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1. Corticospinal excitability in idiopathic normal pressure hydrocephalus:a transcranial magnetic stimulation study

Author

Sirkka, J. (Jani), Säisänen, L. (Laura), Julkunen, P. (Petro), Könönen, M. (Mervi), Kallioniemi, E. (Elisa), Leinonen, V. (Ville), Danner, N. (Nils), Sirkka, J. (Jani), Säisänen, L. (Laura), Julkunen, P. (Petro), Könönen, M. (Mervi), Kallioniemi, E. (Elisa), Leinonen, V. (Ville), and Danner, N. (Nils)

Abstract

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease with an unknown etiology. Disturbed corticospinal inhibition of the motor cortex has been reported in iNPH and can be evaluated in a noninvasive and painless manner using navigated transcranial magnetic stimulation (nTMS). This is the first study to characterize the immediate impact of cerebrospinal fluid (CSF) drainage on corticospinal excitability. Methods: Twenty patients with possible or probable iNPH (16 women and 4 men, mean age 74.4 years, range 67–84 years), presenting the classical symptom triad and radiological findings, were evaluated with motor function tests (10-m walk test, Grooved Pegboard and Box & Block test) and nTMS (silent period, SP, resting motor threshold, RMT and input–output curve, IO-curve). Evaluations were performed at baseline and repeated immediately after CSF drainage via lumbar puncture. Results: At baseline, iNPH patients presented shorter SPs (p < 0.001) and lower RMTs (p < 0.001) as compared to normative values. Positive correlation was detected between SP duration and Box & Block test (rho = 0.64, p = 0.002) in iNPH patients. CSF drainage led to an enhancement in gait velocity (p = 0.002) and a steeper IO-curve slope (p = 0.049). Conclusions: Shorter SPs and lower RMTs in iNPH suggest impaired corticospinal inhibition and corticospinal hyperexcitability. The steeper IO-slope in patients who improve their gait velocity after CSF drainage may indicate a higher recovery potential. Corticospinal excitability correlated with the motor function of the upper limbs implying that the disturbance in motor performance in iNPH extends beyond the classically reported gait impairment.

Published
2020

2. 5-Year health-related quality of life outcome in patients with idiopathic normal pressure hydrocephalus.

Author

Junkkari, A., Sintonen, H., Danner, N., Jyrkkänen, H. K., Rauramaa, T., Luikku, A. J., Koivisto, A. M., Roine, R. P., Viinamäki, H., Soininen, H., Jääskeläinen, J. E., and Leinonen, V.

Subjects
CEREBROSPINAL fluid shunts, QUALITY of life, HYDROCEPHALUS, MINI-Mental State Examination, LOGISTIC regression analysis, BODY mass index
Abstract

Background: Health-related quality of life (HRQoL) is severely impaired in persons with idiopathic normal pressure hydrocephalus (iNPH). The HRQoL improves in a number of patients after the placement of a cerebrospinal fluid (CSF) shunt, but long-term follow-up of HRQoL is rare. Methods: Extended follow-up (60 months) of a prospective cohort study involving 189 patients with iNPH who underwent shunt surgery. Preoperative variables were used to predict favorable HRQoL outcome (improvement or non-deterioration) measured by the 15D instrument 5 years after shunting. Results: Out of the 189 initially enrolled study participants, 88 had completed 5-year HRQoL follow-up (46%), 64 had died (34%), and 37 (20%) failed to complete the HRQoL follow-up but were alive at the end of the study. After initial post-operative HRQoL improvement, HRQoL deteriorated so that 37/88 participants (42%) had a favorable HRQoL outcome 5 years after shunting. Multivariate binary logistic regression analysis indicated that younger age (adjusted OR 0.86, 95% CI 0.77–0.95; p < 0.005), lower body mass index (adjusted OR 0.87, 95% CI 0.77–0.98; p < 0.05) and better Mini-Mental State Examination performance (adjusted OR 1.16, 95% CI 1.01–1.32; p < 0.05) before surgery predicted favorable 5-year outcome. Conclusions: This extended follow-up showed that the self-evaluated HRQoL outcome is associated with iNPH patients' pre-operative cognitive status, overweight and age. The post-operative deterioration may reflect the natural progression of iNPH, but also derive from aging and comorbidities. It indicates a need for long-term follow-up. [ABSTRACT FROM AUTHOR]

Published
2021
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3. The Kuopio idiopathic normal pressure hydrocephalus protocol:initial outcome of 175 patients

Author

Junkkari, A. (A.), Luikku, A. J. (A. J.), Danner, N. (N.), Jyrkkänen, H. K. (H. K.), Rauramaa, T. (T.), Korhonen, V. E. (V. E.), Koivisto, A. M. (A. M.), Nerg, O. (O.), Kojoukhova, M. (M.), Huttunen, T. J. (T. J.), Jääskeläinen, J. E. (J. E.), and Leinonen, V. (V.)

Subjects
Tap test, Normal pressure hydrocephalus, Comorbidity, Infusion test, Outcome
Abstract

Background: The Kuopio University Hospital (KUH) idiopathic normal pressure hydrocephalus (iNPH) cerebrospinal fluid (CSF) shunting protocol is described together with the initial outcomes of 175 patients with probable iNPH treated according to this protocol from a defined population. Our secondary aim was to display the variety of differential diagnoses referred to the KUH iNPH outpatient clinic from 2010 until 2017. Methods: Patients were divided into four groups according to the prognostic tests: tap test (positive or negative) and infusion test (positive or negative). The short-term outcome was compared between groups. The 3-month outcome following shunt surgery was assessed by measuring gait speed improvement, using a 12-point iNPH grading scale (iNPHGS) and the 15D instrument. Results: From 341 patients suspected of iNPH, 88 patients were excluded from further research mostly due to deviation from the protocol’s gait assessment guidelines. Hence 253 patients with suspected iNPH were included in the study, 177/253 (70%) of whom were treated with a CSF shunt. A favorable clinical outcome following surgery was observed in 79–93% of patients depending on the prognostic group. A moderate association (Cramer’s V = 0.32) was found between the gait speed improvement rate and the prognostic group (X2, p = 0.003). Patients with a positive tap test had the highest gait speed improvement rate (75%). In addition, an improvement in walking speed was observed in 4/11 patients who had both a negative tap test and a negative infusion test. Other outcome measures did not differ between the prognostic groups. Conditions other than iNPH were found in 25% of the patients referred to iNPH outpatient clinic, with the most prevalent being Alzheimer’s disease. Conclusions: Our results emphasize the importance of a systematic diagnostic and prognostic workup especially in cases with an atypical presentation of iNPH. Additional diagnostic testing may be required, but should not delay adequate care. Active surgical treatment is recommended in patients with a high clinical probability of iNPH. Other neurological conditions contributed to most of the non iNPH diagnoses.

Published
2019

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