Walking assessment after lumbar puncture in normal-pressure hydrocephalus: a delayed improvement over 3 days
Walking assessment after lumbar puncture in normal-pressure hydrocephalus: a delayed improvement over 3 days
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DOI：
10.3171/2015.12.jns151663
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发表时间：
2017-01-01
影响因子：
4.1
通讯作者：
Jahn, Klaus
中科院分区：
文献类型：
--
作者：
Schniepp, Roman;Trabold, Raimund;Jahn, Klaus
目的：特发性常压脑积水（iNPH）患者腰椎穿刺（LP）后步态改善的确定至关重要，但进行此类评估的最佳时间尚不清楚。作者确定了iNPH患者LP后单任务和双任务步行改善的时间进程。方法在iNPH患者中，在LP前（时间点[TP]0）、LP后1-8小时（TP 1）、LP后24小时（TP 2）、LP后48小时（TP 3）和LP后72小时（TP 4）获得步态速度的连续记录。步态分析是使用压力敏感地毯进行的（GAITRite）在4种条件下：以优选速度行走（STPS）、以最大速度行走（STMS）、在进行连续7次减法时行走（双任务步行与串行7 [DTS 7]），和行走时进行语言流畅性任务结果24例患者的平均年龄为76.1 ± 7.8岁。客观应答状态与主观高假阳性结果患者的自我估计中度一致（83%）。单任务步行的改善程度大于双任务步行（p < 0.05）。在TP 2时，STPS（p = 0.042）和DTVF（p = 0.046）的步行速度显著增加，在TP 3时，STPS（p = 0.035）、DTS 7（p = 0.042）和DTVF（p = 0.044）的步行速度显著增加。心室扩张（Evans指数）与早期改善呈正相关。在TP 3步态改善与分流responses在18 patients.CONCLUSIONS定量步态评估在iNPH是重要的，由于病人的自我评价差。在LP后24-48小时可以观察到步态速度的最大增加。该时间点也是预测分流反应的最佳时间点。对于双任务范式，最大的改善似乎发生在以后（48至72小时）。应在LP后第2天或第3天进行步态评估。
OBJECTIVE The determination of gait improvement after lumbar puncture (LP) in idiopathic normal-pressure hydrocephalus (iNPH) is crucial, but the best time for such an assessment is unclear. The authors determined the time course of improvement in walking after LP for single-task and dual-task walking in iNPH.METHODS In patients with iNPH, sequential recordings of gait velocity were obtained prior to LP (time point [TP]0), 1-8 hours after LP (TP1), 24 hours after LP (TP2), 48 hours after LP (TP3), and 72 hours after LP (TP4). Gait analysis was performed using a pressure-sensitive carpet (GAITRite) under 4 conditions: walking at preferred velocity (STPS), walking at maximal velocity (STMS), walking while performing serial 7 subtractions (dual-task walking with serial 7 [DTS7]), and walking while performing verbal fluency tasks (dual-task walking with verbal fluency [DTVF]).RESULTS Twenty-four patients with a mean age of 76.1 +/- 7.8 years were included in this study. Objective responder status moderately coincided with the self-estimation of the patients with subjective high false-positive results (83%). The extent of improvement was greater for single-task walking than for dual-task walking (p < 0.05). Significant increases in walking speed were found at TP2 for STPS (p = 0.042) and DTVF (p = 0.046) and at TP3 for STPS (p = 0.035), DTS7 (p = 0.042), and DTVF (p = 0.044). Enlargement of the ventricles (Evans Index) positively correlated with early improvement. Gait improvement at TP3 correlated with the shunt response in 18 patients.CONCLUSIONS Quantitative gait assessment in iNPH is important due to the poor self-evaluation of the patients. The maximal increase in gait velocity can be observed 24-48 hours after the LP. This time point is also best to predict the response to shunting. For dual-task paradigms, maximal improvement appears to occur later (48 to 72 hours). Assessment of gait should be performed at Day 2 or 3 after LP.