Titre
CSF tap-test evaluation in patients with idiopathic normal pressure hydrocephalus: what is the best timing for clinical evaluation?
Type
mémoire de master/maîtrise/licence
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Auteur(s)
CLEMENT, E.
Auteure/Auteur
Directrices/directeurs
MESSERER, M.
Directeur⸱rice
COSSU, G.
Codirecteur⸱rice
Liens vers les personnes
Liens vers les unités
Faculté
Université de Lausanne, Faculté de biologie et médecine
Statut éditorial
Accepté
Date de publication
2024
Nombre de pages
22
Langue
anglais
Résumé
Introduction
Idiopathic normal pressure hydrocephalus is a frequently encountered neurological disorder in the elderly population. It is characterized by a typical clinical trial, known as Hakim’s triad, consisting of gait disturbances, cognitive deficits, and urinary incontinence. The most common treatment of iNPH is the surgical placement of a ventriculoperitoneal shunt to drain excess cerebrospinal fluid (CSF). CSF tap-test is a common procedure used to predict shunt efficacity by assessing the reversibility of the patients’ symptoms. Symptoms are typically evaluated before the CSF tap-test and again once or twice within 2-24 hours following the tap-test. Literature varies on when assessment is best, with hospitals employing their own preferred timing. The primary aim of this study is to assess the relevance of evaluating the patient at two time points: 2 hours after the tap-test and again 24 hours later. The secondary endpoint of the study is to determine which test is more sensible and specific in assessing symptom reversibility and therefore better identifying which patient would benefit from shunt surgery.
Materials and methods
We performed a prospective study of 27 patients with a suspected diagnosis of iNPH at the University Hospital of Lausanne (CHUV) from June 2020 to July 2021. Patients included were above the age of 18 years old and presented with clinical and radiological features compatible with iNPH.
A clinical assessment using five tests (TUG, TUGc, Tinetti Balance Scale, ICIQ, FES) was conducted before the tap-test, 2 and 24 hours later. Comparison between the three time points was made by a non-parametric Wilcoxon Signed-Rank test and a p-value was calculated. The results were considered significant if p < 0.05.
Results
Overall, we have not found a clear advantage in a two-timepoint evaluation: the results we obtained did not show a significative improvement for most of the tests performed. We have found that a 24-hour evaluation may be more advantageous in most cases as it allows the patient and their family to notice improvements and prevents the assessment from being impacted by post-tap-test pain. Moreover, there does not seem to be a superiority of one evaluation over the other in terms of sensibility and specificity. Some tests show significative improvement within the first two others, like the TUG test and the Tinetti Balance scale, and other show improvement the next day, like the ICIQ. No test stands out as a better evaluation in assessing symptom reversibility.
Conclusion
We have not found that a two-time assessment at 2 hours and at 24 hours after the tap-test has a clinical relevance. No test has shown to be significantly more specific or more sensitive in the evaluation of the iNPH patient.. Therefore, we recommend a one-time evaluation 24 hours after the tap-test, which seems to be the most appropriate timing.
Idiopathic normal pressure hydrocephalus is a frequently encountered neurological disorder in the elderly population. It is characterized by a typical clinical trial, known as Hakim’s triad, consisting of gait disturbances, cognitive deficits, and urinary incontinence. The most common treatment of iNPH is the surgical placement of a ventriculoperitoneal shunt to drain excess cerebrospinal fluid (CSF). CSF tap-test is a common procedure used to predict shunt efficacity by assessing the reversibility of the patients’ symptoms. Symptoms are typically evaluated before the CSF tap-test and again once or twice within 2-24 hours following the tap-test. Literature varies on when assessment is best, with hospitals employing their own preferred timing. The primary aim of this study is to assess the relevance of evaluating the patient at two time points: 2 hours after the tap-test and again 24 hours later. The secondary endpoint of the study is to determine which test is more sensible and specific in assessing symptom reversibility and therefore better identifying which patient would benefit from shunt surgery.
Materials and methods
We performed a prospective study of 27 patients with a suspected diagnosis of iNPH at the University Hospital of Lausanne (CHUV) from June 2020 to July 2021. Patients included were above the age of 18 years old and presented with clinical and radiological features compatible with iNPH.
A clinical assessment using five tests (TUG, TUGc, Tinetti Balance Scale, ICIQ, FES) was conducted before the tap-test, 2 and 24 hours later. Comparison between the three time points was made by a non-parametric Wilcoxon Signed-Rank test and a p-value was calculated. The results were considered significant if p < 0.05.
Results
Overall, we have not found a clear advantage in a two-timepoint evaluation: the results we obtained did not show a significative improvement for most of the tests performed. We have found that a 24-hour evaluation may be more advantageous in most cases as it allows the patient and their family to notice improvements and prevents the assessment from being impacted by post-tap-test pain. Moreover, there does not seem to be a superiority of one evaluation over the other in terms of sensibility and specificity. Some tests show significative improvement within the first two others, like the TUG test and the Tinetti Balance scale, and other show improvement the next day, like the ICIQ. No test stands out as a better evaluation in assessing symptom reversibility.
Conclusion
We have not found that a two-time assessment at 2 hours and at 24 hours after the tap-test has a clinical relevance. No test has shown to be significantly more specific or more sensitive in the evaluation of the iNPH patient.. Therefore, we recommend a one-time evaluation 24 hours after the tap-test, which seems to be the most appropriate timing.
PID Serval
serval:BIB_750A1B1550A5
Date de création
2024-08-29T14:46:22.978Z
Date de création dans IRIS
2025-05-21T01:04:53Z
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