Introduction: Normal Pressure Hydrocephalus (NPH) is a disease with unknown etiology, which may be treated with cerebral spinal fluid diversion. One way to diagnose NPH is to perform a lumbar drain trial and track improvements in gait. Our institution tracks improvement objectively through the use of the Dynamic Gait Index (DGI) score pre- and post-lumbar drain placement. The purpose of this study was to determine if pre-lumbar drain DGI score could predict which patients would improve with a lumbar drain trial
Methods: We examined the medical records of 120 patients who presented to our institution with a presumed diagnosis of normal pressure hydrocephalus for a lumbar drain trial. Initial DGI scores were calculated on admission and daily after placement of a lumbar drain.
Results: A review of the data indicated that the mean pre-lumbar drain DGI was 8.3±6.9. The mean post-lumbar drain DGI was 11.3±8.0. Overall, there was a statistically significant difference between these groups (p<0.001). Pre-lumbar drain DGI score was a significant predictor of change in DGI outcome after intervention (OR 1.16, 95% CI 1.08-1.24). Our results also indicated a significant ability of the pre-lumbar drain DGI score to predict response to the lumber drain trial (AUC=0.76, 95% CI 0.65-0.87). Patients with a pre-lumbar drain DGI of 5 were most likely to be true responders to the trial (sensitivity=84%, specificity=71%).
Conclusions: Normal pressure hydrocephalus is a disease that may be treated with cerebral spinal fluid diversion. Improvement of gait ataxia as determined by pre- and post-lumbar drain trial dynamic gait index scores may predict successful treatment with a ventriculoperitoneal shunt. The patients most likely to be true responders have initial DGI score of 5. Patients with higher pre-lumber drain DGI scores seemed to have a better response to the lumbar drain trail.
Patient Care: By identifying patients who may respond to csf diversion early, invasive procedures may be avoided. Likewise, identifying patients who are less likely to respond may prevent unnecessary procedures, hospital time, and complications.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify patients who may have normal pressure hydrocephalus. 2) Understand a mechanism to identify patients who may respond to permanent CSF diversion. 3) Predict which patients may respond to CSF diversion before invasive treatment