Corticospinal excitability in idiopathic normal pressure hydrocephalus : a transcranial magnetic stimulation study
Sirkka, Jani; Säisänen, Laura; Julkunen, Petro; Könönen, Mervi; Kallioniemi, Elisa; Leinonen, Ville; Danner, Nils (2020-02-17)
Sirkka, J., Säisänen, L., Julkunen, P. et al. Corticospinal excitability in idiopathic normal pressure hydrocephalus: a transcranial magnetic stimulation study. Fluids Barriers CNS 17, 6 (2020). https://doi.org/10.1186/s12987-020-0167-0
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https://urn.fi/URN:NBN:fi-fe2020050625456
Tiivistelmä
Abstract
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease with an unknown etiology. Disturbed corticospinal inhibition of the motor cortex has been reported in iNPH and can be evaluated in a noninvasive and painless manner using navigated transcranial magnetic stimulation (nTMS). This is the first study to characterize the immediate impact of cerebrospinal fluid (CSF) drainage on corticospinal excitability.
Methods: Twenty patients with possible or probable iNPH (16 women and 4 men, mean age 74.4 years, range 67–84 years), presenting the classical symptom triad and radiological findings, were evaluated with motor function tests (10-m walk test, Grooved Pegboard and Box & Block test) and nTMS (silent period, SP, resting motor threshold, RMT and input–output curve, IO-curve). Evaluations were performed at baseline and repeated immediately after CSF drainage via lumbar puncture.
Results: At baseline, iNPH patients presented shorter SPs (p < 0.001) and lower RMTs (p < 0.001) as compared to normative values. Positive correlation was detected between SP duration and Box & Block test (rho = 0.64, p = 0.002) in iNPH patients. CSF drainage led to an enhancement in gait velocity (p = 0.002) and a steeper IO-curve slope (p = 0.049).
Conclusions: Shorter SPs and lower RMTs in iNPH suggest impaired corticospinal inhibition and corticospinal hyperexcitability. The steeper IO-slope in patients who improve their gait velocity after CSF drainage may indicate a higher recovery potential. Corticospinal excitability correlated with the motor function of the upper limbs implying that the disturbance in motor performance in iNPH extends beyond the classically reported gait impairment.
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