Changes in postural stability after cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus

Eunhee Park; Sanghyeon Lee; Tae-Du Jung; Ki-Su Park; Jong Taek Lee; Kyunghun Kang

doi:10.3389/fneur.2024.1361538

Changes in postural stability after cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus

Front Neurol. 2024 May 1:15:1361538. doi: 10.3389/fneur.2024.1361538. eCollection 2024.

Authors

Eunhee Park^#¹, Sanghyeon Lee^#², Tae-Du Jung¹, Ki-Su Park³, Jong Taek Lee², Kyunghun Kang⁴

Affiliations

¹ Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
² School of Computer Science and Engineering, Kyungpook National University, Daegu, Republic of Korea.
³ Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
⁴ Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

^# Contributed equally.

Abstract

Introduction: In patients with idiopathic normal pressure hydrocephalus (iNPH), the characteristics of balance disturbance are not as well understood as those related to gait. This study examined changes in postural stability in quiet standing after the cerebrospinal fluid tap test (CSFTT) in these patients. Furthermore, the study explored the relationship between the amount of spontaneous body sway and both gait and executive function.

Materials and methods: All patients diagnosed with iNPH underwent CSFTT. We evaluated their center of pressure (COP) measurements on a force plate during quiet standing, both pre- and post-CSFTT. Following the COP measurements, we calculated COP parameters using time and frequency domain analysis and assessed changes in these parameters after CSFTT. At pre-CSFTT, we assessed the Timed Up and Go (TUG) and the Frontal Assessment Battery (FAB). We investigated the relationship between COP parameters and the TUG and FAB scores at pre-CSFTT.

Results: A total of 72 patients with iNPH were initially enrolled, and 56 patients who responded positively to CSFTT were finally included. Post-CSFTT, significant improvements were observed in COP parameters through time domain analysis. These included the velocity of COP (vCOP), root-mean-square of COP (rmsCOP), turn index, torque, and base of support (BOS), compared to the pre-CSFTT values (p < 0.05). In the frequency domain analysis of COP parameters post-CSFTT, there was a decrease in both the peak and average of power spectral density (PSD) values in both the anteroposterior (AP) and mediolateral (ML) directions below 0.5 Hz (p < 0.05). In addition, the TUG scores showed a positive correlation with vCOP, rmsCOP, turn index, torque, BOS, and both the peak and average PSD values in the AP and ML directions below 0.5 Hz (p < 0.05). The FAB scores demonstrated a negative correlation with vCOP, rmsCOP, turns index, BOS, and both peak and average PSD values in the AP direction below 0.5 Hz (p < 0.05).

Conclusion: In patients with iNPH who responded to CSFTT, there was an improvement in spontaneous body sway during quiet standing after CSFTT. Increased spontaneous sway is associated with impaired gait and frontal lobe function. This may be linked to impaired cortico-cortical and cortico-subcortical circuits in patients with iNPH.

Keywords: balance (static); center of pressure; normal pressure hydrocephalus; postural balance; spinal puncture.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The research was supported by National Research Foundation of Korea (NRF-2021R1C1C1011387).