Abstract | BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome that may be reversible by diversion of cerebrospinal fluid (CSF). It is increasingly recognized, and accordingly rates of CSF diversion are increasing despite the absence of level I evidence of efficacy, non-neglible rate of complications and an unclear natural history. METHODS: A total of 349 neurosurgeons, neurologists, geriatricians and neuropsychiatrists rated the perceived efficacy of CSF diversion, the duration of effect of CSF diversion, and the risk-benefit ratio of CSF diversion in iNPH. These physicians then rated the need for a randomized controlled trial (RCT) of CSF diversion in iNPH. Participants detailed their desired selection criteria and supportive testing for a RCT, and their preferred control group. RESULTS: Physicians believe that there is uncertain efficacy of CSF diversion in iNPH, as well as the expected duration of this benefit and the risk-benefit ratio for patients. The greatest degree of uncertainty related to the long-term benefit of surgery. Accordingly, over 75% desire a RCT to determine the efficacy of CSF diversion in iNPH. Only 2.7% of participants believe a RCT of CSF diversion in iNPH is unethical. Patients without a shunt and a programmable valve in the 'off' setting were the preferred control groups. CONCLUSION: A RCT of CSF diversion in iNPH is absent from the literature. The majority (>75%) of physicians involved in the diagnosis and treatment of iNPH believe a RCT is required to determine the efficacy, duration of efficacy and risk-benefit ratio of CSF diversion in iNPH.
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Authors | Alexander McGirr, Safraz Mohammed, Roger Kurlan, Michael D Cusimano |
Journal | Journal of the neurological sciences
(J Neurol Sci)
Vol. 333
Issue 1-2
Pg. 13-8
(Oct 15 2013)
ISSN: 1878-5883 [Electronic] Netherlands |
PMID | 24012011
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | © 2013. |
Topics |
- Attitude of Health Personnel
- Cerebrospinal Fluid Shunts
- Humans
- Hydrocephalus, Normal Pressure
(surgery)
- Middle Aged
- Physicians
- Randomized Controlled Trials as Topic
- Therapeutic Equipoise
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