Is there a spinal tap responder in progressive supranuclear palsy? The first prospective study

Area of Science:

• Neurodegenerative diseases
• Neurology
• Cerebrospinal fluid dynamics

Background:

• Progressive supranuclear palsy (PSP) can mimic idiopathic normal pressure hydrocephalus (iNPH) presentations.
• Understanding PSP's relationship with cerebrospinal fluid (CSF) dynamics is crucial for diagnosis and treatment.

Purpose of the Study:

• To evaluate spinal tap responsiveness in PSP patients.
• To assess the impact of sham spinal taps (placebo effect) on PSP patients.
• To compare PSP patient responses to iNPH and control groups.

Main Methods:

• Prospective enrollment of 11 PSP, 10 iNPH, and 8 control patients.
• Performance of both sham and actual spinal tap procedures.
• Gait analysis using wearable inertial sensors, defining responders by a 10% improvement in gait parameters.

Main Results:

• PSP patients showed significantly higher ratios of tap and sham tap responders compared to controls.
• PSP patient response rates were comparable to iNPH patients.
• PSP patients with iNPH-like MRI features showed a trend towards better spinal tap response.

Conclusions:

• This study is the first to prospectively show spinal tap and shunt responsiveness in PSP.
• Placebo effects from spinal taps are significant in both PSP and iNPH patients.
• Impaired CSF circulation may represent a distinct clinical component in some PSP patients.