The investigation of the gait parameter alterations in response to levodopa therapy and tap test in patients with idiopathic normal pressure hydrocephalus.

Abstract

To investigate the impact of dopamine oral therapy, the effect of cerebrospinal fluid (CSF) tap test on gait parameters in our idiopathic normal pressure hydrocephalus (iNPH) subjects. Patients with a possible diagnosis of iNPH who had been admitted to our outpatient polyclinic between March 2022 and May 2022 were enrolled. In addition to the clinical evaluations, basal gait analysis was performed using a "Gait Analyzer" program which was uploaded to a mobile phone. Thereafter, the gait analyses were re-evaluated after levodopa therapy, 4h and 2weeks after the CSF tap test at distinct times, separately. Ultimately, the data of 8 patients with iNPH were enrolled in this study (mean age = 67.37 ± 7.74, F/M = 3/5). Friedman's analysis of variance analyses did not show a difference in any parameters of gait between the distinct evaluation times. On the other hand, the pairwise analysis results showed that the step time and cadence had improved after levodopa therapy, whereas no significant improvement was detected in any of the parameters after the CSF tap test. In our pilot study, we found that the gait parameters improved after levodopa therapy. However, the gait parameters did not change after the CSF tap test which may suggest that our measurement method might overlook detecting the gait disturbance specific to the iNPH. Future research to develop new evaluation methods and questionnaires detecting the gait disturbance specific to the iNPH pathophysiology may provide substantial clinical applications.