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Sjulstad AS, Odeh F, Baloch FK, Berg DH, Arntzen K, Alstadhaug KB. Occurrence of postdural puncture headache-A randomized controlled trial comparing 22G Sprotte and Quincke. Brain Behav 2020; 10:e01886. [PMID: 33047511 PMCID: PMC7749614 DOI: 10.1002/brb3.1886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To assess the incidence of postdural puncture headache (PDPH) using 22-gauge atraumatic needle (Sprotte, 22GS) compared with 22-gauge traumatic needle (Quincke, 22GQ). BACKGROUND Diagnostic lumbar puncture (dLP) is commonly complicated by PDPH. Despite evidence to support the use of 22GS, European neurologists seem to keep using 22GQ. METHODS This was a randomized, double-blind study. Adults (age: 18-60 years) scheduled for dLP were included. dLP and CSF acquisition were performed in accordance with highly standardized procedures. Patients were followed up on days 2 and 7. RESULTS In total, 172 patients were randomized and lumbar punctured, and 21 were excluded due to wrong inclusion (n = 11), needle switch (n = 7), failed dLP (n = 1), withdrawal (n = 1), and missed follow-up (n = 1). Among the remaining 151 patients (mean age: 40.7 ± 12.4 years), 77 had dLP using 22GQ and 74 using 22GS. Incidence of PDPH among patients punctured with 22GS (18%) was significantly lower (p = .004) than among patients punctured with 22GQ (39%). Relative risk was 0.45, 95% CI 0.26-0.80. Patients with PDPH had significantly lower weight (p = .035), and there was no significant difference related to age (p = .064), sex (p = .239), height (p = .857), premorbid episodic migraine (p = .829), opening pressure (p = .117), operators (p = .148), amount of CSF removed (p = .205), or number of attempts (p = .623). CONCLUSIONS The use of 22GS halves the risk of PDPH compared with 22GQ. This study provides strong support to make a change in practice where traumatic needles are still in regular use.
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Affiliation(s)
| | - Francis Odeh
- Nordland Hospital Trust, Bodø, Norway.,Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | | | | | | | - Karl B Alstadhaug
- Nordland Hospital Trust, Bodø, Norway.,Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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4
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Engelborghs S, Niemantsverdriet E, Struyfs H, Blennow K, Brouns R, Comabella M, Dujmovic I, van der Flier W, Frölich L, Galimberti D, Gnanapavan S, Hemmer B, Hoff E, Hort J, Iacobaeus E, Ingelsson M, Jan de Jong F, Jonsson M, Khalil M, Kuhle J, Lleó A, de Mendonça A, Molinuevo JL, Nagels G, Paquet C, Parnetti L, Roks G, Rosa-Neto P, Scheltens P, Skårsgard C, Stomrud E, Tumani H, Visser PJ, Wallin A, Winblad B, Zetterberg H, Duits F, Teunissen CE. Consensus guidelines for lumbar puncture in patients with neurological diseases. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 8:111-126. [PMID: 28603768 PMCID: PMC5454085 DOI: 10.1016/j.dadm.2017.04.007] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction Cerebrospinal fluid collection by lumbar puncture (LP) is performed in the diagnostic workup of several neurological brain diseases. Reluctance to perform the procedure is among others due to a lack of standards and guidelines to minimize the risk of complications, such as post-LP headache or back pain. Methods We provide consensus guidelines for the LP procedure to minimize the risk of complications. The recommendations are based on (1) data from a large multicenter LP feasibility study (evidence level II-2), (2) systematic literature review on LP needle characteristics and post-LP complications (evidence level II-2), (3) discussion of best practice within the Joint Programme Neurodegenerative Disease Research Biomarkers for Alzheimer's disease and Parkinson's Disease and Biomarkers for Multiple Sclerosis consortia (evidence level III). Results Our consensus guidelines address contraindications, as well as patient-related and procedure-related risk factors that can influence the development of post-LP complications. Discussion When an LP is performed correctly, the procedure is well tolerated and accepted with a low complication rate.
