Objective: To evaluate timing and clinical correlates of motor response after 72-h lumbar CSF drainage in patients with Normal Pressure Hydrocephalus (iNPH) associated with parkinsonism.

Background: Clinical response to 72-h lumbar CSF drainage represents a positive prognostic factors for ventriculoperitoneal shunting in patients with iNPH. However, data concerning timing for the assessment of clinical response as well as factors associated with motor response in such patients are still inconsistent, especially for those affected by concomitant parkinsonism.

Method: We analyzed data of iNPH patients who were referred to the Neurosurgery Clinic for a diagnosis of iNPH based on clinical characteristics as well as for the radiological evidence of cerebral ventriculomegaly. All patients were affected by parkinsonism. Before the procedure of ventriculoperitoneal shunting, they underwent long-term 72-h intracranial-pressure controlled CSF external drainage using the LiquoGuard system. A cognitive assessment was performed before the drainage. Clinical motor response pre- and post- the 72-h lumbar CSF drainage was evaluated.

Results: We identified 14 iNPH patients (age: 69.3±11.6 years; corrected MMSE score: 24.8±3.9; corrected FAB score: 11.8±3.6). The time between the two clinical evaluations (before and after the drainage) was in average 8±3 days. We observed a significantly motor improvement after the drainage (Pre-UPDRS-ME score: 20.1±6.5; Post-UPDRS-ME score: 18.6±7.9; p=0.012). Percent clinical motor response was in average: 10±11%. Overall, 36% of patients presented a motor response greater than 15%. Percent motor response negatively correlated with Pre-UPDRS-ME score (r=-0.798; p<0.001). A borderline positive correlation was also observed between clinical motor response and FAB score evaluate at baseline (r=0.54; p=0.057).

Conclusion: A clinically detectable motor response was detected in about one third of iNPH patients with parkinsonism few days after the 72-h lumbar CSF drainage. Patients with more severe cognitive and motor condition at baseline could present a worse acute motor response to the drainage.

References: [1] Bugalho P, Guimarães J. Gait disturbance in normal pressure hydrocephalus: a clinical study. Parkinsonism Relat Disord. 2007; 13: 434-437. [2] Molde K, Söderström L, Laurell K. Parkinsonian symptoms in normal pressure hydrocephalus: a population-based study. J Neurol. 2017; 264: 2141-2148. [3] Walchenbach R, Geiger E, Thomeer R, Vanneste J. The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 2002; 72: 503-506. [4] Schniepp R, Trabold R, Romagna A, Akrami F, Hesselbarth K, Wuehr M, et al. Walking assessment after lumbar puncture in normal-pressure hydrocephalus: a delayed improvement over 3 days. J Neurosurg. 2017; 126: 148-157. [5] Akiguchi I, Ishii M, Watanabe Y, Watanabe T, Kawasaki T, Yagi H, et al. Shunt-responsive parkinsonism and reversible white matter lesions in patients with idiopathic NPH. J Neurol. 2008; 255: 1392-1399. [6] Wolfsegger T, Topakian R. Cognitive impairment predicts worse short-term response to spinal tap test in normal pressure hydrocephalus. J Neurol Sci. 2017; 379: 222-225.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-response-to-72-h-lumbar-csf-drainage-in-idiopathic-normal-pressure-hydrocephalus-associated-with-parkinsonism-timing-and-correlates/