and shunt placement through clinical evaluation and quantitative ProtoKinetics Zeno walkway assessments. We evaluate the symptomology by determining gait characteristics altered by treatment. METHODS Patients at Barrow Neurological Institute (BNI) who underwent a LP, removing 30-32 mL cerebrospinal fluid) followed by ventriculoperitoneal shunt placement in February 2015 to February 2017 were analyzed for gait impairments. Inclusion in the study required a diagnosis of NPH, no conflicting comorbidities, and pre-LP, post-LP, and 6-month post-shunt assessments. Analyses of gait and balance data recorded by physical therapists and the ProtoKinetics Zeno Walkway at pre-LP, post-LP, and post-shunt were performed. RESULTS A total of 28 patients were included and one-way analysis of variance and Tukey-Kramer HSD was performed. Among the 15 clinical assessments, nine were significantly altered. Using the ProtoKinetics Zeno Walkway, 7 out of 10 characteristics recorded were considered significantly different among the three data sets. Furthermore, there were more significant differences between pre-LP assessments and post-shunt assessments in comparison to differences between pre-LP assessments and post-LP assessments. CONCLUSIONS Our results indicate that certain gait characteristics better fit NPH than others. By focusing on the features that are caused by NPH and alleviated by LP and/or shunt placement, a more definitive NPH diagnosis can be attained. Additionally, our findings confirm a cumulative effect of continuous drainage via shunt placement may lead to increased improvement in NPH symptoms over LP results.
Collapse
Affiliation(s)
- Melissa Song
- Barrow Neurological Institute, Dignity Health Organization; St. Joseph Hospital and Medical Center; Phoenix Arizona
- School of Arts and Sciences; University of Pennsylvania; Philadelphia Pennsylvania
| | - Abraham Lieberman
- Barrow Neurological Institute, Dignity Health Organization; St. Joseph Hospital and Medical Center; Phoenix Arizona
| | - Terry Fife
- Barrow Neurological Institute, Dignity Health Organization; St. Joseph Hospital and Medical Center; Phoenix Arizona
| | - Megan Nielsen
- Barrow Neurological Institute, Dignity Health Organization; St. Joseph Hospital and Medical Center; Phoenix Arizona
- College of Science; University of Arizona; Tucson Arizona
| | - Sharon Hayden
- Barrow Neurological Institute, Dignity Health Organization; St. Joseph Hospital and Medical Center; Phoenix Arizona
| | - Marwan Sabbagh
- Barrow Neurological Institute, Dignity Health Organization; St. Joseph Hospital and Medical Center; Phoenix Arizona
- Cleveland Clinic Lou Ruvo Center for Brain Health; Las Vegas Nevada
| | - Jiong Shi
- Barrow Neurological Institute, Dignity Health Organization; St. Joseph Hospital and Medical Center; Phoenix Arizona
- Department of Neurology, Beijing Tiantan Hospital; Capital Medical University; Beijing China
| |
Collapse
|
37
|
Scholz R, Lemcke J, Meier U, Stengel D. Efficacy and safety of programmable compared with fixed anti-siphon devices for treating idiopathic normal-pressure hydrocephalus (iNPH) in adults - SYGRAVA: study protocol for a randomized trial. Trials 2018; 19:566. [PMID: 30333067 PMCID: PMC6192316 DOI: 10.1186/s13063-018-2951-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Idiopathic normal-pressure hydrocephalus (iNPH) is a distinct form of dementia, characterized by gait ataxia, cognitive impairment and urinary incontinence. In contrast to all other causes of dementia (e.g., Alzheimer-type and others), ventriculoperitoneal (VP) shunt surgery may offer a curative treatment option to patients. While being a rather low-risk type of surgery, it may cause significant over- or underdrainage complications (e.g., headaches, dizziness, vomiting, intracerebral bleeding, etc.) during posture change. Anti-siphon devices (ASDs) are a group of technically different additional valves used in shunt surgery. They are designed to maintain intraventricular pressure within a normal physiological range regardless of patient position. Fixed ASDs proved to substantially lower the rate of overdrainage