Article

Normal pressure hydrocephalus (NPH) was described by Adams et al. (1965). The common clinical presentation is the triad: gait disturbance,
cognitive decline and urinary incontinence. Although these symptoms are
suggestive, they are not specific to diagnosis. The improvement of symptoms after
high-volume lumbar puncture (hVLP) could be a strong criterion for diagnosis. We
tried to determine a specific pattern of dynamic walking and posture parameters
in NPH. Additionally, we tried to specify the evolution of these criteria after
hVLP and to determine predictive values of ventriculoperitoneal shunting (VPS)
efficiency. PATIENTS AND METHODS: Sixty-four patients were followed during seven
years from January 2002 to June 2009. We identified three periods: before (S1),
after hVLP (S2) and after VPS (S3). The following criteria concerned walking and
posture parameters: walking parameters were speed, step length and step rhythm;
posture parameters were statokinesigram total length and surface, length
according to the surface (LFS), average value of equilibration for lateral
movements (Xmoyen), anteroposterior movements (Ymoyen), total movement length in
lateral axis (longX) and anteroposterior axis (longY). RESULTS: Among the 64
patients included, 22 had VPS and 16 were investigated in S3. All kinematic
criteria are decreased in S1 compared with normal values. hVLP improved these
criteria significantly (S2). Among posture parameters, only total length and
surface of statokinesigram showed improvement in S1, but no improvement in S2. A
gain in speed greater or equal to 0.15m/s between S1 and S2 predicted the
efficacy of VPS with a positive predictive value (PPV) of 87.1% and a negative
predictive value (NPV) of 69.7% (area under the ROC curve [AUC]: 0.86).
CONCLUSION: Kinematic walking parameters are the most disruptive and are
partially improved after hVLP. These parameters could be an interesting test for
selecting candidates for VPS. These data have to be confirmed in a larger cohort.
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Langue : FRANCAIS