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Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery: a controlled study

F Lundin1, T Ledin, C Wikkelsø

  • 1Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden. Fredrik.Lundin@lio.se

Clinical Neurology and Neurosurgery
|March 16, 2013
PubMed
Summary

Idiopathic normal pressure hydrocephalus (iNPH) patients exhibit significant postural dysfunction compared to healthy individuals. While shunt surgery offers slight balance improvements, central vestibular issues persist.

Keywords:
Computerized dynamic posturographyIdiopathic normal pressure hydrocephalusPostural functionShunt surgery

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Area of Science:

  • Neurology
  • Biomechanics
  • Vestibular System

Background:

  • Postural dysfunction is a key characteristic of idiopathic normal pressure hydrocephalus (iNPH).
  • Computerized dynamic posturography (CDP) provides objective assessment of balance.
  • Understanding postural control deficits in iNPH is crucial for treatment evaluation.

Purpose of the Study:

  • To objectively assess and compare postural function in iNPH patients and healthy individuals (HI) using CDP.
  • To evaluate the impact of ventriculo-peritoneal shunt surgery on postural control in iNPH patients.
  • To identify the primary origin of postural disturbances in iNPH.

Main Methods:

  • Thirty-five iNPH patients and sixteen HI underwent CDP testing using the EquiTest system.
  • iNPH patients were tested pre-operatively and three months post-shunt surgery.
  • Balance, motor function, and cognition were assessed, with a focus on Sensory Organizing Test (SOT) conditions.

Main Results:

  • Pre-operatively, iNPH patients demonstrated significantly poorer balance across all SOT conditions compared to HI (p<0.01).
  • Vestibular-dominant conditions showed the greatest balance deficits and frequent loss of balance (LOB) in iNPH patients.
  • Post-shunt surgery, 90% of patients responded, showing a 26% mean improvement in motor scores and a slight increase in the composite SOT score (p<0.05), but no significant reduction in LOB.

Conclusions:

  • CDP confirms significant balance impairments in iNPH patients, particularly in vestibular-related SOT conditions (SOT 5-6), suggesting a central vestibular origin.
  • Ventriculo-peritoneal shunt surgery leads to modest improvements in overall balance for iNPH patients.
  • Further research may explore targeted interventions for residual vestibular deficits in iNPH.