complications. No significant differences, however, were noted regarding underdrainage complications. Technical successors of fixed ASDs are programmable ASDs. The aim of this study is to evaluate whether programmable ASDs compared to fixed ASDs are able to avoid both over- and underdrainage complications. METHODS/DESIGN In this investigator-initiated, multicenter randomized trial, 306 patients are planned to be recruited. Male and female patients aged ≥18 years with iNPH who are eligible for VP shunt surgery and meet all other entry criteria can participate. Patients will be randomized in a balanced 1: 1 fashion to a VP shunt with a programmable valve either supplemented with a fixed ASD, or a programmable ASD. Patients will be followed-up 3, 6 and, on an optional basis, 12 months after surgery. The primary outcome measure is the cumulative incidence of over- or underdrainage 6 months post surgery, as defined by clinical and imaging parameters. DISCUSSION SYGRAVA is the first randomized trial to determine whether programmable ASDs reduce complications of drainage compared to fixed ASDs in patients with iNPH. The results of this study may contribute to health-technology assessment of different valve systems used for VP-shunt surgery, and determination of the future standard of care. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN13838310 . Registered on 10 November 2016.
Collapse
Affiliation(s)
- Romy Scholz
- Centre for Clinical Research, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Johannes Lemcke
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
| | - Ullrich Meier
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Dirk Stengel
- Centre for Clinical Research, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.,Department of Trauma and Orthopaedic Surgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.,Julius Wolff Institute, Charité Medical University Centre, Augustenburger Platz 1, 13353, Berlin, Germany
| |
Collapse
|
38
|
Amyloid imaging for differential diagnosis of dementia: incremental value compared to clinical diagnosis and [ 18F]FDG PET. Eur J Nucl Med Mol Imaging 2018; 46:312-323. [PMID: 30094462 PMCID: PMC6333717 DOI: 10.1007/s00259-018-4111-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/10/2018] [Indexed: 11/24/2022]
Abstract
Purpose Cerebral beta-amyloid and regional glucose metabolism assessed by positron emission tomography (PET) are used as diagnostic biomarkers for Alzheimer’s disease (AD). The present study validates the incremental diagnostic value of amyloid PET in addition to clinical diagnosis and [18F]FDG PET in a real-life memory clinic population. Methods Of 138 consecutive patients with cognitive impairment who received combined [18F]FDG and [11C]PIB PET, 84 were diagnosed with major neurocognitive disorder (DSM-5) and included. Baseline clinical and [18F]FDG PET diagnoses were independently established with and without access to amyloid PET results and were dichotomized into AD or non-AD disorders. The incremental value of amyloid PET was evaluated in terms of: (1) the change in clinical and [18F]FDG PET diagnoses, (2) the change in agreement between clinical and [18F]FDG PET diagnoses, and (3) diagnostic accuracy using an interdisciplinary consensus diagnosis after an extended follow-up (2.4 ± 1.3 years after PET) as the reference. Results After disclosure of the amyloid PET results, clinical and [18F]FDG PET diagnoses changed in 23% and 18% of patients, respectively, and agreement between both ratings increased from 62% to 86% (p < 0.001). The accuracy of clinical and [18F]FDG PET diagnoses improved from 71% to 89% (p < 0.01) and from 76% to 94% (p < 0.001), respectively. The additional value of amyloid PET was rather uniform in relation to age at onset and consistency with appropriate use criteria. Conclusion Amyloid PET provides significant incremental diagnostic value beyond clinical and [18F]FDG PET diagnoses of AD. Given the high diagnostic accuracy of combined clinical and amyloid PET assessment, further studies are needed to clarify the role of an additional [18F]FDG PET scan in these patients.
