Cerebral derivation surgery improves walking and quality of life in older adults with hydrocephalus

Implementing a brain derivation in older people diagnosed with idiopathic normal pressure hydrocephalus (INPH) is effective in improving their symptoms, a randomized multiple, double blind patients trial and multiple multiple centers.

This condition is associated with an extension of the ventricles of the brain, the spaces where fluid is produced and stored to cushion the brain and spine. The disorder is manifested by the slow problems of march and balance that increase the risk of falls, as well as difficulty thinking, memory loss and urinary incontinence.

“If there is something that this study does, it solves a controversy that has existed for many, many years,” said Dr. Michael A. Williams, a professor of neurology and neurological surgery at the Faculty of Medicine of the University of Washington in Seattle, and one of the main authors of the study. The other main authors are Dr. Mark G. Luciano of the Johns Hopkins University, who is the main researcher of the study, and Dr. Mark G. Hamilton of the University of Calgary in Alberta, Canada.

There have been many doctors who doubt that the disorder exists or that the treatment with the surgical implementation of a derivation is effective or safe. Our judgment puts that to rest. Our hope is that now, more neurologists, more neurosurgeons, more doctors entertain the possibility of INPH as a diagnosis for their patients, take them through appropriate diagnostic steps and treat them when hydrocephalus is found. “

Dr. Michael A. Williams, professor of neurology and neurological surgery, Faculty of Medicine at Washington

The first set of results compared the treatment and placebo groups were published today, on September 16, at the New England Journal of Medicine and presented themselves simultaneously at the 150th Annual Meeting of the American Neurological Association in Baltimore.

Symptoms are often not attributed to normal pressure hydrocephalus, because such problems are common in older people and could be due to many other factors. Consequently, the condition is difficult to diagnose. However, if Hydrocefalus contributes significantly to such symptoms, then treating it can make a big difference in patients’ lives, according to these last findings.

The average age of people with the condition is 75 years old, and the higher the population, the more likely they have normal pressure hydrocephalus. It affects approximately 1.5% of the population of people in their 70 years, and up to 7% of those of 80 years. The condition is diagnosed through a series of tests that include evaluation of symptoms, brain scans of magnetic resonance and hospital response evaluations to eliminate some spinal liquid.

Williams pointed out, however, that, at best, perhaps only 5% to 10% of patients diagnosed with normal pressure hydrocephalus receive treatment.

The controlled efficacy with placebo in the participants of the study of the normal idiopathic pressure hydrocephalus (pens), all of which had a confirmed diagnosis, had a derivation surgically placed under general anesthesia.

The derivation is an internal drainage system. A valve goes under the skin to the side or on the back of the head. A small valve tube is inserted into a cerebral ventricle, and a second tube is guided from the valve under the skin to the abdomen, where excess brain fluid can drain.

The derivation used in the study can be turned on or off, and the adjusted flow, with a magnetic device placed on the valve in the scalp. Half of the participants lit the derivations and half turned off. Neither the patients nor those who evaluated them knew what option they had.

When comparing the two groups, the researchers found that patients with an open derivation increased their speed by more than 0.2 meters per second or double the minimum clinically significant difference of 0.1 meters per second. In addition, 80% of them approved that threshold. In the group of patients with closed derivations, the speed of the march did not improve.

“There was very clearly a difference between the two groups in this measurement,” said Williams. In addition, those with closed referrals reported more than those with open derivations.

Patients were surveyed about their quality of life and their ability to perform daily activities. Those rose in the treated group and stayed the same or decreased in the placebo group.

At the end of this part of the trial, the researchers lit the leads of the Placebo Group. Both groups continue to be evaluated. The additional long -term results of the study are still pending, as if the improvements were maintained and if the brain images of magnetic resonance can be correlated with the reduction of symptoms.

The first phase of the study used only detection methods to verify cognitive deterioration. As the study continues, researchers will use more complete evaluations with neuropsychology tests. This will provide information about the impediments range and if they improve with the treatment.

Dr. Nikolas Dasher, a neuropsychologist of the UW Medicine Rehabilitation Medicine Department, played a key role in the evaluation of the effectiveness of the derivation for this study.

Twenty -one medical centers participated in the trial. One was in Sweden; The rest were located in the United States and Canada. Ninety -nine participants enrolled. “If our study has an influence, we should see an increase in the number of people who are who have INPH and who are being treated,” said Williams. “That will be a great improvement for the elderly population. There should be some reduction in medical care costs associated with that too.”

The study was supported by the National Institute of Neurological Disorders and stroke (U01NS122764) and the Trial Innovation Network of National Health Institutes (U24TR001597 and U24TR004440).