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Title: Conservative versus treatment of idiopathic normal pressure hydrocephalus
Author: Toma, Ahmed Kassem Abbass
ISNI:       0000 0004 2724 1402
Awarding Body: University of London
Current Institution: University of London
Date of Award: 2011
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Objectives: Idiopathic normal pressure hydrocephalus (INPH) is a condition that affects the elderly population with clinical presentation of gait and balance impairment, cognitive impairment and urinary incontinence. Brain imaging shows -. ventriculomegaly in the absence of raised intracranial pressure. Shunt insertion is the standard method of treatment. However; there is a lack of good quality evidence of its effectiveness. As a result, many physicians and even few surgeons are sceptic about the existence of this condition as a separate entity. The aim of this thesis is to provide evidence supporting or refuting the role of surgical management in INPH, through a prospective randomized controlled double blinded study. Methods: Fourteen probable INPH patients who showed clinical improvement following extended lumbar drainage were randomized to have ventriculoperitoneal shunt insertion with an open or closed adjustable valve. Closed shunts were opened after three months. Primary endpoint was improvement in walking speed. Secondary endpoints were improvement in cognitive function, urinary symptoms and incidence of complications. Results: There was a statistically significant advantage of the open shunt in improving walking speed compared with the closed shunt at the study endpoint (43% vs. 0% p=0.02). In addition, the prospectively collected data has shown that both groups improved in terms of mobility one year following shunt insertion (47% and 46.7% respectively). There was a trend suggesting that delay in opening the shunt has delayed improvement beyond the 3 months hypothesized in study design. However; this delay was not statistically significant (p=0.08). 4 us.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available