Abram Katrin, Bohne Silvia, Bublak Peter, Karvouniari Panagiota, Klingner Carsten M, Witte Otto W, Guntinas-Lichius Orlando, Axer Hubertus
Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
Dement Geriatr Cogn Dis Extra. 2016 Sep 27;6(3):447-457. doi: 10.1159/000450602. eCollection 2016 Sep-Dec.
BACKGROUND/AIMS: Postural instability in patients with normal pressure hydrocephalus (NPH) is a most crucial symptom leading to falls with secondary complications. The aim of the current study was to evaluate the therapeutic effect of spinal tap on postural stability in these patients.
Seventeen patients with clinical symptoms of NPH were examined using gait scale, computerized dynamic posturography (CDP), and neuropsychological assessment. Examinations were done before and after spinal tap test.
The gait score showed a significant improvement 24 h after spinal tap test in all subtests and in the sum score (p < 0.003), while neuropsychological assessment did not reveal significant differences 72 h after spinal tap test. CDP showed significant improvements after spinal tap test in the Sensory Organization Tests 2 (p = 0.017), 4 (p = 0.001), and 5 (p = 0.009) and the composite score (p = 0.01). Patients showed best performance in somatosensory and worst performance in vestibular dominated tests. Vestibular dominated tests did not improve significantly after spinal tap test, while somatosensory and visual dominated tests did.
Postural stability in NPH is predominantly affected by deficient vestibular functions, which did not improve after spinal tap test. Conditions which improved best were mainly independent from visual control and are based on proprioceptive functions.
背景/目的：正常压力脑积水（NPH）患者的姿势不稳是导致跌倒及继发并发症的关键症状。本研究旨在评估腰椎穿刺对这些患者姿势稳定性的治疗效果。
对17例有NPH临床症状的患者进行步态量表、计算机动态姿势描记法（CDP）及神经心理学评估。在腰椎穿刺试验前后进行检查。
腰椎穿刺试验24小时后，步态评分在所有子测试及总分中均有显著改善（p < 0.003），而神经心理学评估在腰椎穿刺试验72小时后未显示出显著差异。CDP显示，腰椎穿刺试验后，感觉组织测试2（p = 0.017）、4（p = 0.001）和5（p = 0.009）以及综合评分（p = 0.01）有显著改善。患者在躯体感觉测试中表现最佳，在前庭主导测试中表现最差。腰椎穿刺试验后，前庭主导测试未显著改善，而躯体感觉和视觉主导测试有所改善。
NPH患者的姿势稳定性主要受前庭功能不足影响，腰椎穿刺试验后未得到改善。改善最明显的情况主要独立于视觉控制，且基于本体感觉功能。
