Institutional Outcomes in Patients Evaluated for Possible Normal Pressure Hydrocephalus: Which Factors Are Predictive of Positive Response to Ventriculoperitoneal Shunt Placement? (P02.245)

Abstract

Objective: The goal of this study was to examine patient outcomes after their initial evaluation in the Movement Disorders (MD) Clinic at our institution for possible normal pressure hydrocephalus (NPH). We attempted to identify predictive factors that lead to the clinical diagnosis of NPH and ultimately to pursuit of ventriculoperitoneal shunt (VPS) placement, as well as those that lead to positive post-surgical outcomes. Background First, we wanted to review patient outcomes after VPS placement for NPH at our institution. Second, given current limitations in successfully identifying optimal surgical candidates among patients with possible NPH, we wanted to review the clinical and radiological data utilized for decision-making with each patient to see if certain factors were more predictive of positive outcome. Design/Methods: This was a retrospective chart review of patients evaluated in MD Clinic for gait disturbance between January 2007 and October 2010. Outcomes were based on the patients9 postoperative assessments in Neurosurgery and/or MD Clinic and Clinical Global Impression (CGI) scale scores. Results: Fourteen of 25 patients initally evaluated in MD Clinic for gait disturbance and possible NPH ultimately underwent VPS placement, 12 of those at our institution. Of those, 11 had post-operative CGIs between 1 (very much improved) and 3 (minimally improved). Only one patient had no change after surgery. In the patients that underwent high-volume lumbar puncture (LP) as part of evaluation for possible NPH, a higher percent change in gait speed and lower post-LP CGI were associated with surgery, but not necessarily with more positive post-surgical outcome. Conclusions: In general, patients undergoing VPS placement for probable NPH after evaluation in MD Clinic had positive outcomes, with improvement in gait dysfunction. However, measures such as percent change in gait speed after high-volume lumbar puncture, frequently used to predict response to VPS, were not necessarily predictive of the degree of improvement after surgery. Disclosure: Dr. Tate has nothing to disclose. Dr. Siddiqui has nothing to disclose.