Treatment
Treatment of Normal Pressure Hydrocephalus (NPH)
NPH is usually treated by the insertion of a permanent shunt that diverts CSF from the brain into the abdominal cavity for clearance. The potential risks of this surgery can include, but are not limited to: infection, seizure, bleeding, and subdural hematoma - therefore it is important to be selective and only place a permanent shunt in those patients who will likely benefit from the procedure. Though not all cases of NPH are completely curable, many can be safely and effectively treated to allow the patient and his/her families to lead a much more enjoyable and productive life.
Florida Hospital NPH Program Timeline of Events
Patients with a potential NPH diagnosis are admitted to Florida Hospital(after an initial evaluation), for a three day hospital stay.
Day One
-Initial MRI or CT scan of brain
-Initial Neuropsychological assessment
-Initial Physical therapy assessment
-Nursing and geriatrics evaluate and follow patient throughout stay
-Neurology assessment
-Placement of the lumbar drain
-Nursing assessment
Day Two
-Physical therapy assessment
-NPH Clinical Care Program Coordinator visitation
Day Three
-Final Neuropsychology assessment
-Final Physical therapy assessment
-Removal of the lumbar drain
-Final MRI or CT scan of brain
On the first day, the patient comes in for initial assessments from our multidisciplinary team. After these assessments are complete, a lumbar drain is placed. The lumbar drain is a small tube placed in the back that will continuously drain CSF over the three days the patient is in the hospital –this attempts to simulate what a permanent shunt would do, or in other words mimic the NPH treatment. The patient is continuously reevaluated throughout the stay to determine how he/she is performing as the CSF is being drained. An improvement in performance on repeated testing would suggest that draining the fluid is helping, and therefore that treating NPH by placing a shunt may be of benefit to the patient.
After the three day stay in the hospital, our multidisciplinary team meets to review the patient’s stay and collectively determine whether the patient is an unlikely, possible, or probable candidate for the placement of a permanent shunt to treat their condition. The recommendations of the committee are then forwarded to the patient / family, and also to their Primary care Physician and Referring Physician(if not one and the same). It is then left up to the patient and his/her family to decide on whether to have a shunt placed or not. The patient is always encouraged to maintain a close working relationship with his/her primary care physician.
Regardless of whether the patient has a permanent shunt placed or not, the Florida Hospital NPH Program is committed to follow this patient with repeat testing at six months and twelve months ( MRI or CT scan, Neuropsychological evaluation, Physical Therapy assessment, and Neurosurgical evaluation). The important of this requirement is that it helps us to objectively determine each individual’s long-term outcome, and how this outcome differs between patients who received a shunt and those who did not.
To learn more about our NPH program, call our NPH Care Coordinator at (407) 303-3282 or contact us online.
