Intermittent gait disturbance in idiopathic normal pressure hydrocephalus

Abstract

Intermittent gait disturbance is not a rare symptom in mild stage of iNPH and may serve as an important clinical diagnostic marker for identifying mild iNPH patients.

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

“…Patients with iNPH commonly exhibit improvements in gait parameters such as velocity and step length after CSF drainage [4,5,8,16]. Following TT and SS, our patients also exhibited improved velocities and step numbers and, notably, mitigated abnormalities of ambulatory COM movement.…”

“…In any case, clarifying the features of ambulatory COM movement in iNPH may help explain the patients' gait and balance disorders and elucidate the appropriate diagnostic and treatment strategies, which may include exercise therapy. Objective gait assessments in patients with iNPH have examined various gait parameters such as temporal and spatial parameters [4][5][6]8,10,[16][17][18][19], but the ambulatory COM movements in iNPH remain unclear.…”

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

“…FGA can be used to evaluate dynamic balance and vestibular function during gait, and it is useful in almost all neurologic disorders, including vestibular dysfunction, 22 as the FGA is less affected by a ceiling effect. 33,34 Gait disturbance in iNPH includes dysfunction of dynamic postural equilibrium, 18,[35][36][37] and iNPH-associated postural impairment is considered to occur due to disequilibrium associated with central and/or peripheral vestibular dysfunction. [8][9][10] Therefore, we believe that FGA can detect both actual and perceived changes following CSF shunting in patients with iNPH, independent of gait ability.…”

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

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