iNPH with parkinsonism: response to lumbar CSF drainage and ventriculoperitoneal shunting
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ORIGINAL COMMUNICATION
iNPH with parkinsonism: response to lumbar CSF drainage and ventriculoperitoneal shunting Giovanni Mostile1 · Giacomo Portaro1 · Francesco Certo2 · Antonina Luca1 · Roberta Manna1 · Roberta Terranova1 · Roberto Altieri2 · Alessandra Nicoletti1 · Giuseppe Maria Vincenzo Barbagallo2 · Mario Zappia1 Received: 16 June 2020 / Revised: 15 September 2020 / Accepted: 7 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To evaluate clinical response after external lumbar drainage (ELD) and ventriculoperitoneal shunting (VPS) in a cohort of patients with idiopathic normal pressure hydrocephalus associated with parkinsonism (iNPH-P), considering parkinsonism as clinical primary outcome. Methods Patients underwent long-term 72-h intracranial pressure-controlled CSF ELD. Clinical motor response before and after ELD was evaluated using changes in UPDRS-ME as outcome measure. A standardized cognitive assessment was also performed. iNPH-P patients who underwent VPS were clinically followed-up after surgery. Results Fourteen iNPH-P patients (age: 69.3 ± 11.6 years) were studied. The time of evaluation after ELD removal was 3.5 ± 1.8 days. We observed a significant motor improvement after the drainage in eight (57.1%) patients. Percent clinical motor response was 18.4 ± 6.7%. Twelve (85.7%) patients underwent VPS. Nine patients were examined after surgery at 31.6 ± 7 months. Four (44.4%) patients presented a clinically detectable improvement in motor response after VPS. No significant changes in cognitive performances were detected. Conclusions A clinically detectable motor response on parkinsonian signs was observed in a consistent part of iNPH-P patients few days after ELD as well as over two and half years after VPS. Parkinsonism should be considered as outcome measure for the clinical management of patients with iNPH-P. Keywords Normal pressure hydrocephalus · Parkinsonism · External lumbar drainage · Ventriculoperitoneal shunt
Introduction Idiopathic normal-pressure hydrocephalus (iNPH) has been first described in 1965 by Hakim and Adams [1] as a clinical syndrome characterized by the presence of gait disturbance, urinary incontinence, and cognitive impairment in patients with radiological evidence of ventriculomegaly. To date, few and heterogeneous data are available about the prevalence Giovanni Mostile, Giacomo Portaro these authors have equally contributed to this work. * Mario Zappia [email protected] 1
Department “G.F. Ingrassia”, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
Department “G.F. Ingrassia”, Neurosurgery Clinic, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
2
of iNPH, although it has been recently estimated between 0.2% in the eighth decade and 5.9% in people aged 80 years and older [2]. Gait disturbances are typically present at the clinical onset of disease, even though cerebral ventriculomegaly can be also detected in asymptomatic or minimally symptomatic adult [3, 4].
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