Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Lacie Manthripragada, Advent Health Pediatric Neurosurgery, Orlando, FL, USA; Department of Neurosurgery, Johns Hopkins University Baltimore, MD, USA.
Clin Neurol Neurosurg. 2021 Aug;207:106810. doi: 10.1016/j.clineuro.2021.106810. Epub 2021 Jul 10.
The primary aim of the study was to assess the effect comorbid Parkinson syndromes have on results of CSF tap test (TT) and shunt outcomes for patients presenting with Normal Pressure Hydrocephalus (NPH). We hypothesized that patients with possible NPH and comorbid Parkinson syndromes with Positive DaT scans will not respond to CSF TT at the same rate as patients without comorbid Parkinson syndromes. Additionally, we followed a small number of patients with positive DaT scans who were shunted to assess long term outcome of comorbid Parkinson syndromes.
Medical records and neurological exams of 251 patients were reviewed. In our analysis 101 patients with no parkinsonian symptoms and no DaT scans were included as a control group, there were 52 patients with DaT scans, 31 patients were positive (DaT-P). Gait measures were assessed before and after CSF TT using the Wilcoxon matched-pairs signed-rank test or paired t-tests were used. To compare the effect of DaT-P and Control, we used an ANCOVA controlling for age, sex, assistive device used, and past medical history effecting gait.
There was not a significant difference in response between Control and DaT-P group. The Control group improved on timed up and go (TUG) by 14.82%, DualTUG 16.35%, 10-meter Walk Test (10MWT) 18.13%, MiniBEST 15.91%, and 6-minute Walk Test (6MWT) 13.96%, while the DaT-P group improved on TUG by 14.93%, DualTUG 17.24%, 10MWT 22.68%, MiniBEST 18.07%, and 6MWT 16.06%.
Our findings suggest that patients with possible NPH and suspected comorbid movement disorder, showed similar improvement after diagnostic CSF TT compared to participants with no parkinsonian symptoms present on exam.
Data relevant to the study will be made available from the corresponding author upon a reasonable request.
本研究的主要目的是评估合并帕金森综合征对伴有正常压力脑积水（NPH）患者腰椎穿刺（TT）结果和分流术结果的影响。我们假设，伴有可能的 NPH 和合并帕金森综合征且 DaT 扫描阳性的患者，对 CSF TT 的反应率不会与无合并帕金森综合征的患者相同。此外，我们对一些 DaT 扫描阳性且接受分流术的患者进行了随访，以评估合并帕金森综合征的长期预后。
回顾了 251 例患者的病历和神经检查。在我们的分析中，纳入了 101 例无帕金森症状和无 DaT 扫描的患者作为对照组，52 例有 DaT 扫描，31 例为阳性（DaT-P）。使用 Wilcoxon 配对符号秩检验或配对 t 检验评估 CSF TT 前后的步态测量值。为了比较 DaT-P 和对照组的效果，我们使用协方差分析（ANCOVA）控制年龄、性别、使用的辅助设备以及影响步态的既往病史。
对照组和 DaT-P 组之间的反应没有显著差异。对照组在计时起立行走测试（TUG）中改善了 14.82%，双 TUG 改善了 16.35%，10 米步行测试（10MWT）改善了 18.13%，MiniBEST 改善了 15.91%，6 分钟步行测试（6MWT）改善了 13.96%，而 DaT-P 组在 TUG 中改善了 14.93%，双 TUG 改善了 17.24%，10MWT 改善了 22.68%，MiniBEST 改善了 18.07%，6MWT 改善了 16.06%。
我们的发现表明，伴有可能的 NPH 和疑似合并运动障碍的患者，在接受诊断性 CSF TT 后，与体检无帕金森症状的患者相比，表现出相似的改善。
与研究相关的数据将根据合理请求，由通讯作者提供。
