现在是时候重新考虑替换程序的价值,以治疗"异常性正常压力脑水性"
1Program in Neuroscience, Division of Sleep Medicine, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Annals of neurology
|February 25, 2026
概括
正常压力脑症 (NPH) 随着分流的治疗,没有表现出认知或克制能力的改善. 套路程序只提供轻微的步态改善,但带有重大风险,质疑NPH概念.
科学领域:
- 神经学 神经学
- 神经外科 神经外科
- 临床试验 临床试验
背景情况:
- 正常压力脑症 (NPH) 的特征是心室膨胀,脑脊液 (CSF) 压力正常,以及三位一体的认知障碍,尿失禁和步行不良.
- 从历史上看,通过转程序扭转症状验证了NPH概念,特别是在二次通讯性水头发症的情况下.
- 对于"非原发性NPH"而言,车的广泛应用缺乏强有力的证据,直到最近的随机,安慰剂对照试验.
研究的目的:
- 为了评估在患有异常性正常压力头症的患者中移位手术的疗效.
- 评估变流对认知功能,尿失禁和步态的影响.
- 为了确定与NPH患者的分流相关的不良事件的发生率.
主要方法:
- 对最近的随机化,安慰剂对照试验的审查,这些试验调查了异常性正常压力头症的变流.
- 分析结果,包括认知功能,尿,步行速度和不良事件发生率.
- 结果与关于变动效率的历史数据进行比较.
主要成果:
- 轮手术没有证明认知功能或尿的改善.
- 在移动后,观察到步行速度的轻微改善 (约25%).
- 严重的不良事件发生在10-15%的患者在移动后的第一年内,随着时间的推移有可能积累.
结论:
- 针对异常性正常压力头症的分流疗法的有效性值得怀疑,特别是在认知障碍和失禁方面.
- 这些发现挑战了固定的异常性NPH概念和常规运用变流的概念.
- 需要进一步的研究来澄清轮流和替代治疗对NPH症状的作用.
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