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Affiliation(s)
- Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Ellis Niemantsverdriet
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Raf Brouns
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irena Dujmovic
- Clinic of Neurology, Clinical Centre of Serbia, Department of Neurology, Faculty of Medicine, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Wiesje van der Flier
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty, Mannheim/Heidelberg University, Mannheim, Germany
| | - Daniela Galimberti
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy
| | - Sharmilee Gnanapavan
- Department of Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Bernhard Hemmer
- Department of Neurology, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Erik Hoff
- Department of Neurology, Atrium Medisch Centrum Parkstad, Heerlen, The Netherlands
| | - Jakub Hort
- Memory Disorders Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Frank Jan de Jong
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michael Jonsson
- Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Michael Khalil
- Department of Neurology, Medical University Graz, Graz, Austria
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red en enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Alexandre de Mendonça
- Laboratory of Neurosciences, Department of Molecular Medicine and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - José Luis Molinuevo
- Alzheimer's disease and other cognitive disorders unit, Neurology Service, Hospital Clinic i Universitari, IDIBAPS, Barcelona, Spain
| | - Guy Nagels
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Faculté de Psychologie et des sciences de l'éducation, UMons, Mons, Belgium.,National MS Center Melsbroek, Brussels, Belgium
| | - Claire Paquet
- Research Memory Center Lariboisière Hospital University Paris Diderot INSERMU942, Paris, France
| | - Lucilla Parnetti
- Section of Neurology, Centre for Memory Disturbances, Department of Medicine, University of Perugia, Perugia, Italy
| | - Gerwin Roks
- Department of Neurology, St Elisabeth Ziekenhuis, Tilburg, The Netherlands
| | - Pedro Rosa-Neto
- Departments of Neurology & Neurosurgery and Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada.,Departments of Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada
| | - Philip Scheltens
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hayrettin Tumani
- CSF Laboratory and Multiple Sclerosis Outpatient Unit, Department of Neurology, University of Ulm, Ulm, Germany
| | - Pieter Jelle Visser
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Anders Wallin
- Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Bengt Winblad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,UCL Institute of Neurology, Department of Molecular Neuroscience, London, United Kingdom
| | - Flora Duits
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Simonsen AH, Kuiperij B, El-Agnaf OMA, Engelborghs S, Herukka SK, Parnetti L, Rektorova I, Vanmechelen E, Kapaki E, Verbeek M, Mollenhauer B. The utility of α-synuclein as biofluid marker in neurodegenerative diseases: a systematic review of the literature. Biomark Med 2016; 10:19-34. [DOI: 10.2217/bmm.14.105] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The discovery of α-synuclein (α-syn) as a major component of Lewy bodies, neuropathological hallmark of Parkinson's disease (PD), dementia with Lewy bodies and of glial inclusions in multiple system atrophy initiated the investigation of α-syn as a biomarker in cerebrospinal fluid (CSF). Due to the involvement of the periphery in PD the quantification of α-syn in peripheral fluids such as serum, plasma and saliva has been investigated as well. We review how the development of multiple assays for the quantification of α-syn has yielded novel insights into the variety of α-syn species present in the different fluids; the optimal preanalytical conditions required for robust quantification and the potential clinical value of α-syn as biomarker. We also suggest future approaches to use of CSF α-syn in neurodegenerative diseases.
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Affiliation(s)
- Anja Hviid Simonsen
- Memory Disorders Research Group, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bea Kuiperij
- Department of Neurology, Department of Laboratory Medicine, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Omar Mukhtar Ali El-Agnaf
- College of Science and Engineering, Hamid Bin Khalifa University, Qatar Foundation, Education City, PO Box 5825 Doha, Qatar
| | - Sebastian Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp & Department of Neurology & Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine – Neurology University of Eastern Finland School of Medicine, Kuopio, Finland
| | - Lucilla Parnetti
- Centro Disturbi della Memoria- Unità Valutativa Alzheimer, Clinica Neurologica, Università di Perugia, Italy
| | - Irena Rektorova
- Applied Neuroscience Research Group, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Eugeen Vanmechelen
- ADx NeuroSciences, VIB-Bioincubator, Technologiepark Zwijnaarde 4, 9052 Ghent, Belgium
| | - Elisabeth Kapaki
- National & Kapodistrian University of Athens, School of Medicine, 1st Department of Neurology, Eginition Hospital, Athens, Greece
| | - Marcel Verbeek
- Department of Neurology, Department of Laboratory Medicine, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel & University Medical Center (Departments of Neuropathology & Neurosurgery), Georg-August University Goettingen, Germany
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7
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Castrillo A, Tabernero C, García-Olmos LM, Gil C, Gutiérrez R, Zamora MI, Mendoza A, Rodríguez MF, Guerrero P, Rodríguez-Vico JS, Ferrero M, Morollón N, Duarte J. Postdural puncture headache: impact of needle type, a randomized trial. Spine J 2015; 15:1571-6. [PMID: 25794941 DOI: 10.1016/j.spinee.2015.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 01/20/2015] [Accepted: 03/07/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times. PURPOSE The purpose of this study was to define the impact of needle type, atraumatic (Sprotte [S]) versus traumatic (Quincke [Q]) on postdural puncture headache (PDPH) incidence. STUDY DESIGN The study is based on a prospective, randomized, and simple-blinded clinical trial. PATIENT SAMPLE Patients older than 14 years were scheduled for a diagnostic or therapeutic LP. OUTCOME MEASURES The outcome measure included the development of PDPH according to the International Headache Association criteria. METHODS Patients fulfilling eligibility criteria were randomly allocated to one of two kinds of spinal needle: atraumatic or S-type or traumatic or Q-type. They were interviewed on days 2 and 7 about the development of PDPH. RESULTS The incidence of PDPH was 22.43% with Q-type needle and 8.51% with S-type needle, p=.04. The duration of PDPH in patients in the S-type was 1 day or less, compared with a median of 4.14 days in the Q-type (p=.00). In the logistic regression model, the S-type needle together with the age of the patient were the only two statistically significant factors in the development of postlumbar puncture headache (PLPH), both of them being protective. CONCLUSIONS We found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.
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Affiliation(s)
- Ana Castrillo
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
| | - César Tabernero
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Luis M García-Olmos
- Multiprofessional Education Unit for Family and Community Care, Madrid (South-East), C/ Hacienda de Pavones 28030, Spain
| | - Cecilia Gil
- Division of Neurology, General Hospital, Burgos, Spain
| | - Raúl Gutiérrez
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - María I Zamora
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Amelia Mendoza
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - María F Rodríguez
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Pilar Guerrero
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | | | - Marta Ferrero
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Noemí Morollón
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Jacinto Duarte
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
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