title: [Predictive value of postural and dynamic walking parameters after high-volume lumbar puncture in normal pressure hydrocephalus].
abstract: BACKGROUND
  Normal pressure hydrocephalus (NPH) was described by Adams et al. (1965). The common clinical presentation is the triad: gait disturbance, cognitive decline and urinary incontinence. Although these symptoms are suggestive, they are not specific to diagnosis. The improvement of symptoms after high-volume lumbar puncture (hVLP) could be a strong criterion for diagnosis. We tried to determine a specific pattern of dynamic walking and posture parameters in NPH. Additionally, we tried to specify the evolution of these criteria after hVLP and to determine predictive values of ventriculoperitoneal shunting (VPS) efficiency.
  
  
  METHODS
  Sixty-four patients were followed during seven years from January 2002 to June 2009. We identified three periods: before (S1), after hVLP (S2) and after VPS (S3). The following criteria concerned walking and posture parameters: walking parameters were speed, step length and step rhythm; posture parameters were statokinesigram total length and surface, length according to the surface (LFS), average value of equilibration for lateral movements (Xmoyen), anteroposterior movements (Ymoyen), total movement length in lateral axis (longX) and anteroposterior axis (longY).
  
  
  RESULTS
  Among the 64 patients included, 22 had VPS and 16 were investigated in S3. All kinematic criteria are decreased in S1 compared with normal values. hVLP improved these criteria significantly (S2). Among posture parameters, only total length and surface of statokinesigram showed improvement in S1, but no improvement in S2. A gain in speed greater or equal to 0.15m/s between S1 and S2 predicted the efficacy of VPS with a positive predictive value (PPV) of 87.1% and a negative predictive value (NPV) of 69.7% (area under the ROC curve [AUC]: 0.86).
  
  
  CONCLUSIONS
  Kinematic walking parameters are the most disruptive and are partially improved after hVLP. These parameters could be an interesting test for selecting candidates for VPS. These data have to be confirmed in a larger cohort.
authors: Service de neurologie, hôpital Saint-Jean, 20, avenue du Languedoc, 66046 Perpignan cedex, France.
authors: P
authors: P
authors: Mary
authors: J-M
authors: JM
authors: Gallisa
authors: S
authors: S
authors: Laroque
authors: G
authors: G
authors: Bedou
authors: A
authors: A
authors: Maillard
authors: C
authors: C
authors: Bousquet
authors: C
authors: C
authors: Negre
authors: N
authors: N
authors: Gaillard
authors: A
authors: A
authors: Dutray
authors: B
authors: B
authors: Fadat
authors: S
authors: S
authors: Jurici
authors: N
authors: N
authors: Olivier
authors: B
authors: B
authors: Cisse
authors: D
authors: D
authors: Sablot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D013129:Spinal Puncture; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt; D016138:Walking / Q000502:physiology*