Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response

NPH Overview, Halperin JJ et al. 2015


Objective: We evaluated evidence for utility of shunting in idiopathic normal pressure hydrocephalus (iNPH) and for predictors of shunting effectiveness.

Methods: We identified and classified relevant published studies according to 2004 and 2011 American Academy of Neurology methodology.

Results: Of 21 articles, we identified 3 Class I articles.

Conclusions: Shunting is possibly effective in iNPH (96% chance subjective improvement, 83% chance improvement on timed walk test at 6 months) (3 Class III). Serious adverse event risk was 11% (1 Class III). Predictors of success included elevated Ro (1 Class I, multiple Class II), impaired cerebral blood flow reactivity to acetazolamide (by SPECT) (1 Class I), and positive response to either external lumbar drainage (1 Class III) or repeated lumbar punctures. Age may not be a prognostic factor (1 Class II). Data are insufficient to judge efficacy of radionuclide cisternography or aqueductal flow measurement by MRI.

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