İdiyopatik normal basınçlı hidrosefali hastalarında ve sağlıklı kontrollerde spinal tap test öncesi ve sonrası yürüme özelliklerinin karşılaştırılması

Abstract

Amaç: İdiyopatik normal basınçlı hidrosefali(iNBH), ventrikülomegali ve normal beyin omurilik sıvısı basıncı ile ilişkili, yürüme bozuklukları, kognitif değişiklikler ve üriner inkontinans ile karakterize nörolojik bir hastalıktır. Amacımız; iNBH’li hastaların beyin omurilik sıvısı (BOS) tap test öncesi ve sonrası yürüyüş özelliklerini belirlemek ve kontrol grubu ile karşılaştırmaktır. Yöntem: Çalışmaya yaş ortalaması 75.34±5.36 olan 23 iNBH’li hasta ve yaş ortalaması 72.65±5.63 olan 20 sağlıklı kontrol katıldı. iNBH grubuna BOS tap testinin hemen öncesinde ve uygulama sonrası ilk 24 saat içinde yürüyüş özellikleri değerlendirmesi yapıldı. G-walk sensörlü yürüyüş analiz sistemi kullanılarak, yürüyüş hızı, adım uzunluğu ve kadans değerlendirildi. Aynı değerlendirmeler kontrol grubuna da yapıldı. Bulgular: iNPH’li hastalarda yürüme hızı, sağ ve sol adım uzunluğu ve kadans ölçümlerinde BOS tap testi sonrası değerlerde öncesine göre sırasıyla yüzdesel olarak 6,49, 2,06, 1,02 ve 4,16 arttı. Bununla birlikte yürüme hızındaki artış istatistiksel olarak anlamlı iken (p<0.05), adım uzunluğu ve kadanstaki (p>0.05) artışlar istatistiksel olarak anlamlı değildi. iNBH’li hastaların yürüyüş özellikleri, kontrol grubunun özellikleri ile karşılaştırıldığında ise hem BOS tap test öncesi hem de sonrasında ölçüm değerlerinin daha düşük olduğu görüldü (p<0.05). Sonuç: iNBH’li hastalarda, BOS tap test uygulanması, hastaların yürüme özelliklerini olumlu yönde iyileştirmekle birlikte, çalışma sonuçlarımız BOS tap test uygulaması yapılan hastaların hala iNBH’li olmayan yaşlı bireylere göre daha yavaş yürüme hızı, daha kısa adım uzunluğu ve daha düşük kadansa sahip olduğunu göstermiştir.

Keywords

• yaşlı
• normal basınçlı hidrosefali
• yürüme analizi
• spinal ponksiyon

COMPARISON OF GAIT CHARACTERISTICS BEFORE AND AFTER CEREBROSPINAL FLUID TAP TEST IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS PATIENTS AND HEALTHY CONTROLS

Abstract

Purpose: Idiopathic normal pressure hydrocephalus (iNBH) is a neurological disorder associated with ventriculomegaly and normal cerebrospinal fluid pressure and characterized by gait disturbances, cognitive changes and urinary incontinence. We aimed to compare patients' gait characteristics with iNBH before and after the cerebrospinal fluid (CSF) tap test with the control group. Methods: Twenty-three iNBH patients with a mean age of 75.34±5.36 years and 20 healthy controls with a mean age of 72.65±5.63 years participated in the study. The iNPH group underwent gait characteristics assessment immediately before and within the first 24 hours after the CSF tap test. Gait speed, stride length, and cadence were evaluated using the G-walk sensor-based gait analysis system. The same assessments were performed in the control group. Results: The percentage change in walking speed, right and left stride length, and cadence parameters of patients with iNPH after the CSF tap test were 6.49, 2.06, 1.02, and 4.16, respectively. In patients with iNPH, there was a statistically significant increase in walking speed (p<0.05) after the tap test, while stride length(p>0.05) and cadence(p>0.05) did not significantly increase. Walking speed, stride length, and cadence assessment performed before and after the CSF tap test in patients with iNBH were statistically worse than the control group. Conclusion: The CSF tap test improved gait characteristics in patients with iNPH, but our results showed that iNPH patients with the CSF tap test still had slower gait speed, shorter stride length, and lower cadence than older individuals without iNPH.

