Lim T S, Yong S W, Moon S Y
Department of Neurology, Ajou University School of Medicine, Yeongtong-Gu, Suwon, South Korea.
Eur Neurol. 2009;62(5):293-7. doi: 10.1159/000235808. Epub 2009 Aug 27.
Selected normal pressure hydrocephalus (NPH) patients cannot be treated by shunt operation because of the procedure's high complication rate. We have treated cases in which prolonged clinical improvement of NPH was experienced after one or two lumbar punctures (LPs). We evaluated the predictors of prolonged improvement of NPH symptoms by repeated LP. Thirty-one NPH patients were retrospectively evaluated (age 72.5 +/- 5.8 years). Gait disturbance, urinary incontinence, and cognitive impairment were semiquantified. We divided the patients into three groups (non-responders, temporary responders, and prolonged responders) according to their responses after LP. We analyzed the characteristics of the groups. Gait disturbance (p = 0.046) and urinary incontinence (p = 0.040) scores and total NPH symptom score (p = 0.007) after cerebrospinal fluid drainage were more significantly improved in prolonged responders than in temporary responders. On multiple logistic regression analyses, total NPH score improvement was the only predictor of the prolonged responders (p = 0.03, odds ratio 0.148). Our study showed that some NPH patients could maintain favorable courses for at least 1 year after LP without shunt operation. Repeated LP could be an alternative treatment in selected NPH patients.
部分正常压力脑积水（NPH）患者因分流手术并发症发生率高而无法接受该手术治疗。我们曾治疗过一些患者，他们在接受一两次腰椎穿刺（LP）后，NPH症状出现了长期的临床改善。我们评估了重复LP后NPH症状长期改善的预测因素。对31例NPH患者进行了回顾性评估（年龄72.5±5.8岁）。对步态障碍、尿失禁和认知障碍进行了半定量评估。根据患者LP后的反应，我们将其分为三组（无反应者、临时反应者和长期反应者）。我们分析了这几组患者的特征。与临时反应者相比，长期反应者在脑脊液引流后的步态障碍评分（p = 0.046）、尿失禁评分（p = 0.040）和NPH症状总评分（p = 0.007）改善更为显著。在多因素logistic回归分析中，NPH总评分的改善是长期反应者的唯一预测因素（p = 0.03，比值比0.148）。我们的研究表明，一些NPH患者在LP后不进行分流手术至少可维持1年的良好病程。重复LP可能是部分NPH患者的一种替代治疗方法。