Collapse
|
39
|
Panciani PP, Migliorati K, Muratori A, Gelmini M, Padovani A, Fontanella M. Computerized gait analysis with inertial sensor in the management of idiopathic normal pressure hydrocephalus. Eur J Phys Rehabil Med 2018; 54:724-729. [PMID: 29962192 DOI: 10.23736/s1973-9087.18.04949-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gait disturbance (GD) is usually the first and most prominent symptom observed in idiopathic normal pressure hydrocephalus (iNPH). The reversibility of symptoms is related to early diagnosis and treatment. Nowadays early recognition of patients is challenging because GD in the elderly is frequently neglected, leading to late diagnosis and increased disability. In addition, GD is generally assessed by clinical evaluation since computerized gait analysis methods are rarely available. In the present study, we demonstrate the clinical application of an inertial sensor system for gait analysis in iNPH. AIM The primary aim was to test the sensor performance in quantifying impairment in gait parameters in iNPH. The secondary aim was to detect a range of improvement after CSF subtraction test, which could be considered as predictive of favorable shunt response. DESIGN We performed a case-control prospective study from March 2012 to May 2014. SETTING Inpatients at the Division of Neurology, Department of Clinical and Experimental Sciences, Brescia. POPULATION We enrolled 79 patients with clinical and radiological findings of iNPH and 300 healthy adults over 70 years old without GD as a control group. METHODS We performed gait analysis, CSF Tap Test (TT), and shunt surgery in all patients with a diagnosis of iNPH according to the International Guidelines. According to clinical outcomes, we divided patients in responsive (group A) and non-responsive (group B). We then compared pre-operative gait analysis of group A with the control group, and calculated the percentage of improvement after TT between group A and group B. RESULTS Shunt surgery was performed in 52 patients. After 3 months, 35 patients (group A: 67.3%) showed a positive response to shunt. We quantified the impaired gait parameters in iNPH and assessed the differences with controls. Improvement of speed, stride length and double support time after TT was predictive of positive shunt response. CONCLUSIONS The proposed inertial sensor system is a reliable and easy-to-use system for early detection of iNPH and may be used in any clinical setting. CLINICAL REHABILITATION IMPACT Identification of a GD pattern for iNPH, especially in rehabilitation, may be useful for recognizing patients who are candidates for surgery, thus avoiding permanent disability.
Collapse
Affiliation(s)
| | - Karol Migliorati
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Muratori
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Gelmini
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Division of Neurology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
40
|
Mostile G, Nicoletti A, Zappia M. Vascular Parkinsonism: Still Looking for a Diagnosis. Front Neurol 2018; 9:411. [PMID: 29962998 PMCID: PMC6013552 DOI: 10.3389/fneur.2018.00411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giovanni Mostile
- Section of Neurosciences, Department "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Section of Neurosciences, Department "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Mario Zappia
- Section of Neurosciences, Department "G.F. Ingrassia", University of Catania, Catania, Italy
| |
Collapse
|
41
|
Souza RKMD, Rocha SFBD, Martins RT, Kowacs PA, Ramina R. Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:324-331. [DOI: 10.1590/0004-282x20180037] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/14/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT Normal pressure hydrocephalus (NPH), described by Hakim and Adams in 1965, is characterized by gait apraxia, urinary incontinence, and dementia. It is associated with normal cerebrospinal fluid (CSF) pressure and ventricular dilation that cannot be attributed to cerebral atrophy. Objectives: To evaluate gait characteristics in patients with idiopathic NPH and investigate the effect of the CSF tap test (CSF-TT) on gait. Methods: Twenty-five patients diagnosed with probable idiopathic NPH were submitted to the CSF-TT. The procedure aimed to achieve changes in gait parameters. Results: Fifteen gait parameters were assessed before and after the CSF-TT. Five showed a statistically significant improvement (p < 0.05): walking speed (p < 0.001), cadence (p < 0.001), step length (p < 0.001), en bloc turning (p = 0.001), and step height (p = 0.004). Conclusion: This study demonstrated that gait speed was the most responsive parameter to the CSF-TT, followed by cadence, step length, en bloc turning, and step height.
