Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus

Alfonso Fasano^{1

2

3

4

5}, Alberto J Espay⁶, David F Tang-Wai^{2

3

5

7}, Carsten Wikkelsö⁸, Joachim K Krauss^{9

10}

Affiliations

¹ Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.
² Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
³ Krembil Brain Institute, Toronto, Ontario, Canada.
⁴ Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada.
⁵ Howard Cohen Normal Pressure Hydrocephalus Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
⁶ James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.
⁷ University Health Network Memory Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
⁸ Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁹ Department of Neurosurgery, Medical School Hannover, Hannover, Germany.
¹⁰ Center for Systems Neuroscience, Hannover, Germany.

PMID: 32959936
DOI: 10.1002/mds.28251

Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus

Alfonso Fasano et al. Mov Disord. 2020 Nov.

. 2020 Nov;35(11):1945-1954.

doi: 10.1002/mds.28251. Epub 2020 Sep 22.

Authors

Alfonso Fasano^{1

2

3

4

5}, Alberto J Espay⁶, David F Tang-Wai^{2

3

5

7}, Carsten Wikkelsö⁸, Joachim K Krauss^{9

10}

Affiliations

¹ Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.
² Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
³ Krembil Brain Institute, Toronto, Ontario, Canada.
⁴ Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada.
⁵ Howard Cohen Normal Pressure Hydrocephalus Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
⁶ James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.
⁷ University Health Network Memory Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
⁸ Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁹ Department of Neurosurgery, Medical School Hannover, Hannover, Germany.
¹⁰ Center for Systems Neuroscience, Hannover, Germany.

PMID: 32959936
DOI: 10.1002/mds.28251

Abstract

Idiopathic normal pressure hydrocephalus is considered common but remains underinvestigated. There are no uniformly accepted diagnostic criteria and therapeutic guidelines. We summarize the accumulated evidence regarding the definition, pathophysiology, diagnosis, and treatment of idiopathic normal pressure hydrocephalus, highlighting the many gaps and controversies, including diagnostic challenges, the frequent association with neurodegeneration and vascular disease, and the many unknowns regarding patient selection and outcome predictors. A roadmap to fill these gaps and solve the controversies around this condition is also proposed. More evidence is required with respect to diagnostic criteria, the value of ancillary testing, prospective population-based studies and novel trial designs. Furthermore, a need exists to develop new advanced options in shunt technology. © 2020 International Parkinson and Movement Disorder Society.

Keywords: Alzheimer's; Parkinson's disease; diagnosis; gait; idiopathic; normal pressure hydrocephalus; shunt.

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Comment in

Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus.
Sidiropoulos C. Sidiropoulos C. Mov Disord. 2021 Apr;36(4):1043. doi: 10.1002/mds.28574. Mov Disord. 2021. PMID: 33851754 No abstract available.
Reply to: "Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus".
Fasano A, Espay AJ, Tang-Wai DF, Wikkelsö C, Krauss JK. Fasano A, et al. Mov Disord. 2021 Apr;36(4):1043-1044. doi: 10.1002/mds.28573. Mov Disord. 2021. PMID: 33851755 No abstract available.

References

1. Paulus W, Krauss JK, Gerloff C, et al. S1-Leitlinie Normaldruckhydrozephalus. Deutsche Gesellschaft für Neurologie, Hrsg Leitlinien für Diagnostik und Therapie in der Neurologie 2018.
1. Espay AJ, Da Prat GA, Dwivedi AK, et al. Deconstructing normal pressure hydrocephalus: ventriculomegaly as early sign of neurodegeneration. Annals of neurology 2017;82:503-513.
1. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 2005;57:S4-S16; discussion ii-v.
1. Mori E, Ishikawa M, Kato T, et al. Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurologia medico-chirurgica 2012;52:775-809.
1. Tullberg M, Jensen C, Ekholm S, Wikkelso C. Normal pressure hydrocephalus: vascular white matter changes on MR images must not exclude patients from shunt surgery. AJNR Am J Neuroradiol 2001;22:1665-1673.

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Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus

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Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus

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