Keywords

• aged
• gait analysis
• normal pressure hydrocephalus
• spinal puncture

References

1. Andersson, J., Rosell, M., Kockum, K., Lilja-Lund, O., Söderström, L., & Laurell, K. (2019). Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population-based study. PloS one, 14(5), e0217705.
2. Böttcher, N., Bremova, T., Feil, K., Heinze, C., Schniepp, R., & Strupp, M. (2016). Normal pressure hydrocephalus: Increase of utricular input in responders to spinal tap test. Clinical Neurophysiology, 127(5), 2294–2301.
3. Bovonsunthonchai, S., Witthiwej, T., Vachalathiti, R., Hengsomboon, P., Thong-On, S., Sathornsumetee et al. (2024). Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus. Scientific Reports, 14(1), 2053.
4. Bräutigam, K., Vakis, A., & Tsitsipanis, C. (2019). Pathogenesis of idiopathic Normal Pressure Hydrocephalus: A review of knowledge. Journal of Clinical Neuroscience, 61, 10–13.
5. Chunyan, L., Rongrong, H., Youping, W., Hongliang, L., Qiong, Y., Xing, L., & Yan, X. (2021). Gait characteristics and effects of the cerebrospinal fluid tap test in probable idiopathic normal pressure hydrocephalus. Clinical Neurology and Neurosurgery, 210, 106952.
6. Dias, S. F., Graf, C., Jehli, E., Oertel, M. F., Mahler, J., Schmid Daners, M., & Stieglitz, L. H. (2023). Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus. Frontiers in neurology, 14, 1126298.
7. Gallagher, R., Marquez, J., & Osmotherly, P. (2018). Gait and balance measures can identify change from a cerebrospinal fluid tap test in idiopathic normal pressure hydrocephalus. Archives of Physical Medicine and Rehabilitation, 99(11), 2244–2250.
8. Grasso, G., Torregrossa, F., Leone, L., Frisella, A., & Landi, A. (2019). Long-term efficacy of shunt therapy in idiopathic normal pressure hydrocephalus. World Neurosurgery, 129, e458–e463.

9. Griffa, A., Bommarito, G., Assal, F., Herrmann, F. R., Van De Ville, D., & Allali, G. (2021). Dynamic functional networks in idiopathic normal pressure hydrocephalus: Alterations and reversibility by CSF tap test. Human Brain Mapping, 42(5), 1485–1502.
10. Isik, A. T., Kaya, D., Bulut, E. A., Dokuzlar, O., & Soysal, P. (2019). The outcomes of serial cerebrospinal fluid removal in elderly patients with idiopathic normal pressure hydrocephalus. Clinical Interventions in Aging, 14, 2063–2069.
11. Lim, Y. H., Ko, P. W., Park, K. S., Hwang, S. K., Kim, S. H., Han, J. et al. (2019). Quantitative gait analysis and cerebrospinal fluid tap test for idiopathic normal-pressure hydrocephalus. Scientific Reports, 9(1), 16255.
12. Cakmak, O. O., Akar, K., Youssef, H., Samanci, M. Y., Ertan, S., & Vural, A. (2023). Comparative assessment of gait and balance in patients with parkinson’s disease and normal pressure hydrocephalus. The Medical Bulletin of Sisli Hospital, 57(2), 232–237
13. Passaretti, M., Maranzano, A., Bluett, B., Rajalingam, R., & Fasano, A. (2023). Gait analysis in idiopathic normal pressure hydrocephalus: a meta-analysis. Movement Disorders Clinical Practice 10(11), 1574–1584.
14. Relkin, N., Marmarou, A., Klinge, P., Bergsneider, M., & Black, P. M. (2005). Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery, 57(3), 4-16.
15. Schniepp, R., Trabold, R., Romagna, A., Akrami, F., Hesselbarth, K., Wuehr, M. et al. (2017). Walking assessment after lumbar puncture in normal-pressure hydrocephalus: A delayed improvement over 3 days. Journal of Neurosurgery, 126(1), 148–157.
16. Song, M., Lieberman, A., Fife, T., Nielsen, M., Hayden, S., Sabbagh, M., & Shi, J. (2019). A prospective study on gait dominant normal pressure hydrocephalus. Acta Neurologica Scandinavica, 139(4), 389–394.
17. Stolze, H., Kuhtz-Buschbeck, J. P., Drücke, H., Jöhnk, K., Diercks, C., Palmié, S. et al. (2000). Gait analysis in idiopathic normal pressure hydrocephalus--which parameters respond to the CSF tap test?. Clinical Neurophysiology, 111(9), 1678–1686.
18. Tseng, P.-H., Huang, W.-T., Wang, J.-H., Huang, B.-R., Huang, H.-Y., & Tsai, S.-T. (2024). Cerebrospinal fluid shunt surgery reduces the risk of developing dementia and Alzheimer’s disease in patients with idiopathic normal pressure hydrocephalus: a nationwide population-based propensity-weighted cohort study. Fluids and Barriers of the CNS, 21(1), 16.
19. Vítečková, S., Horáková, H., Poláková, K., Krupička, R., Růžička, E., & Brožová, H. (2020). Agreement between the GAITRite R System and the Wearable Sensor BTS G-Walk R for measurement of gait parameters in healthy adults and Parkinson’s disease patients. PeerJ, 8, e8835.
20. Yang, L., Yang, F., Deng, Y., Yan, A., Wei, W., & Fang, X. (2023). White matter hyperintensity mediating gait disorders in iNPH patients via neurofilament light chain. Frontiers in Aging Neuroscience, 15, 1117675.