Cerebrospinal fluid sampling for research of Alzheimer's disease and other neurodegenerative diseases when lumbar punctures are performed by anaesthetists

Kelly J Atkins, Lisbeth Evered, David A Scott, Christopher Fowler, Colin L Masters, Brendan Silbert, Kelly J Atkins, Lisbeth Evered, David A Scott, Christopher Fowler, Colin L Masters, Brendan Silbert

Abstract

Objectives: An increasing number of people are undergoing lumbar puncture (LP) for the purposes of research. Performing LP for research purposes introduces considerations that differ from LP performed for clinical, diagnostic or therapeutic reasons. The demand for research LP will greatly increase as biomarkers are used to both diagnose and monitor disease progression in clinical trials. Minimising adverse events is paramount because research participants receive no clinical benefit and often need repeat procedures. We describe the experience of performing LP for research by anaesthetists.

Methods: We reviewed the clinical protocol and incidence of adverse events in 326 research LP in an anaesthesia department.

Results: There was a lower incidence of adverse events compared with previous reports when LP was undertaken for clinical reasons. The incidence of severe post-LP headache was 1.3% when an atraumatic spinal needle with a 27 gauge tip and a 22 gauge shaft was used.

Conclusions: We describe the practice to sample cerebrospinal fluid (CSF) by LP for research purposes. Specific practices include the sitting position of the participant, aspiration rather than passive CSF withdrawal, attention to the sterility of the procedure, monitoring of vital signs and importantly the use of 22/27 gauge microtip spinal needle.

Trial registration numbers: ACTRN12612000493842, NCT04623242.

Keywords: CSF; alzheimer's disease; clinical neurology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
(A) Flow chart of lumbar punctures scheduled and completed by needle utilised. size for the Australian Imaging, Biomarker and Lifestyle Study of Ageing (AIBL). (B) Flow chart of lumbar punctures scheduled and completed by needle size for the Dominately Inherited Alzheimer’s Disease Network Study. Note: LP = lumbar puncture. *Procedure cancelled due to patient withdrawal or inaccessibility.**Procedure cancelled due to medical reasons.

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