Multiple sclerosis and related disorders · 2026
Normal pressure hydrocephalus in people with multiple sclerosis.
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Chowdhury Purnashree, Cutsforth-Gregory Jeremy K, Jones David T, Young Nathan P, Flanagan Eoin P, Kantarci Orhun H, Tobin W Oliver, Albites Coen Bianca, Keegan B Mark
Аннотация
BACKGROUND: Aging people with multiple sclerosis (pwMS) may develop idiopathic normal pressure hydrocephalus (INPH).
OBJECTIVES: Describe clinical, investigational, and treatment courses in pwMS and INPH.
METHODS: Retrospective Mayo Clinic database review of "MS" and "NPH" and "Gait disorder" 1996-2025.
INCLUSION CRITERIA: 1) pwMS; 2) INPH; 3) INPH gait impairment (gait apraxia and/or ataxia).
EXCLUSION CRITERIA: non-INPH gait impairment or absent neurologist examination. Demographics, clinical course, INPH triad features (gait disorder, cognitive dysfunction, bladder dysfunction) were recorded. INPH was defined as possible (≥2 INPH triad and ventriculomegaly), probable (possible INPH with Disproportionately Enlarged Sub-arachnoid space Hydrocephalus [DESH] or positive high-volume tap test [HVTT]) and definite (gait improvement following ventriculoperitoneal [VP] shunt). Cerebrospinal fluid studies, brain magnetic resonance imaging findings and gait outcome following HVTT and VP shunt were recorded.
RESULTS: Thirty-six pwMS and INPH were included. Twenty-six (72%) female, 35 (97%) white ethnicity, age (median, interquartile range [IQR]) at MS onset 49.0 (32.5-59.0) years, and at INPH onset 67.5 (60.8-70.3) years. Nineteen (53%) had secondary progressive MS; 10 (28%), relapsing-remitting and 7 (19%), primary progressive MS. INPH was definite in 10 (28%), probable in 9 (25%) and possible in 17 (47%). All had INPH gait disorder, 30 (83%) bladder dysfunction, 24 (67%) cognitive dysfunction and 20 (56%) with full INPH triad. DESH was present in 23/36 (64%). HVTT performed in 24/36 (67%), with gait improvement in 14 (58%). Twelve (33%) underwent VP shunt, with gait improvement in 10 (83%).
CONCLUSION: PwMS and INPH may have a surgically amenable gait disorder.
OBJECTIVES: Describe clinical, investigational, and treatment courses in pwMS and INPH.
METHODS: Retrospective Mayo Clinic database review of "MS" and "NPH" and "Gait disorder" 1996-2025.
INCLUSION CRITERIA: 1) pwMS; 2) INPH; 3) INPH gait impairment (gait apraxia and/or ataxia).
EXCLUSION CRITERIA: non-INPH gait impairment or absent neurologist examination. Demographics, clinical course, INPH triad features (gait disorder, cognitive dysfunction, bladder dysfunction) were recorded. INPH was defined as possible (≥2 INPH triad and ventriculomegaly), probable (possible INPH with Disproportionately Enlarged Sub-arachnoid space Hydrocephalus [DESH] or positive high-volume tap test [HVTT]) and definite (gait improvement following ventriculoperitoneal [VP] shunt). Cerebrospinal fluid studies, brain magnetic resonance imaging findings and gait outcome following HVTT and VP shunt were recorded.
RESULTS: Thirty-six pwMS and INPH were included. Twenty-six (72%) female, 35 (97%) white ethnicity, age (median, interquartile range [IQR]) at MS onset 49.0 (32.5-59.0) years, and at INPH onset 67.5 (60.8-70.3) years. Nineteen (53%) had secondary progressive MS; 10 (28%), relapsing-remitting and 7 (19%), primary progressive MS. INPH was definite in 10 (28%), probable in 9 (25%) and possible in 17 (47%). All had INPH gait disorder, 30 (83%) bladder dysfunction, 24 (67%) cognitive dysfunction and 20 (56%) with full INPH triad. DESH was present in 23/36 (64%). HVTT performed in 24/36 (67%), with gait improvement in 14 (58%). Twelve (33%) underwent VP shunt, with gait improvement in 10 (83%).
CONCLUSION: PwMS and INPH may have a surgically amenable gait disorder.