Eighty-Year-Old Male With Normal Pressure Hydrocephalus Presenting With Dementia and Parkinsonism Treated Using Electroencephalography (EEG)-Guided H4 Coil Protocol: A Case Report.

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a rare syndrome of apractic or ataxic gait, mild to moderate dementia, and urinary incontinence. The cerebrospinal fluid tap test is widely used in the diagnosis of NPH. Using deep Transcranial Magnetic Simulation (DTMS) with H coils, we developed a novel treatment method that incorporates electroencephalography (EEG)-based customization of the treatment protocol. An 80-year-old male presented with clinical signs of slowness of gait and activity, rigidity, and urinary incontinence, which progressed to bradykinesia, magnetic, short, and shuffling gait. He later developed altered behavior, memory loss, and cognitive deficit. Administration of 17 DTMS sessions with an H4 coil provided transient relief from a few symptoms for approximately two months. Fast Fourier transform analysis of the frontal EEG was used to find the peak activity and customize the treatment protocol. Eleven DTMS sessions with optimized protocol gave a sustainable symptomatic relief as well as improved functionality, as estimated on 10-month follow-up.