Quantitative gait analysis value as a predictor of shunt surgery effectiveness in normal pressure hydrocephalus: A technical note

Abstract

IntroductionShunt surgery (SS) remains the most effective treatment for idiopathic Normal pressure hydrocephalus (iNPH), but the selection of the patients with the greatest potential benefit remains elusive. ObjectiveIdentify gait features predictive of best response to SS in iNPH. MethodsEight patients with iNPH were assessed at baseline, after Cerebrospinal fluid tap-test (CSF-TT) and SS, with clinical scales (Clinical/Patient Global Clinical Impression, EuroQol-5D, Clinical Dementia Rating Scale(CDR), MoCA test, Hoehn-Yahr Scale) and gait analysis with inertial sensors. ResultsThe 8 included iNPH patients had a mean age of 73 years(59−81), moderate cognitive (CDR-1.5 (0.5–2); MoCA-9.5 (3−21)) and motor impairment (Hoehn-Yahr-2.75(2−3)). After SS, patients had a significant improvement in cognition (MoCA, p = 0.001) and quality of life. At baseline, patients with lower improvement (no change/ minimally improved) (n = 2), in comparison to patient with higher improvement (much/very much improved) (n = 6), already had higher cognitive impairment (MoCa-3(3−3) vs. 11(7−21)). Patients with lower improvement had a lower % of change in gait performance at LP (mean 10.2 %) and were absent of additional benefit after SS(mean −0.8 %). In contrast, gait performance in patients with higher improvement consistently got better from baseline to LP (mean 23.1 %) and from baseline to SS (mean 82.9 %). A significant negative correlation was observed between CDR score and several gait variables: speed (rpb=−0.92,p = 0.009); stride length (rpb=−0.92,p = 0.009); lift-off angle (rpb=−0.96,p = 0.003); and maximum heel (rpb=−0.81,p = 0.049). ConclusionThe magnitude of gait improvement after CSF-TT, quantified by gait analysis, can be used as an integral variable in the multimodal clinical approach to the prediction of improvement after SS.