Repetitive Lumbar Punctures As an Alternative Treatment of Shunt Operation in Normal Pressure Hydrocephalus

Abstract

Background: Normal pressure hydrocephalus (NPH) is one of the reversible dementia and a shunt operation can improve major symptoms of NPH. However, selected cases of NPH patients can be treated by shunt operation because of high complication rate. We experienced some cases of prolonged clinical improvement of NPH after one or two lumbar punctures (LP) and evaluated the predictors of prolonged improvement of NPH symptoms by repeated LP.

Methods: Thirty- one NPH patients were retrospectively evaluated (age 72.5±5.8 yr). Gait disturbance, urinary incontinence and cognitive impairment were semi-quantified. We divided the patients into three groups (non-responders, transient responders and long-term responders) according to their responses after LP and analyzed the characteristics of the groups.

Results: Gait disturbance (p=0.046) and urinary incontinence (p=0.040) score and total NPH symptom score (p=0.007) after cerebrospinal fluid (CSF) drainage were more significantly improved in long term responders than transient responders. On multiple logistic regression analysis, total NPH score improvement was the only predictor of the long-term responders (p=0.03, odd ratio=0.148).

Conclusions: Our study showed that some of NPH patients could maintain favorable courses for at least one year after LP without shunt operation. Repeated LP could be an alternative treatment in selective NPH patients.