Neuropsychological Effects of Shunt Treatment in Idiopathic Normal Pressure Hydrocephalus

Hellström, Per; Edsbagge, Mikael; Blomsterwall, Elisabeth; Archer, Trevor; Tisell, Magnus; Tullberg, Mats; Wikkelsø, Carsten

doi:10.1227/01.neu.0000325258.16934.bb

Cited by 67 publications

(57 citation statements)

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“…They all showed clear impairments of both motor and cognitive function and most of them had urgency or incontinence problems (Table 2b). Their MMSE and motor function scores were comparable with the results of other investigators [13,14]. They were also of the same age as the HI, and the gender distribution was similar.…”

Section: Discussionsupporting

confidence: 85%

How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study

Lundin¹,

Ulander²,

Svanborg³

et al. 2013

Clinical Neurology and Neurosurgery

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Section: Discussionsupporting

confidence: 85%

How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study

Lundin¹,

Ulander²,

Svanborg³

et al. 2013

Clinical Neurology and Neurosurgery

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“…The shunt operation was judged to be successful in 86% (12/14) of cases and a median MOS improvement was found in 23% of the patients, which is similar to the results of other investigators 22 23. The reduction of lateral ventricle size, measured with quantitative volumetry, supported our clinical findings that the shunts were functioning.…”

Section: Discussionsupporting

confidence: 90%

Preoperative and postoperative¹H-MR spectroscopy changes in frontal deep white matter and the thalamus in idiopathic normal pressure hydrocephalus

Lundin

Tisell

Leijon

et al. 2012

J Neurol Neurosurg Psychiatry

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“…It has been shown that patients with more severe symptoms show a greater improvement than less impaired patients on the tests included in this study. 12 The complication rate between the 2 groups (20-4 and 12) was recently published, showing no significant difference in the complication rate. 20 To our knowledge, this is the first RCT to explore the clinical effect of lowering the valve setting.…”

Section: Discussionmentioning

confidence: 98%

A double-blind randomized trial on the clinical effect of different shunt valve settings in idiopathic normal pressure hydrocephalus

Farahmand

Sæhle²,

Eide

et al. 2016

JNS

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However, complications following shunt surgery are common, 11,16 especially subdural hematoma (SDH) seen in 2%-21% of iNPH patients treated with VP or VA shunts. 7,8,15,21 Adjustable valves that permit the opening pressure to be changed externally have been recommended as a means of reducing the complication rate and enabling clinicians to optimize individual treatment. 1,2Randomized studies have indicated that lower opening pressure is related to better outcome 5 but also to more overdrainage symptoms, 6 SDH, and subdural effusions. 5,6Delwel et al. recommended that shunt treatment should beabbreviatioNs ASD = antisiphon device; BMI = body mass index; ICP = intracranial pressure; iNPH = idiopathic normal pressure hydrocephalus; ITT = intention-totreat; RCT = randomized controlled trial; SDH = subdural hematoma; SDS = standard deviation score (standardized score); tSDS = total SDS; VA = ventriculoatrial; VP = ventriculoperitoneal. obJective The study aim was to examine the effect of gradually reducing the opening pressure on symptoms and signs in the shunt treatment of idiopathic normal pressure hydrocephalus (iNPH). methods In this prospective double-blinded, randomized, controlled, double-center study on patients with iNPH, a ventriculoperitoneal shunt with an adjustable Codman Medos Valve was implanted in 68 patients randomized into 2 groups. In 1 group (the 20-4 group) the valve setting was initially set to 20 cm H 2 O and gradually reduced to 4 cm H 2 O over the course of the 6-month study period. In the other group (the 12 group), the valve was kept at a medium level of 12 cm H 2 O during the whole study period. All patients were clinically evaluated using 4 tests preoperatively as well as postoperatively at 1, 2, 3, 4, and 6 months. The test scores between the 2 groups (20-4 and 12) were compared for each clinical evaluation. results Fifty-five patients (81%) were able to complete the study. There were no significant differences between the 2 groups (20-4 and 12) preoperatively or at any time postoperatively. Both groups exhibited significant clinical improvement after shunt insertion at all valve settings compared with the preoperative score, with the greatest improvement observed at the first postoperative evaluation. The clinical improvement was significant within the first 3 months, and thereafter no significant improvement was seen in either group. coNclusioNs Gradual reduction of the valve setting from 20 to 4 cm H 2 O did not improve outcome compared with a fixed valve setting of 12 cm H 2 O. Improvement after shunt surgery in iNPH patients was evident within 3 months, irrespective of valve setting.

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Neuropsychological Effects of Shunt Treatment in Idiopathic Normal Pressure Hydrocephalus

Abstract: Most of the wide range of neuropsychological functions that are affected by INPH are markedly improved by shunt treatment, but not completely restored.

Cited by 67 publications

References 50 publications

How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study

How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study

Preoperative and postoperative¹H-MR spectroscopy changes in frontal deep white matter and the thalamus in idiopathic normal pressure hydrocephalus

A double-blind randomized trial on the clinical effect of different shunt valve settings in idiopathic normal pressure hydrocephalus

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Neuropsychological Effects of Shunt Treatment in Idiopathic Normal Pressure Hydrocephalus

Abstract: Most of the wide range of neuropsychological functions that are affected by INPH are markedly improved by shunt treatment, but not completely restored.

Cited by 67 publications

References 50 publications

How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study

How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study

Preoperative and postoperative1H-MR spectroscopy changes in frontal deep white matter and the thalamus in idiopathic normal pressure hydrocephalus

A double-blind randomized trial on the clinical effect of different shunt valve settings in idiopathic normal pressure hydrocephalus

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Preoperative and postoperative¹H-MR spectroscopy changes in frontal deep white matter and the thalamus in idiopathic normal pressure hydrocephalus