Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus
Abstract Background The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates among patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to evaluate the predictive value of the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-04-01
|
| Series: | Fluids and Barriers of the CNS |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12987-021-00252-5 |
| _version_ | 1818937506639380480 |
|---|---|
| author | Johanna Rydja Andreas Eleftheriou Fredrik Lundin |
| author_facet | Johanna Rydja Andreas Eleftheriou Fredrik Lundin |
| author_sort | Johanna Rydja |
| collection | DOAJ |
| description | Abstract Background The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates among patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to evaluate the predictive value of the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method. Methods One hundred and sixteen shunt-operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as the postoperative outcome. A positive response to CSF TT was defined as a change of ≥ 5 points in the gait domain and ≥ 16 points in the balance domain. Differences between CSF TT responders and non-responders, sensitivity, specificity, positive and negative predictive values, accuracy, and correlations between changes from baseline to post CSF TT and from baseline to the postoperative follow-up, were calculated. Results In the CSF TT there were 63.8% responders in the gait domain and correspondingly 44.3% in the balance domain. CSF TT responders had a significantly better postoperative outcome in the total scale score (gait P ≤ 0.001, balance P ≤ 0.012) and gait CSF TT responders improved more in gait (P ≤ 0.001) and balance CSF TT responders in balance (P ≤ 0.001). No differences between CSF TT gait or balance responders could be found in neuropsychological or urinary continence assessments postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 68.1% and 52.0% for gait and 47.8% and 68.0% for balance, respectively. Conclusions The CSF TT, with the Hellström iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to predict outcomes for gait, but the balance domain is too insensitive. |
| first_indexed | 2024-12-20T05:53:03Z |
| format | Article |
| id | doaj.art-60bc75d09f5241a5b001fb607480c654 |
| institution | Directory Open Access Journal |
| issn | 2045-8118 |
| language | English |
| last_indexed | 2024-12-20T05:53:03Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Fluids and Barriers of the CNS |
| spelling | doaj.art-60bc75d09f5241a5b001fb607480c6542022-12-21T19:51:06ZengBMCFluids and Barriers of the CNS2045-81182021-04-0118111210.1186/s12987-021-00252-5Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalusJohanna Rydja0Andreas Eleftheriou1Fredrik Lundin2Department of Activity and Health, and Department of Biomedical and Clinical Sciences, Linköping UniversityDepartment of Neurology, and Department of Biomedical and Clinical Sciences, Linköping UniversityDepartment of Neurology, and Department of Biomedical and Clinical Sciences, Linköping UniversityAbstract Background The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates among patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to evaluate the predictive value of the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method. Methods One hundred and sixteen shunt-operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as the postoperative outcome. A positive response to CSF TT was defined as a change of ≥ 5 points in the gait domain and ≥ 16 points in the balance domain. Differences between CSF TT responders and non-responders, sensitivity, specificity, positive and negative predictive values, accuracy, and correlations between changes from baseline to post CSF TT and from baseline to the postoperative follow-up, were calculated. Results In the CSF TT there were 63.8% responders in the gait domain and correspondingly 44.3% in the balance domain. CSF TT responders had a significantly better postoperative outcome in the total scale score (gait P ≤ 0.001, balance P ≤ 0.012) and gait CSF TT responders improved more in gait (P ≤ 0.001) and balance CSF TT responders in balance (P ≤ 0.001). No differences between CSF TT gait or balance responders could be found in neuropsychological or urinary continence assessments postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 68.1% and 52.0% for gait and 47.8% and 68.0% for balance, respectively. Conclusions The CSF TT, with the Hellström iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to predict outcomes for gait, but the balance domain is too insensitive.https://doi.org/10.1186/s12987-021-00252-5Idiopathic normal pressure hydrocephalusCSF TTOutcomeSensitivitySpecificity |
| spellingShingle | Johanna Rydja Andreas Eleftheriou Fredrik Lundin Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus Fluids and Barriers of the CNS Idiopathic normal pressure hydrocephalus CSF TT Outcome Sensitivity Specificity |
| title | Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus |
| title_full | Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus |
| title_fullStr | Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus |
| title_full_unstemmed | Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus |
| title_short | Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus |
| title_sort | evaluating the cerebrospinal fluid tap test with the hellstrom inph scale for patients with idiopathic normal pressure hydrocephalus |
| topic | Idiopathic normal pressure hydrocephalus CSF TT Outcome Sensitivity Specificity |
| url | https://doi.org/10.1186/s12987-021-00252-5 |
| work_keys_str_mv | AT johannarydja evaluatingthecerebrospinalfluidtaptestwiththehellstrominphscaleforpatientswithidiopathicnormalpressurehydrocephalus AT andreaseleftheriou evaluatingthecerebrospinalfluidtaptestwiththehellstrominphscaleforpatientswithidiopathicnormalpressurehydrocephalus AT fredriklundin evaluatingthecerebrospinalfluidtaptestwiththehellstrominphscaleforpatientswithidiopathicnormalpressurehydrocephalus |