Abstract
There is no level I evidence to indicate whether placement of a shunt is effective in the management of idiopathic normal pressure hydrocephalus (INPH), because no trial has as yet compared the placement of a shunt versus no shunt in a randomized controlled manner. We started recruiting patients into a prospective double-blind randomized controlled study aiming to provide class I evidence supporting or refuting the role of surgical management in INPH. Inclusion criterion was the diagnosis of probable INPH plus objective improvement of walking speed following 72 h of extended lumbar drainage. Patients with concomitant Alzheimer’s disease or vascular dementia were excluded. All patients included in the trial were to have a shunt placed with proGAV® adjustable valve. Patients were randomly assigned into two groups: group A was to have the shunt immediately adjusted to function, and group B was to have the shunt valve adjusted to the highest setting for 3 months then adjusted to function. Assessment of gait, cognitive function, and urinary symptoms were done before shunt insertion and at 3 months. Primary end point was to be an improvement in gait. Secondary end points were improvement in mental function or urinary function and incidence of complications. Final results are expected mid 2011.
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References
Allin DM, Czosnyka ZH, Czosnyka M, Richards HK, Pickard JD (2006) In vitro hydrodynamic properties of the Miethke proGAV hydrocephalus shunt. Cerebrospinal Fluid Res 3:9
Bergsneider M, Black PML, Klinge P, Marmarou A, Relkin N (2005) INPH guidelines, part IV: surgical management of idiopathic normal-pressure hydrocephalus. Neurosurgery 57:S2-29–S2-39
Bradshaw DY (2008) Lost to follow-up. Neurology 70:2081–2084
Brecknell JE, Brown JI (2004) Is idiopathic normal pressure hydrocephalus an independent entity? Acta Neurochir 146:1003–1006
Cohen PD, Herman L, Jedlinski S, Willocks P, Wittekind P (2007) Ethical issues in clinical neuroscience research: a patient’s perspective. Neurotherapeutics 4:537–544
Esmonde T, Cooke S (2002) Shunting for normal pressure hydrocephalus (NPH). Cochrane Database Syst Rev (3): CD003157
Frank S, Kieburtz K, Holloway R, Kim SYH (2005) What is the risk of sham surgery in Parkinson disease clinical trials? A review of published reports. Neurology 65:1101–1103
Frank SA, Wilson R, Holloway RG, Zimmerman C, Peterson DR, Kieburtz K, Kim SYH (2008) Ethics of sham surgery: perspective of patients. Mov Disord 23:63–68
Hakim S, Adams R (1965) The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure: observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2:307–327
Hebb AO, Cusimano MD, Mapstone TB, Cohen AR, McComb JG, Gjerris F, Bech-Azeddine R (2001) Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49:1166–1186
Heckerling PS (2006) Placebo surgery research: a blinding imperative. J Clin Epidemiol 59:876–880
Meier U, Lemcke J (2006) First clinical experiences in patients with idiopathic normal-pressure hydrocephalus with the adjustable gravity valve manufactured by Aesculap (proGAV(Aesculap)). Acta Neurochir Suppl 96:368–372
Miller FG (2003) Sham surgery: an ethical analysis. Am J Bioeth 3:41–48
Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PML (2005) Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57:4–16
Stein SC, Burnett MG, Sonnad SS (2006) Shunts in normal-pressure hydrocephalus: do we place too many or too few? J Neurosurg 105:815–822
Toma AK, Tarnaris A, Kitchen ND, Watkins LD (2011) Use of proGAV® shunt valve in normal pressure hydrocephalus. Neurosurgery [Epub ahead of print]
Conflicts of interest statement
A clinical research fellow post at the National Hospital for Neurology and Neurosurgery is supported by a grant from B. Braun Medical Ltd.
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Toma, A.K., Papadopoulos, M.C., Stapleton, S., Kitchen, N.D., Watkins, L.D. (2012). Conservative Versus Surgical Management of Idiopathic Normal Pressure Hydrocephalus: A Prospective Double-Blind Randomized Controlled Trial: Study Protocol. In: Aygok, G., Rekate, H. (eds) Hydrocephalus. Acta Neurochirurgica Supplementum, vol 113. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0923-6_4
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DOI: https://doi.org/10.1007/978-3-7091-0923-6_4
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