Collapse
|
42
|
Allali G, Laidet M, Armand S, Saj A, Krack P, Assal F. Apathy in idiopathic normal pressure hydrocephalus: A marker of reversible gait disorders. Int J Geriatr Psychiatry 2018; 33:735-742. [PMID: 29292530 DOI: 10.1002/gps.4847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/27/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Apathy-the most common behavioral disturbance in idiopathic normal pressure hydrocephalus (iNPH)-is associated with poor gait, but the role of apathy on gait improvement after cerebrospinal fluid (CSF) tapping has not been studied yet. This study aims to compare gait improvement after CSF tapping in iNPH patients with and without apathy. METHODS Stride time variability (STV), a marker of higher level of gait control, was measured in 33 iNPH patients (78.4 ± 5.7 years; 36.4% women) with an optoelectronic system during usual walking (single task) and during walking while dual tasking of counting and verbal fluency before and 24 hours after CSF tapping. Apathy was defined by a score ≥14 on the Starkstein apathy scale. RESULTS Apathy was present in 60.6% of patients. Cerebrospinal fluid tapping led to greater improvement of STV (ie, decrease) during dual-task walking (and more specifically categorical verbal fluency) in apathetic compared to nonapathetic patients (-44.7 ± 58.1% versus +4.24 ± 67.6%, respectively; P = .040), even after adjusting for age and depressive symptoms. More severe apathy was correlated with better STV improvement while dual tasking (categorical verbal fluency) after CSF tapping (r = -0.412; P-value = 0.021), while it was not correlated with improvement on executive tests. CONCLUSIONS Our findings suggest that the presence of apathy is a predictor of better outcomes of gait disorders after CSF tapping in patients with iNPH.
Collapse
Affiliation(s)
- Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Magali Laidet
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Arnaud Saj
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Paul Krack
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frédéric Assal
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
43
|
Murakami Y, Matsumoto Y, Hoshi K, Ito H, Fuwa TJ, Yamaguchi Y, Nakajima M, Miyajima M, Arai H, Nollet K, Kato N, Nishikata R, Kuroda N, Honda T, Sakuma J, Saito K, Hashimoto Y. Rapid increase of ‘brain-type’ transferrin in cerebrospinal fluid after shunt surgery for idiopathic normal pressure hydrocephalus: a prognosis marker for cognitive recovery. J Biochem 2018; 164:205-213. [DOI: 10.1093/jb/mvy043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/01/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Yuta Murakami
- Departments of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Yuka Matsumoto
- Departments of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Kyoka Hoshi
- Biochemistry, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Hiromi Ito
- Biochemistry, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Takashi J Fuwa
- Biochemistry, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Yoshiki Yamaguchi
- Structural Glycobiology Team, Systems Glycobiology Research Group, RIKEN-Max Planck Joint Research Center, RIKEN Global Research Cluster, Wako, Saitama, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | | | - Hajime Arai
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | - Kenneth Nollet
- Departments of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Naho Kato
- Forensic Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Rie Nishikata
- Forensic Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Naohito Kuroda
- Forensic Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Takashi Honda
- Human Life Science, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Jun Sakuma
- Departments of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Kiyoshi Saito
- Departments of Neurosurgery, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Yasuhiro Hashimoto
- Biochemistry, Fukushima Medical University, Fukushima City, Fukushima, Japan
| |
Collapse
|
44
|
Kwon J, Kang K. Four-and-a-half-year Follow-up of Idiopathic Normal Pressure Hydrocephalus Patient Treated with a Ventriculoperitoneal Shunt. ACTA ACUST UNITED AC 2018. [DOI: 10.17340/jkna.2018.1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
45
|
