Morgan Broggi1, Veronica Redaelli2, Giovanni Tringali3, Francesco Restelli3, Luigi Romito4, Silvia Schiavolin5, Fabrizio Tagliavini2, Giovanni Broggi3. 1. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. Electronic address: morganbroggi@hotmail.com. 2. Neuropathology Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 3. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 4. Movement Disorders Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 5. Public Health and Disability Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Abstract
OBJECTIVE:Idiopathic normal pressure hydrocephalus (iNPH) may present, besides the classic triad of symptoms, with extrapyramidal parkinsonianlike movement disorders. We present a randomized prospective study comparing adjustable ventriculoperitoneal (VP) shunt insertion plus dopamine oral therapy (group A) versus VP shunt alone (group B) in patients affected by iNPH associated with parkinsonism. METHODS: A detailed screening process included neurologic, neurosurgical, and neuropsychological evaluations, followed by a cerebrospinal fluid tap test and resistance outflow measurement. Outcome was evaluated through the Japanese NPH Grading Scale-Revised (JNPHGSR) and the motor (third) section of the Unified Parkinson's Disease Rating Scale, Motor Section (UPDRS-m). Friedman analysis of variance with a Wilcoxon post hoc test was used to evaluate the difference in JNPHGSR and UPDRS-m scores between pretreatment and follow-up (12 months) in the 2 groups, and a Kruskal-Wallis statistic and post hoc Mann-Whitney test were used to compare the change in JNPHGSR and UPDRS-m scores between the 2 groups. RESULTS:Thirty-two of 54 (59%) patients (mean age, 73.2 years) screened in 36 months met the inclusion criteria, but only 30 were enrolled (2 refused surgery) (15 in each group). Preoperative (123)I-ioflupane-cerebral single-photon emission computed tomography (DaTSCAN) revealed striatal dopaminergic deficit in 14/30 patients (46.5%). At the final 12 months follow-up, both groups improved JNPHGSR and UPRDS-m scores. The UPDRS-m score improvement was significant in both groups, but greater in group A (P = 0.003); JNPHGSR score improvement was similar in the 2 groups. CONCLUSIONS: iNPH associated with parkinsonism may be a frequent finding. In these cases, patients may benefit from VP shunt plus dopamine oral therapy.
RCT Entities:
OBJECTIVE: Idiopathic normal pressure hydrocephalus (iNPH) may present, besides the classic triad of symptoms, with extrapyramidal parkinsonianlike movement disorders. We present a randomized prospective study comparing adjustable ventriculoperitoneal (VP) shunt insertion plus dopamine oral therapy (group A) versus VP shunt alone (group B) in patients affected by iNPH associated with parkinsonism. METHODS: A detailed screening process included neurologic, neurosurgical, and neuropsychological evaluations, followed by a cerebrospinal fluid tap test and resistance outflow measurement. Outcome was evaluated through the Japanese NPH Grading Scale-Revised (JNPHGSR) and the motor (third) section of the Unified Parkinson's Disease Rating Scale, Motor Section (UPDRS-m). Friedman analysis of variance with a Wilcoxon post hoc test was used to evaluate the difference in JNPHGSR and UPDRS-m scores between pretreatment and follow-up (12 months) in the 2 groups, and a Kruskal-Wallis statistic and post hoc Mann-Whitney test were used to compare the change in JNPHGSR and UPDRS-m scores between the 2 groups. RESULTS: Thirty-two of 54 (59%) patients (mean age, 73.2 years) screened in 36 months met the inclusion criteria, but only 30 were enrolled (2 refused surgery) (15 in each group). Preoperative (123)I-ioflupane-cerebral single-photon emission computed tomography (DaTSCAN) revealed striatal dopaminergic deficit in 14/30 patients (46.5%). At the final 12 months follow-up, both groups improved JNPHGSR and UPRDS-m scores. The UPDRS-m score improvement was significant in both groups, but greater in group A (P = 0.003); JNPHGSR score improvement was similar in the 2 groups. CONCLUSIONS: iNPH associated with parkinsonism may be a frequent finding. In these cases, patients may benefit from VP shunt plus dopamine oral therapy.
Authors: Giovanni Mostile; Giacomo Portaro; Francesco Certo; Antonina Luca; Roberta Manna; Roberta Terranova; Roberto Altieri; Alessandra Nicoletti; Giuseppe Maria Vincenzo Barbagallo; Mario Zappia Journal: J Neurol Date: 2020-10-19 Impact factor: 4.849
Authors: Maria Vittoria Mattoli; Giorgio Treglia; Maria Lucia Calcagni; Annunziato Mangiola; Carmelo Anile; Gianluca Trevisi Journal: Int J Mol Sci Date: 2020-09-07 Impact factor: 5.923
Authors: André Corsino da Costa; Nilson Pinheiro Júnior; Clecio Godeiro Junior; Ana Clara Aragão Fernandes; Cítara Trindade de Queiroz; Anaís Concepcion Marinho Andrade de Moura; Carlos Eduardo França de Aquino; Marianne de Araújo Rego Journal: Surg Neurol Int Date: 2021-08-30
Authors: Eng Tah Goh; Christine Lock; Audrey Jia Luan Tan; Bee Ling Tan; Sai Liang; Robin Pillay; Sumeet Kumar; Azlina Ahmad-Annuar; Vairavan Narayanan; Janell Kwok; Yi Jayne Tan; Adeline Sl Ng; Eng King Tan; Zofia Czosnyka; Marek Czosnyka; John D Pickard; Nicole C Keong Journal: Front Neurol Date: 2022-07-12 Impact factor: 4.086