A prospective study on gait dominant normal pressure hydrocephalus

Area of Science:

• Neurology
• Neurosurgery
• Gait Analysis

Background:

• Idiopathic normal pressure hydrocephalus (NPH) is a neurological disorder characterized by gait disturbance, cognitive impairment, and urinary incontinence.
• Lumbar puncture (LP) and ventriculoperitoneal shunt placement are common treatments for NPH, but their comparative effectiveness on gait is not fully elucidated.

Purpose of the Study:

• To characterize the gait alterations in idiopathic normal pressure hydrocephalus (NPH) patients following treatment with lumbar puncture (LP) and shunt placement.
• To evaluate the efficacy of these interventions by assessing changes in gait characteristics using quantitative walkway analysis.

Main Methods:

• A cohort of 28 NPH patients at Barrow Neurological Institute (BNI) underwent LP (30-32 mL CSF removal) followed by ventriculoperitoneal shunt placement.
• Gait and balance data were collected using clinical assessments and the ProtoKinetics Zeno Walkway at pre-LP, post-LP, and 6-month post-shunt stages.
• Statistical analyses, including one-way ANOVA and Tukey-Kramer HSD, were performed to compare gait parameters across the three assessment points.

Main Results:

• Nine out of 15 clinical assessments showed significant alterations post-treatment.
• The ProtoKinetics Zeno Walkway identified significant differences in 7 out of 10 recorded gait characteristics among the pre-LP, post-LP, and post-shunt datasets.
• Greater significant improvements were observed between pre-LP and post-shunt assessments compared to pre-LP and post-LP assessments.

Conclusions:

• Specific gait characteristics are more indicative of NPH and its response to treatment.
• Focusing on NPH-specific gait features alleviated by LP and/or shunt placement can enhance diagnostic accuracy.
• Continuous cerebrospinal fluid drainage via shunt placement demonstrates a cumulative effect, leading to more substantial NPH symptom improvement than LP alone.