Allali G, Laidet M, Armand S, Assal F. Brain comorbidities in normal pressure hydrocephalus. Eur J Neurol 2018; 25:542-548. [PMID: 29222955 DOI: 10.1111/ene.13543] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/01/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE This cross-sectional study aims to compare gait changes after the cerebrospinal fluid (CSF) tap test between normal pressure hydrocephalus patients with and without brain comorbidities (NPH+ and NPH- respectively) and then to identify significant contributors to a poor CSF tap test amongst individuals with NPH+. METHODS Gait changes (during the single task and the dual task of backward counting) were quantified before and 24 h after the CSF tap test with an optoelectronic system in 52 NPH patients (77.4 ± 6.0 years; 34.6% women). Changes after the CSF tap test in stride time variability (STV, %) were our main outcome. CSF Alzheimer's disease biomarkers, cerebrovascular white matter changes assessed with brain imaging and neurodegenerative diseases with parkinsonian syndrome represented the three individual brain comorbidities. RESULTS Brain comorbidities were frequently identified, NPH+ patients representing 40 patients of our sample (76.9%). NPH- patients improved their STV better in the single task (delta of STV = -58.6% ± 54.3% vs. -14.1% ± 62.0%; P = 0.031) and in the dual task (delta of STV =-32.2% ± 33.7% vs. 6.3% ± 58.4%; P = 0.028) after the CSF tap test than NPH+ patients. Amongst NPH+ individuals, only comorbid Alzheimer's disease was associated with STV increase (i.e. deterioration of gait) in the dual task [β 38.4; 95% confidence interval (5.64; 71.24); P = 0.023] after the CSF tap test, whilst it was borderline in the single task [β 35.0; 95% confidence interval (-1.97; 71.90); P = 0.063]. CONCLUSIONS Brain comorbidities affect gait improvement after the CSF tap test in NPH patients; this influence is driven by Alzheimer's disease-related pathology.
Collapse
Affiliation(s)
- G Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - M Laidet
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - S Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - F Assal
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
46
|
Liouta E, Gatzonis S, Kalamatianos T, Kalyvas A, Koutsarnakis C, Liakos F, Anagnostopoulos C, Komaitis S, Giakoumettis D, Stranjalis G. Finger tapping and verbal fluency post-tap test improvement in INPH: its value in differential diagnosis and shunt-treatment outcomes prognosis. Acta Neurochir (Wien) 2017; 159:2301-2307. [PMID: 28828534 DOI: 10.1007/s00701-017-3301-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (INPH) diagnosis is challenging as it can be mimicked by other neurological conditions, such as neurodegenerative dementia and motor syndromes. Additionally, outcomes after lumbar puncture (LP) tap test and shunt treatment may vary due to the lack of a common protocol in INPH assessment. The present study aimed to assess whether a post-LP test amelioration of frontal cognitive dysfunctions, characterizing this syndrome, can differentiate INPH from similar neurological conditions and whether this improvement can predict INPH post-shunt outcomes. METHOD Seventy-one consecutive patients referred for INPH suspicion and LP testing, were enrolled. According to the consensus guidelines criteria, 29 patients were diagnosed as INPH and 42 were assigned an alternative diagnosis (INPH-like group) after reviewing clinical, neuropsychological and imaging data, and before LP results. A comprehensive neuropsychological assessment for frontal executive, upper extremity fine motor functions, aphasias, apraxias, agnosias and gait evaluation were administered at baseline. Executive, fine motor functions and gait were re-examined post-LP test in all patients and post-shunt placement in INPH patients. RESULTS Of the INPH patients, 86.2% showed cognitive amelioration in the post-LP test; in addition, all but one (97%) presented with neurocognitive and gait improvement post-shunt. Verbal phonological fluency and finger tapping task post-LP improvement predicted positive clinical outcome post-shunt. None of the INPH-like group presented with neurocognitive improvement post-LP. CONCLUSIONS Post-LP amelioration of verbal fluency and finger tapping deficits can differentiate INPH from similar disorders and predict positive post-shunt clinical outcome in INPH. This becomes of great importance when gait assessment is difficult to perform in clinical practice.
Collapse
Affiliation(s)
- Evangelia Liouta
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece.
