Acosta Lealani Mae Y, Stubblefield Kassandra, Conwell Trisha, Espaillat Kiersten, Koons Heather, Konrad Peter, Fang John, Kirshner Howard, Davis Thomas
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
Neurol Clin Pract. 2021 Aug;11(4):e447-e453. doi: 10.1212/CPJ.0000000000001018.
The workup for idiopathic normal pressure hydrocephalus (INPH) can be difficult to coordinate, and determining appropriate patients for ventriculoperitoneal shunting can be challenging. Therefore, we hypothesized that implementing a formalized protocol can improve patient selection for a shunt. In conjunction with neurology and neurosurgery, we instituted a standardized means of assessing patients whose presentation is concerning for INPH and compared their workup with similar patients seen without the Protocol (i.e., preprotocol [PP]) regarding baseline characteristics, assessment, and outcomes.
Twenty-six PP patients were compared with 40 Protocol patients on measures, including baseline deficits, workup, neurosurgical evaluation, and response to shunt.
Average age was similar between groups, and the percentage of patients who had a decline in gait, cognition, and/or incontinence was not statistically different ( > 0.05). Significantly more Protocol patients underwent high-volume lumbar puncture (HVLP; 97.5%; PP, 61.5%; < 0.001) and received formalized gait assessment with the Gait Scale (90%; PP, 0%, < 0.001) and standardized cognitive testing (95%; PP, 38.5%; < 0.001). Significantly more Protocol patients had no improvement after HVLP (33.3%; PP, 6.25%; < 0.045); subsequently, fewer got shunted (57.5%; PP, 84.6%; < 0.030). More Protocol patients who were shunted reported gait improvement (100%; PP, 72.7%; = 0.009), although there was no difference in cognition (59.2%; PP, 82.6%; = 0.108) or incontinence (18.2%; PP, 39.1%; = 0.189).
Implementing an INPH Protocol leads to standardized and more extensive assessment and better patient selection for and subsequent outcomes from shunting, specifically regarding gait.
特发性正常压力脑积水（INPH）的检查工作可能难以协调，确定适合进行脑室腹腔分流术的患者具有挑战性。因此，我们假设实施一个规范化方案可以改善分流患者的选择。我们与神经内科和神经外科合作，建立了一种标准化方法来评估那些表现疑似INPH的患者，并将他们的检查情况与未采用该方案（即方案前[PP]）就诊的类似患者在基线特征、评估和结果方面进行比较。
对26例PP患者和40例方案患者进行了包括基线缺陷、检查、神经外科评估和分流反应等方面的比较。
两组患者的平均年龄相似，步态、认知和/或失禁出现下降的患者百分比无统计学差异（P>0.05）。采用方案的患者接受大量腰椎穿刺（HVLP）的比例显著更高（97.5%；PP组为61.5%；P<0.001），并且接受了使用步态量表进行的规范化步态评估（90%；PP组为0%，P<0.001）以及标准化认知测试（95%；PP组为38.5%；P<0.001）。采用方案的患者在HVLP后无改善的比例显著更高（33.3%；PP组为6.25%；P<0.045）；随后，接受分流的患者更少（57.5%；PP组为84.6%；P<0.030）。更多接受分流的采用方案患者报告步态有改善（100%；PP组为72.7%；P=0.009），尽管在认知（59.2%；PP组为82.6%；P=0.108）或失禁（18.2%；PP组为39.1%；P=0.189）方面没有差异。
实施INPH方案可导致标准化且更广泛的评估，并能更好地选择分流患者以及改善分流后的后续结果，特别是在步态方面。
