Abstract Details

Title Predictors of Shunt Responsiveness and Long-term Outcomes in Idiopathic Normal Pressure Hydrocephalus: A Retrospective Cohort Study

Topic Movement Disorders

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 16-002

Objective This study aimed to identify clinical, imaging, and CSF biomarkers associated with favorable long-term outcomes following shunt placement.

Background Idiopathic Normal Pressure Hydrocephalus (iNPH) remains a challenging clinical diagnosis with variable treatment response.

Design/Methods All patients evaluated for iNPH at the Tel-Aviv Medical Center (TLVMC) between 2020 and 2022 were included. Participants underwent clinical, cognitive, and imaging assessments, high-volume lumbar puncture (LP). LP responders were referred for shunt placement, and outcomes assessed at one year.

Results

183 patients were evaluated; 167 met criteria for suspected iNPH and underwent LP. Sixty-two (37%) patients showed improvement after CSF drainage and were referred for shunting of these, 38 (61%) underwent shunt placement. Gait disturbance was the most common presenting symptom (68%), and more frequent in LP responders (p=0.007), whereas cognitive symptoms were more common among non-responders (29.5% vs. 10%). LP responders had lower CSF total tau (t-tau) (222.6 ± 99.1 vs. 256 ± 107.1, p=0.045) and protein (41.1 ± 17.1 vs. 49.1 ± 25.7, p=0.032), and were more likely to exhibit a disproportionately enlarged subarachnoid-space hydrocephalus (DESH) pattern (73% vs. 46%, p<0.001). Among the 38 shunted patients, 21 (55%) had a favourable outcome at one year which was associated with lower t-tau (p=0.056) and more frequent DESH (p=0.026).

Conclusions A significant proportion of patients with suspected iNPH benefit from CSF shunting. Lower t-tau and DESH pattern were associated with better outcomes.

Authors/Disclosures
Dror Shir, MD (Mayo Clinic) PRESENTER	Dr. Shir has nothing to disclose.
Noa Bregman	Noa Bregman has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medison. The institution of Noa Bregman has received research support from Ionis pharmaceuticals.
Elissa L. Ash, MD, PhD (Tel Aviv Sourasky Medical Center)	Dr. Ash has nothing to disclose.
Tamara Shiner	Tamara Shiner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli lilly. Tamara Shiner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Tamara Shiner has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. Tamara Shiner has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. The institution of Tamara Shiner has received research support from MJFF.

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