- Hellenic Centre for Neurosurgical Research "Prof. Petros Kokkalis", Athens, Greece.
| | - Stylianos Gatzonis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece
- Hellenic Centre for Neurosurgical Research "Prof. Petros Kokkalis", Athens, Greece
| | | | - Aristotelis Kalyvas
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece
| | - Christos Koutsarnakis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece
| | - Faidon Liakos
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece
| | - Christos Anagnostopoulos
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece
| | - Spyridon Komaitis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece
| | - Dimitris Giakoumettis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece
| | - George Stranjalis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece
- Hellenic Centre for Neurosurgical Research "Prof. Petros Kokkalis", Athens, Greece
| |
Collapse
|
47
|
Satow T, Aso T, Nishida S, Komuro T, Ueno T, Oishi N, Nakagami Y, Odagiri M, Kikuchi T, Yoshida K, Ueda K, Kunieda T, Murai T, Miyamoto S, Fukuyama H. Alteration of Venous Drainage Route in Idiopathic Normal Pressure Hydrocephalus and Normal Aging. Front Aging Neurosci 2017; 9:387. [PMID: 29218007 PMCID: PMC5703706 DOI: 10.3389/fnagi.2017.00387] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/10/2017] [Indexed: 12/13/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a highly prevalent condition in the elderly population; however, the underlying pathophysiology in relation to the aging process remains unclear. To investigate the effect of removal of cerebrospinal fluid by lumbar “tap test” on the cerebral circulation in patients with iNPH, 14 patients with “probable” iNPH were studied using a novel blood tracking technique based on blood oxygenation level-dependent (BOLD) magnetic resonance signal intensity. By tracking the propagation of the low-frequency component of the BOLD signal, extended venous drainage times were observed in the periventricular region of the patients, which was reversed by tap test. Interestingly, the venous drainage time in the periventricular region exhibited an age-related prolongation in the healthy control group. Additional regression analyses involving 81 control subjects revealed a dissociation of deep and superficial venous systems with increasing age, presumably reflecting focal inefficiency in the deep system. Our results not only provide insights into the etiology of iNPH, but also point to a potential non-invasive biomarker for screening iNPH.
Collapse
Affiliation(s)
- Takeshi Satow
- Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan
| | - Toshihiko Aso
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sei Nishida
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Taro Komuro
- Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan
| | - Tsukasa Ueno
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoya Oishi
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukako Nakagami
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masashi Odagiri
- Faculty of Health Care Science, Kyoto Tachibana University, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keita Ueda
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Neurosurgery, Graduate School of Medicine, Ehime University, Matsuyama, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenao Fukuyama
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
48
|
Aruga S, Kuwana N, Shiroki Y, Takahashi S, Samejima N, Watanabe A, Seki Y, Igawa Y, Homma Y. Effect of cerebrospinal fluid shunt surgery on lower urinary tract dysfunction in idiopathic normal pressure hydrocephalus. Neurourol Urodyn 2017; 37:1053-1059. [PMID: 28892272 DOI: 10.1002/nau.23399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/28/2017] [Indexed: 11/07/2022]
Abstract
AIMS To examine the outcomes of lower urinary tract symptoms (LUTS) and urodynamic test results after cerebrospinal fluid (CSF) shunt surgery in idiopathic normal pressure hydrocephalus (iNPH). METHODS Records of 48 patients (33 men; 15 women), who met the definite iNPH criteria and underwent CSF shunt surgery, were retrospectively analyzed. LUTS and their impact on quality of life (QOL) were evaluated using an all-or-none questionnaire targeting four symptoms, the Overactive Bladder Symptoms Score (OABSS), and the QOL index. Urodynamic investigations included filling cystometry and pressure-flow studies performed before and after surgery. RESULTS Forty-seven (98%) patients complained of LUTS, 41 (87%) patients of whom experienced LUTS improvement after surgery. The OABSS and QOL index, which before surgery were 6.8 ± 0.7 and 4.1 ± 0.4, respectively, significantly decreased to 4.6 ± 0.6 and 3.2 ± 0.3, respectively, after surgery. The maximum cystometric capacity (174.9 ± 13.3 mL to 222.4 ± 14.7 mL) and bladder compliance (35.8 ± 4.4 ml/cmH2 O to 52.1 ± 5.4 ml/cmH2 O) significantly increased after surgery. Detrusor overactivity, which was observed in 37 (77%) patients preoperatively, became undetectable in 7 patients postoperatively. Voiding dysfunction (defined as maximum flow rate <10 mL/s or post-void residual >100 mL) was observed in 29 (60%) patients, 22 (75%) of whom had detrusor underactivity before surgery. None of the voiding urodynamic parameters significantly improved postoperatively. CONCLUSIONS iNPH is often associated with LUTS and both storage and voiding dysfunctions. CSF shunt surgery improved LUTS and storage dysfunction, with limited effects on voiding dysfunction.
