EP 51. Determination of gait improvement after lumbar puncture in idiopathic normal pressure hydrocephalus. Issue 9 (September 2016)

• Record Type: Journal Article
• Authors: Möhwald, K.; Wuehr, M.; Pradhan, C.; Dieterich, M.; Brandt, T.; Jahn, K.; Schniepp, R.
• Is Part Of: Clinical neurophysiology. Volume 127:Issue 9(2016:Sep.)
• Page Start: e260
• Publication Date: 2016-09
• Subjects: Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2016.05.105
• Languages: English
• ISSNs: 1388-2457

Abstract

Abstract : Objective: Determination of gait improvement after lumbar puncture (LP) in idiopathic normal pressure hydrocephalus (iNPH) is crucial, but the best time to do is unclear. We determined the time course of walking improvement after LP for single task (ST) and dual task (DT) walking in iNPH. Methods: Sequential recordings of gait velocity of 24 patients (79.8 ± 7.8 years) prior to LP (TP0), on day 1 (TP1, 1-8 h), day 2 (TP2, 24 h), day 3 (TP3, 48 h), and day 4 (TP4, 72 h). Gait analysis was performed using a pressure sensitive carpet (GAITRite) under four conditions: walking at preferred velocity (STPS), walking at maximal velocity (STMS), dual-task "serial 7" (DTS7), dual-task "verbal fluency" (DTVF). Results: Objective responder status moderately coincides with the self-estimation of the patients with high false positive subjective results (83%). The extent of improvement is higher for ST compared to DT ( p 〈0.05). Significant increases of walking speed were found at TP2 for STPS ( p = 0.042), and DTVF ( p = 0.046), and at TP3 for STPS ( p = 0.035), DTS7 ( p = 0.042), and DTVF ( p = 0.044). The enlargement of ventricles (Evans Index) positively correlated with early improvement. Gait improvement at TP 3 correlated with the shunt response in 18 patients. Conclusions: Quantitative gait assessment in iNPH is important due to the poor self-evaluation of the patients. The maximal increase in gait velocity can be observed 24–48 h after the LP. This time point is also best to predict the response to shunting. For DT paradigms the maximal improvement appears to be later (48–72 h). Assessment of gait should be performed at day 2 or 3 of LP.