NDLI: Motor cortex disinhibition in normal-pressure hydrocephalus.

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Motor cortex disinhibition in normal-pressure hydrocephalus.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Chistyakov, Andrei V. Hafner, Hava Sinai, Alon Kaplan, Boris Zaaroor, Menashe
Description	Country affiliation: Israel Author Affiliation: Chistyakov AV ( Department of Neurosurgery, Rambam Health Care Campus, and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. a_chistyakov@rambam.health.gov.il)
Abstract	OBJECT: Previous studies have shown a close association between frontal lobe dysfunction and gait disturbance in idiopathic normal-pressure hydrocephalus (iNPH). A possible mechanism linking these impairments could be a modulation of corticospinal excitability. The aim of this study was 2-fold: 1) to determine whether iNPH affects corticospinal excitability; and 2) to evaluate changes in corticospinal excitability following ventricular shunt placement in relation to clinical outcome. METHODS: Twenty-three patients with iNPH were examined using single- and paired-pulse transcranial magnetic stimulation of the leg motor area before and 1 month after ventricular shunt surgery. The parameters of corticospinal excitability assessed were the resting motor threshold (rMT), motor evoked potential/M-wave area ratio, central motor conduction time, intracortical facilitation, and short intracortical inhibition (SICI). The results were compared with those obtained in 8 age-matched, healthy volunteers, 19 younger healthy volunteers, and 9 age-matched patients with peripheral neuropathy. RESULTS: Significant reduction of the SICI associated with a decrease of the rMT was observed in patients with iNPH at baseline evaluation. Ventricular shunt placement resulted in significant enhancement of the SICI and increase of the rMT in patients who markedly improved, but not in those who failed to improve. CONCLUSIONS: This study demonstrates that iNPH affects corticospinal excitability, causing disinhibition of the motor cortex. Recovery of corticospinal excitability following ventricular shunt placement is correlated with clinical improvement. These findings support the view that reduced control of motor output, rather than impairment of central motor conduction, is responsible for gait disturbances in patients with iNPH.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	2
Volume Number	116
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2012-02-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Gait Disorders, Neurologic Physiopathology Hydrocephalus, Normal Pressure Motor Cortex Neural Inhibition Physiology Cerebrospinal Fluid Shunts Efferent Pathways Evoked Potentials, Motor Etiology Surgery Complications Pyramidal Tracts Recovery Of Function Transcranial Magnetic Stimulation
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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