Collapse
Affiliation(s)
- Seiji Aruga
- Department of Urology, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Nobumasa Kuwana
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | | | | | - Naoyuki Samejima
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Akira Watanabe
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Yojiro Seki
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, University of Tokyo Graduate school of Medicine, Bunkyo-ku, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Shibuya-ku, Tokyo
| |
Collapse
|
49
|
Serarslan Y, Yilmaz A, Çakır M, Güzel E, Akakin A, Güzel A, Urfalı B, Aras M, Kaya ME, Yılmaz N. Use of programmable versus nonprogrammable shunts in the management of normal pressure hydrocephalus: A multicenter retrospective study with cost-benefit analysis in Turkey. Medicine (Baltimore) 2017; 96:e8185. [PMID: 28953678 PMCID: PMC5626321 DOI: 10.1097/md.0000000000008185] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Ventriculoperitoneal shunt systems that are used in the treatment of normal pressure hydrocephalus are often associated with drainage problems. Adjustable shunt systems can prevent or treat these problems, but they may be expensive. The aim of our study is to compare the complications and total cost of several shunt systems.Patients with normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between 2011 and 2016 were included in the study. The study involves patient consent and the informed consent was given. Complications and the average cost per person were compared between patients with adjustable and nonadjustable shunts. Shunt prices, surgical complications, and revision costs were taken into account to calculate the average cost.Of the 110 patients who were evaluated, 80 had a nonadjustable shunt and 30 had an adjustable shunt. In the group with adjustable shunts, the rates of subdural effusion and hematoma were 19.73% and 3.29%, respectively. In the group with nonadjustable shunts, these rates were 22.75% and 13.75%, respectively. One patient in the adjustable group underwent surgery for subdural hematoma, while 8 patients in the nonadjustable group underwent the same surgery. Ten patients required surgical intervention for subdural effusion and existing shunt systems in these patients were replaced by an adjustable shunt system. When these additional costs were factored into the analysis, the difference in cost between the shunt systems was reduced from 600 United States dollars (USD) to 111 USD.When the complications and additional costs that arise during surgical treatment of normal pressure hydrocephalus were considered, the price difference between adjustable and nonadjustable shunt systems was estimated to be much lower.
Collapse
Affiliation(s)
| | - Atilla Yilmaz
- Neurosurgery Department, Mustafa Kemal University, Hatay
| | - Mürteza Çakır
- Neurosurgery Department, Ataturk University, Erzurum
| | - Ebru Güzel
- Radiology Department, Gaziantep Medical Park Hospital, Gaziantep
| | - Akin Akakin
- Neurosurgery Department, Bahcesehir University, Istanbul
| | - Aslan Güzel
- Neurosurgery Department, Gaziantep Medical Park Hospital, Bahcesehir University, Gaziantep
| | - Boran Urfalı
- Neurosurgery Department, Mustafa Kemal University, Hatay
| | - Mustafa Aras
- Neurosurgery Department, Mustafa Kemal University, Hatay
| | | | - Nebi Yılmaz
- Neurosurgery Department, Eryaman Hospital, Ankara, Turkey
| |
Collapse
|
50
|
The Timed Up and Go Test as a Diagnostic Criterion in Normal Pressure Hydrocephalus. World Neurosurg 2017; 105:456-461. [DOI: 10.1016/j.wneu.2017.05.137] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 11/18/2022]
|