Objective: To evaluate the alterations in postural control among patients diagnosed with normal pressure hydrocephalus (NPH) following lumbar puncture

Background: Posturography is an indispensable tool for assessing postural control, including individuals afflicted with NPH. However, post-lumbar puncture, there exists an ambiguous gap in comprehending the dynamics of the postural system, necessitating further exploration to elucidate potential alterations and especially implications in indication process for shunt surgery.

Method: Patients diagnosed with NPH based on radiological and clinical criteria were included in this analysis (Relkin et al., 2005). Inclusion criteria encompassed the ability to maintain upright stance without assistance and the absence of significant cognitive impairment. All participants underwent a comprehensive battery of static posturography tests, including assessments with eyes open and closed, head tilt backwards, standing on a foam pad, as well as galvanic vestibular and Achilles tendon stimulation. Selected postural control parameters, such as total root mean square of center of pressure (rms-COP) and velocity of center of pressure (v-COP), were evaluated. Statistical analysis employed the non-parametric Wilcoxon test to compare posturographic parameters before and after lumbar puncture.

Results: Analysis involved twenty-eight patients, with a mean age of 72 years (SD 6.26) and a mean symptom duration of 2.3 years (SD 0.72), along with a mean Montreal Cognitive Assessment score of 22 points (SD 5.92). Following lumbar puncture, an increase in COP-v was observed solely in the eyes open condition (mean before: 38.6, SD 18.5; mean after: 43.1, SD 21.3; p=0.022), while the COP-rms across all conditions remained statistically unchanged.

Conclusion: Postural sway parameters exhibited minimal changes subsequent to lumbar puncture in patients with NPH. This suggests that probatory lumbar puncture and potentially shunt surgery primarily influence dynamic balance, including gait, rather than directly impacting postural control. Further research is warranted to explore the implications of these findings in clinical management and intervention strategies for individuals with NPH.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/changes-in-postural-control-of-patients-with-normal-pressure-hydrocephalus-after-lumbar-puncture/