Normal pressure hydrocephalus and CSF tap test response: the gait phenotype matters
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NEUROLOGY AND PRECLINICAL NEUROLOGICAL STUDIES - SHORT COMMUNICATION
Normal pressure hydrocephalus and CSF tap test response: the gait phenotype matters Eric Morel1,2 · Stéphane Armand2,3 · Frédéric Assal2,4 · Gilles Allali2,4,5 Received: 27 June 2020 / Accepted: 9 October 2020 © The Author(s) 2020
Abstract This study compared gait speed changes after CSF tap test in patients with idiopathic normal pressure hydrocephalus presenting with various gait phenotypes (frontal, parkinsonian, normal, or other). All patients improved, except those with parkinsonian gait. Keywords Gait disorders · Normal pressure hydrocephalus · Clinical evaluation · Gait phenotypes
Introduction Gait disorders are the hallmark feature of patients with idiopathic normal pressure hydrocephalus (iNPH) (Relkin et al. 2005). INPH patients present various gait phenotypes from normal gait to severe frontal or parkinsonian gait (Morel et al. 2019). The variability of these phenotypes may be due to the severity of iNPH or influenced by comorbid neurological (i.e., vascular lesions) and non-neurological (i.e., arthritis) diseases (Stolze et al. 2001). To assess the reversibility of gait impairment in iNPH, the CSF tap test represents a widely used prognostic procedure (Krauss and Halve 2004). However, the influence of gait phenotypes on gait changes after CSF tap test has never been studied in * Eric Morel [email protected] 1
Department of Neurology, University Clinic of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16, 3010 Bern, Switzerland
2
Faculty of Medicine, University Geneva Hospitals, University of Geneva, Rue Gabrielle‑Perret‑Gentil 4, 1205 Geneva, Switzerland
3
Willy Taillard Laboratory of Kinesiology, University Geneva Hospitals, Geneva, Switzerland
4
Division of Neurology, Department of Clinical Neurosciences, University Geneva Hospitals, Geneva, Switzerland
5
Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA
patients with iNPH. Therefore, we aimed to compare gait speed changes after CSF tap test among the various gait phenotypes presented by patients with iNPH. Establishing which gait phenotype in iNPH is associated with good clinical outcomes after CSF tap test may improve the identification of appropriate candidates for shunt surgery.
Methods A total of 77 consecutive iNPH patients from the Geneva iNPH cohort (Allali et al. 2017) were included in this retrospective study (age 76.1 ± 6.2 years; 32.5% female). Study procedures have been previously described (Allali et al. 2017). Briefly, patients were referred for suspicion of iNPH based on gait disturbances, cognitive impairment, and/or urine incontinence. Inclusion criteria were patients with a diagnosis of possible or probable iNPH (i), able to walk without assistance (ii), a video recording of their gait preCSF tap test (iii), and a measure of gait speed pre- and postCSF tap test (iv). Exclusion criteria were any acute medical condition in the 3 months b
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