Objectives

To evaluate clinical response after external lumbar drainage (ELD) and ventriculoperitoneal shunting (VPS) in a cohort of patients with idiopathic normal pressure hydrocephalus associated with parkinsonism (iNPH-P), considering parkinsonism as clinical primary outcome.

Methods

Patients underwent long-term 72-h intracranial pressure-controlled CSF ELD. Clinical motor response before and after ELD was evaluated using changes in UPDRS-ME as outcome measure. A standardized cognitive assessment was also performed. iNPH-P patients who underwent VPS were clinically followed-up after surgery.

Results

Fourteen iNPH-P patients (age: 69.3 ± 11.6 years) were studied. The time of evaluation after ELD removal was 3.5 ± 1.8 days. We observed a significant motor improvement after the drainage in eight (57.1%) patients. Percent clinical motor response was 18.4 ± 6.7%. Twelve (85.7%) patients underwent VPS. Nine patients were examined after surgery at 31.6 ± 7 months. Four (44.4%) patients presented a clinically detectable improvement in motor response after VPS. No significant changes in cognitive performances were detected.

Conclusions

A clinically detectable motor response on parkinsonian signs was observed in a consistent part of iNPH-P patients few days after ELD as well as over two and half years after VPS. Parkinsonism should be considered as outcome measure for the clinical management of patients with iNPH-P.

中文翻译：

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iNPH伴帕金森病：对腰CSF引流和脑室-腹膜分流的反应

目标

为了评估帕金森病为临床主要结局的特发性正常压力脑积水伴帕金森病（iNPH-P）的患者队列中的外部腰椎引流（ELD）和脑室腹膜分流（VPS）后的临床反应。

方法

患者接受长期72小时颅内压控制的CSF ELD。使用UPDRS-ME的变化作为结果指标评估ELD前后的临床运动反应。还进行了标准化的认知评估。接受VPS的iNPH-P患者在手术后进行临床随访。

结果

研究了14名iNPH-P患者（年龄：69.3±11.6岁）。去除ELD后的评估时间为3.5±1.8天。我们观察到八名（57.1％）患者引流后的运动功能有了明显改善。临床运动反应百分比为18.4±6.7％。十二名（85.7％）患者接受了VPS。手术后31.6±7个月检查了9例患者。VPS后有四名（44.4％）患者表现出运动反应临床上可检测到的改善。没有发现认知能力有明显变化。

结论

在ELD几天后以及VPS两年半后，在iNPH-P患者的一致部位观察到临床可检测到的帕金森氏体征运动反应。帕金森病应作为iNPH-P患者临床治疗的结局指标。