Objective: NPH is a clinical entity causing impairment in gait, bladder and memory functions. Of these, gait dysfunction is the most prominent and disabling as well as significantly responsive to CSF drainage and shunting. This study analyzes the change in gait parameters in patients of NPH after CSF drainage and assesses its role in identification of patients who may respond to shunting.

Background: Gait dysfunction is the primary debilitating symptom among NPH patients leading to frequent falls and disability. Abnormal features of gait include broad base, slow speed, short steps, difficulty initiation and turning, abnormal foot patterns and gait apraxia. CSF drainage has found to improve the symptoms of NPH, especially the gait. A documented improvement in the gait after CSF removal can thus be used for diagnostic confirmation of NPH and as a predictor for shunt responsiveness.

Method: The study included thirty-two patients. Gait analysis was done at baseline and after CSF drainage (via single large volume tap or continuous 48-hour lumbar drain). Assessment included specific parameters – velocity, stride length, cadence and number of steps per turn. The analysis was done using a digital pedometer and videographic records. Patients who showed improvement and underwent VP shunt were reassessed at follow up.

Results: The study population consisted of 32 patients. Gait impairment was seen in all (100%) the patients. All the gait parameters (velocity, stride length, cadence and number of steps per turn) showed significant improvement after CSF drainage (p<0.0001). Maximum improvement was noted with velocity (109%) followed by stride length (72%) and number of steps per turn (26%). Cadence showed the least improvement. The most consistent parameter showing significant improvement was stride length.

Eight patients that were included in the study underwent VP shunt and showed consistent improvement at 3-month follow up. Among the patients who did not go for surgery, we tried repeated CSF taps as a conservative approach. No improvement was noted beyond 3 taps in any patient.

Conclusion: The results demonstrate that gait dysfunction in NPH patients shows objective improvement with CSF removal; with velocity being the most responsive parameter followed by stride length. Gait analysis constitutes a simple and effective means for identification of NPH patients responsive to CSF drainage, who may benefit from VP shunt surgery.

Change in Velocity

Change in Stride Length

Change in Cadence

Change in number of steps per turn

References: 1. Williams MA, Thomas G, De Lateur B, Imteyaz H, Rose JG, Shore WS, et al. Objective assessment of gait in normal-pressure hydrocephalus. Am J Phys Med Rehabil. 2008 Jan;87(1):39–45.
2. de Souza RKM, da Rocha SFB, Martins RT, Kowacs PA, Ramina R. Gait in normal pressure hydrocephalus: Characteristics and effects of the CSF tap test. Arq Neuropsiquiatr. 2018 May 1;76(5):324–31.
3. Fasano A, Espay AJ, Tang-Wai DF, Wikkelsö C, Krauss JK. Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus. Movement Disorders. 2020 Nov 1;35(11):1945–54.
4. Relkin N, Marmarou A, Klinge P, Bergsneider M, McL Black P. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57:S24–216.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gait-analysis-and-outcome-of-csf-drainage-in-patients-of-normal-pressure-hydrocephalus/