Purpose and summary of clinical guidelines for idiopathic normal pressure hydrocephalus

Abstract

Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome manifesting with gait disturbance, dementia and urinary incontinence without any preceding disorders in elderly patients. The rapid increase of the elderly population in Japan prompted us to make guidelines for the management of iNPH. The Japanese guidelines committee started work in March 2002. The guidelines were made according to evidence-based medicine and were published in May 2004. The Japanese guidelines are summarized as follows : 1) It is simple and practical. 2) Three levels of diagnosis for iNPH (possible, probable and definite) are proposed to make preoperative diagnosis more accurate. 3) Gait disturbance is a major symptom, and such cases are most suitable for CSF shunting operation, 4) The CSF tap test is regarded as a best predictor, when it is positive. 5) Use of a programmable shunt valve is recommended. 6) Flow-charts for diagnosis, indication of shunt operation and prevention of complications are made for wider use. Thus, the Japanese guidelines are useful to make diagnosis more precise and treatment more appropriate.