Low-dose acetazolamide reverses periventricular white matter hyperintensities in iNPH
Low-dose acetazolamide reverses periventricular white matter hyperintensities in iNPH
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DOI：
10.1212/wnl.0000000000000313
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发表时间：
2014-04-15
期刊：
影响因子：
9.9
通讯作者：
Relkin, Norman
中科院分区：
文献类型：
--
作者：
Alperin, Noam;Oliu, Carlos J.;Relkin, Norman
目的：评估低剂量乙酰唑胺治疗对特发性常压脑积水（iNPH）患者的体积MRI标记物和临床结局的影响。方法：我们分析了8例iNPH患者的MRI和步态测量结果，这些患者均接受了低剂量乙酰唑胺（125-375 mg/d）的标签外治疗，并接受了机构审查委员会批准的成像方案的系列MRIs。MRI研究包括液体衰减反转恢复和3D T1加权高分辨率成像。在治疗前和整个治疗过程中，采用自动分析来量化每个患者的心室、整体白色高信号（WMH）和脑室周围WMH（PVH）体积。临床结果是基于步态变化的定量评估使用的布恩scale.Results：5 8例患者积极响应治疗，中位步态改善4点的布恩规模。治疗后，这些患者的PVH体积显著降低（-6.1 ~1.9 mL，p = 0.002）。1例患者步态不变，2例患者步态恶化，转诊接受分流术。后2例患者PVH体积未减少。Nonperiventricular WMH和侧脑室容积在很大程度上保持不变，在所有patients.Conclusions：这些初步研究结果提供了新的证据，低剂量乙酰唑胺可以减少PVH，并可能改善步态在iNPH。反映经室管膜CSF的PVH体积被证明是药物干预有效性的潜在MRI指标。iNPH的药物治疗的进一步研究是必要的，并可能通过纳入定量MRI outcomes.Classification证据增强：这项研究提供了IV类证据，低剂量乙酰唑胺逆转PVH体积，并在某些情况下，改善步态在iNPH。
Objective:To assess the effects of low-dose acetazolamide treatment on volumetric MRI markers and clinical outcome in idiopathic normal-pressure hydrocephalus (iNPH).Methods:We analyzed MRI and gait measures from 8 patients with iNPH with serial MRIs from an institutional review board-approved imaging protocol who had been treated off-label with low-dose acetazolamide (125-375 mg/day). MRI studies included fluid-attenuated inversion recovery and 3D T1-weighted high-resolution imaging. Automated analyses were employed to quantify each patient's ventricular, global white matter hyperintensities (WMH), and periventricular WMH (PVH) volumes prior to and throughout treatment. Clinical outcome was based on gait changes assessed quantitatively using the Boon scale.Results:Five of 8 patients responded positively to treatment, with median gait improvement of 4 points on the Boon scale. A significant decrease in PVH volume (-6.1 1.9 mL, p = 0.002) was seen in these patients following treatment. One patient's gait was unchanged and 2 patients demonstrated worsened gait and were referred for shunt surgery. No reduction in PVH volume was detected in the latter 2 patients. Nonperiventricular WMH and lateral ventricle volumes remained largely unchanged in all patients.Conclusions:These preliminary findings provide new evidence that low-dose acetazolamide can reduce PVH and may improve gait in iNPH. PVH volume, reflecting transependymal CSF, is shown to be a potential MRI indicator of pharmacologic intervention effectiveness. Further studies of pharmacologic treatment of iNPH are needed and may be enhanced by incorporating quantitative MRI outcomes.Classification of evidence:This study provides Class IV evidence that low-dose acetazolamide reverses PVH volume and, in some cases, improves gait in iNPH.