Repetitive Lumbar Punctures as Treatment for Normal Pressure Hydrocephalus

Abstract

Selected normal pressure hydrocephalus (NPH) patients cannot be treated by shunt operation because of the procedure’s high complication rate. We have treated cases in which prolonged clinical improvement of NPH was experienced after one or two lumbar punctures (LPs). We evaluated the predictors of prolonged improvement of NPH symptoms by repeated LP. Thirty-one NPH patients were retrospectively evaluated (age 72.5 ± 5.8 years). Gait disturbance, urinary incontinence, and cognitive impairment were semiquantified. We divided the patients into three groups (non-responders, temporary responders, and prolonged responders) according to their responses after LP. We analyzed the characteristics of the groups. Gait disturbance (p = 0.046) and urinary incontinence (p = 0.040) scores and total NPH symptom score (p = 0.007) after cerebrospinal fluid drainage were more significantly improved in prolonged responders than in temporary responders. On multiple logistic regression analyses, total NPH score improvement was the only predictor of the prolonged responders (p = 0.03, odds ratio 0.148). Our study showed that some NPH patients could maintain favorable courses for at least 1 year after LP without shunt operation. Repeated LP could be an alternative treatment in selected NPH patients.

Shunt-Responsive Idiopathic Normal Pressure Hydrocephalus Patient with Delayed Improvement after Tap Test

“…As the disease progresses and the ventricles get larger, they may lose elasticity12). If the ventricles are slightly shrunken by CSF removal, the elasticity of the ventricles may recover along with symptomatic improvement over a certain period12).…”

Hydrocéphalie à pression normale : mise au point et aspects pratiques

“…Traitement par PL déplétives répétées. Une alternative au traitement chirurgical proposée par Lim et al [52] en 2009 serait la répétition de PL déplétives. Selon cette étude, une ou deux PL déplé-tives pourraient suffire à maintenir une efficacité clinique allant au-delà d'un an après la ponction.…”

Biology of Cilia and Ciliopathies

“…The disease dates back to the time of Hippocrates when he described a "liquefaction of the brain" that showed symptoms such as headache, vomiting, and visual impairment [109]. Other symptoms can include high intracranial pressure, in addition to impairments in gait, cognition, alertness, and continence [110]. Although this disease can have various causes, it has been shown that there is a higher prevalence of hydrocephalus in patients that are known to have ciliary defects, and the disease can also be linked to genes known to impact cilia function or structure [111].…”

“…In elderly patients shunt implantation is very risky. Repeated lumbar puncturing in patients with communicating hydrocephalus can potentially prevent the need for shunt surgery in these patients [110]. The newest addition to shunt technology is antibiotic-impregnated shunts that help prevent post-surgical infections [128].…”