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Normal Pressure Hydrocephalus and Parkinsonism: Preliminary Data on Neurosurgical and Neurological Treatment.

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.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Broggi M,Redaelli V,Tringali G,Restelli F,Romito L,Schiavolin S,Tagliavini F,Broggi G

doi

10.1016/j.wneu.2016.03.004

subject

Has Abstract

pub_date

2016-06-01 00:00:00

pages

348-356

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(16)00408-3

journal_volume

pub_type

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Normal Pressure Hydrocephalus and Parkinsonism: Preliminary Data on Neurosurgical and Neurological Treatment.