The Effect of Spinal Tap Test on Different Sensory Modalities of Postural Stability in Idiopathic Normal Pressure Hydrocephalus

Katrin Abram, Silvia Bohne, Peter Bublak, Panagiota Karvouniari, Carsten M Klingner, Otto W Witte, Orlando Guntinas-Lichius, Hubertus Axer, Katrin Abram, Silvia Bohne, Peter Bublak, Panagiota Karvouniari, Carsten M Klingner, Otto W Witte, Orlando Guntinas-Lichius, Hubertus Axer

Abstract

Background/aims: Postural instability in patients with normal pressure hydrocephalus (NPH) is a most crucial symptom leading to falls with secondary complications. The aim of the current study was to evaluate the therapeutic effect of spinal tap on postural stability in these patients.

Methods: Seventeen patients with clinical symptoms of NPH were examined using gait scale, computerized dynamic posturography (CDP), and neuropsychological assessment. Examinations were done before and after spinal tap test.

Results: The gait score showed a significant improvement 24 h after spinal tap test in all subtests and in the sum score (p < 0.003), while neuropsychological assessment did not reveal significant differences 72 h after spinal tap test. CDP showed significant improvements after spinal tap test in the Sensory Organization Tests 2 (p = 0.017), 4 (p = 0.001), and 5 (p = 0.009) and the composite score (p = 0.01). Patients showed best performance in somatosensory and worst performance in vestibular dominated tests. Vestibular dominated tests did not improve significantly after spinal tap test, while somatosensory and visual dominated tests did.

Conclusion: Postural stability in NPH is predominantly affected by deficient vestibular functions, which did not improve after spinal tap test. Conditions which improved best were mainly independent from visual control and are based on proprioceptive functions.

Keywords: Computerized dynamic posturography; Normal pressure hydrocephalus; Postural stability; Spinal tap test.

Figures

Fig. 1
Fig. 1
Conditions of Sensory Organization Test (SOT 1-6). The photos on the left hand side show the CDP system in the neuro-otological laboratory.
Fig. 2
Fig. 2
Gait scores (a), CDP (b), and neuropsychological assessment (c) before and after spinal tap test. Significant differences are marked. Error bars depict 1 standard deviation.
Fig. 3
Fig. 3
Sensory analysis of CDP results.
Fig. 4
Fig. 4
Difference scores of test variables in patients with clinical improvement (n = 11) and patients without (n = 6).

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