Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Translations
    • Topics A-Z
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Translations
    • Topics A-Z
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Articles
  • Issues
  • Practice Current
  • Practice Buzz

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology Clinical Practice
Home
A peer-reviewed clinical neurology journal for the practicing neurologist
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Articles
  • Issues
  • Practice Current
  • Practice Buzz

Share

August 2021; 11 (4) Research

Protocolizing the Workup for Idiopathic Normal Pressure Hydrocephalus Improves Outcomes

View ORCID ProfileLealani Mae Y. Acosta, Kassandra Stubblefield, Trisha Conwell, Kiersten Espaillat, Heather Koons, Peter Konrad, John Fang, View ORCID ProfileHoward Kirshner, Thomas Davis
First published December 9, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000001018
Lealani Mae Y. Acosta
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Lealani Mae Y. Acosta
Kassandra Stubblefield
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Trisha Conwell
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kiersten Espaillat
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Heather Koons
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Peter Konrad
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
John Fang
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Howard Kirshner
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Howard Kirshner
Thomas Davis
Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Citation
Protocolizing the Workup for Idiopathic Normal Pressure Hydrocephalus Improves Outcomes
Lealani Mae Y. Acosta, Kassandra Stubblefield, Trisha Conwell, Kiersten Espaillat, Heather Koons, Peter Konrad, John Fang, Howard Kirshner, Thomas Davis
Neurol Clin Pract Aug 2021, 11 (4) e447-e453; DOI: 10.1212/CPJ.0000000000001018

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
151

Share

  • Article
  • Figures & Data
  • Info & Disclosures
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

Background The workup for idiopathic normal pressure hydrocephalus (INPH) can be difficult to coordinate, and determining appropriate patients for ventriculoperitoneal shunting can be challenging. Therefore, we hypothesized that implementing a formalized protocol can improve patient selection for a shunt. In conjunction with neurology and neurosurgery, we instituted a standardized means of assessing patients whose presentation is concerning for INPH and compared their workup with similar patients seen without the Protocol (i.e., preprotocol [PP]) regarding baseline characteristics, assessment, and outcomes.

Methods Twenty-six PP patients were compared with 40 Protocol patients on measures, including baseline deficits, workup, neurosurgical evaluation, and response to shunt.

Results Average age was similar between groups, and the percentage of patients who had a decline in gait, cognition, and/or incontinence was not statistically different (p > 0.05). Significantly more Protocol patients underwent high-volume lumbar puncture (HVLP; 97.5%; PP, 61.5%; p < 0.001) and received formalized gait assessment with the Gait Scale (90%; PP, 0%, p < 0.001) and standardized cognitive testing (95%; PP, 38.5%; p < 0.001). Significantly more Protocol patients had no improvement after HVLP (33.3%; PP, 6.25%; p < 0.045); subsequently, fewer got shunted (57.5%; PP, 84.6%; p < 0.030). More Protocol patients who were shunted reported gait improvement (100%; PP, 72.7%; p = 0.009), although there was no difference in cognition (59.2%; PP, 82.6%; p = 0.108) or incontinence (18.2%; PP, 39.1%; p = 0.189).

Conclusions Implementing an INPH Protocol leads to standardized and more extensive assessment and better patient selection for and subsequent outcomes from shunting, specifically regarding gait.

Footnotes

  • Previously presented as an abstract at the 70th annual meeting of the American Academy of Neurology, Los Angeles, CA, April 2018.

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Received August 28, 2020.
  • Accepted October 22, 2020.
  • © 2020 American Academy of Neurology
View Full Text

AAN Members

We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.

Google Safari Microsoft Edge Firefox

Click here to login

AAN Non-Member Subscribers

Click here to login

Purchase access

For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)

Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here 

Purchase
Individual access to articles is available through the Add to Cart option on the article page.  Access for 1 day (from the computer you are currently using) is US$ 39.00.  Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means.  The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use.  Distributing copies (electronic or otherwise) of the article is not allowed.

The Nerve!: Rapid online correspondence

No comments have been published for this article.
Comment

REQUIREMENTS

If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org

Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.

If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.

Submission specifications:

  • Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
  • Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
  • Submit only on articles published within 6 months of issue date.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Publishing Agreement Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • Methods
    • Results
    • Discussion
    • Study Funding
    • Disclosure
    • Appendix Authors
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
Advertisement

Preferences and User Experiences of Wearable Devices in Epilepsy A Systematic Review and Mixed-Methods Synthesis

Dr. Daniel Friedman and Dr. Sharon Chiang

► Watch

Related Articles

  • No related articles found.

Topics Discussed

  • All Clinical Neurology
  • Gait disorders/ataxia
  • Diagnostic test assessment
  • Hydrocephalus
  • Assessment of cognitive disorders/dementia

Alert Me

  • Alert me when eletters are published
Neurology: Clinical Practice: 13 (1)

Articles

  • Articles
  • Issues
  • Popular Articles

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Education
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology: Clinical Practice |  Print ISSN: 2163-0402
Online ISSN: 2163-0933

© 2023 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise