Recovery process of gait disturbance after ventriculo-peritoneal shunt in patients with idiopathic normal pressure hydrocephalus

Abstract

To clarify the characteristics of the recovery process of gait disturbances after ventriculo-peritoneal shunt (VP shunt) surgery in patients with idiopathic normal pressure hydrocephalus (iNPH), we investigated three areas in two severely disabled patients: longitudinal changes of the severity of postural instability of motor aspects of the Unified Parkinson's disease Rating Scale (UPDRS); time taken in the "timed up and go (TUG)" test; and the prevalence of freezing episodes and the severity of bradykinesia. We also compared the computed tomography findings before and after VP shunt. Gait disturbances in the early stage after VP shunt fall under the frontal gait disorder of Nutt's classification or the mixed gait apraxia of Liston's classification. Disequilibrium clearly improved gradually after VP shunt, however, gait ignition failure and hypokinesia showed no significant improvement in our study. In the early stage after VP shunt, complementing disequilibrium using high-heeled shops was highly effective at improving the time taken in TUG. The improvements in radiographic findings were reported after VP shunt.