Massimiliano Todisco1, Marta Picascia2, Patrizia Pisano3, Roberta Zangaglia1, Brigida Minafra1, Paolo Vitali4, Elisa Rognone4, Anna Pichiecchio4, Roberto Ceravolo5, Nicola Vanacore6, Alfonso Fasano7,8,9, Claudio Pacchetti10. 1. Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy. 2. Alzheimer's Disease Assessment Unit/Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy. 3. Neurosurgery Unit, IRCCS San Matteo Foundation, Pavia, Italy. 4. Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy. 5. Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 6. National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy. 7. Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada. 8. Krembil Research Institute, Toronto, ON, Canada. 9. CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada. 10. Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy. claudio.pacchetti@mondino.it.
Abstract
OBJECTIVE: In this prospective, controlled, monocentric study, we described the clinical and neuroimaging 12-month follow-up of two parallel cohorts of subjects with idiopathic normal pressure hydrocephalus (iNPH), who did or did not undergo lumboperitoneal shunt (LPS). METHODS: We recruited 78 iNPH patients. At baseline, subjects underwent clinical and neuropsychological assessments, 3 T magnetic resonance imaging (MRI), and tap test. After baseline, 44 patients (LPS group) opted forLPS implantation, whereas 34 subjects (control group) declined surgery. Both cohorts were then followed up for 12 months through scheduled clinical and neuropsychological evaluations every 6 months. 3 T MRI was repeated at 12-month follow-up. RESULTS:Gait, balance, and urinary continence improved in the LPS group, without significant influence on cognitive functions. Conversely, gait and urinary continence worsened in the control group. No preoperative MRI parameter was significant outcome predictor after LPS. Of relevance, in responders to LPS, we found postoperative reduction of periventricular white matter (PWM) hyperintensities, which were instead increased in the control group. CONCLUSIONS:LPS is safe and effective in iNPH. An early surgical treatment is desirable to prevent clinical worsening. Post-surgery decrease of PWM hyperintensities may be a useful MRI marker surrogate for clinical effectiveness of LPS.
RCT Entities:
OBJECTIVE: In this prospective, controlled, monocentric study, we described the clinical and neuroimaging 12-month follow-up of two parallel cohorts of subjects with idiopathic normal pressure hydrocephalus (iNPH), who did or did not undergo lumboperitoneal shunt (LPS). METHODS: We recruited 78 iNPH patients. At baseline, subjects underwent clinical and neuropsychological assessments, 3 T magnetic resonance imaging (MRI), and tap test. After baseline, 44 patients (LPS group) opted for LPS implantation, whereas 34 subjects (control group) declined surgery. Both cohorts were then followed up for 12 months through scheduled clinical and neuropsychological evaluations every 6 months. 3 T MRI was repeated at 12-month follow-up. RESULTS: Gait, balance, and urinary continence improved in the LPS group, without significant influence on cognitive functions. Conversely, gait and urinary continence worsened in the control group. No preoperative MRI parameter was significant outcome predictor after LPS. Of relevance, in responders to LPS, we found postoperative reduction of periventricular white matter (PWM) hyperintensities, which were instead increased in the control group. CONCLUSIONS:LPS is safe and effective in iNPH. An early surgical treatment is desirable to prevent clinical worsening. Post-surgery decrease of PWM hyperintensities may be a useful MRI marker surrogate for clinical effectiveness of LPS.
Entities:
Keywords:
Idiopathic normal pressure hydrocephalus; Lumboperitoneal shunt; Magnetic resonance imaging; Outcome; Prospective study