shunts and csf fluid changes

[Guest guest]

Shunt related changes in somatostatin, neuropeptide Y, and corticotropin

releasing factor concentrations in patients with normal pressure

hydrocephalus.

Poca MA, Mataró M, Sahuquillo J, Catalán R, Ibañez J, Galard R

J Neurol Neurosurg Psychiatry 2001 Mar 70:298-304

BROWSE

 : 

J Neurol Neurosurg Psychiatry • Volume 70 • Issue 3

VIEW

 : 

MEDLINE, full MEDLINE, related records

Abstract

OBJECTIVES: Recent data indicate that alterations in brain neuropeptides may

play a pathogenic role in dementia. Neuropeptide Y (NPY), somastostatin

(SOM), and corticotropin releasing factor (CRF) are neuropeptides involved in

cognitive performance. Decreased SOM and NPY concentrations have been found

in patients with normal pressure hydrocephalus and are probably the result of

neuronal dysfunction, which could potentially be restored by shunting. The

effects of shunt surgery on preoperative SOM, NPY, and CRF concentrations

were studied. Any improvements in neuropeptide concentrations that could lead

to clinically significant neuropsychological and functional changes were also

investigated. METHODS: A prospective study was performed in 14 patients with

normal pressure hydrocephalus syndrome with a duration of symptoms between 3

months and 12 years. Diagnosis was based on intracranial pressure (ICP)

monitoring and CSF dynamics. Concentrations of SOM, NPY, and CRF in lumbar

CSF were determined before shunting and again 6-9 months after surgery. A

battery of neuropsychological tests and several rating functional scales were

also given to patients before and after shunting. RESULTS: After shunting,

SOM and CRF concentrations were significantly increased in all patients.

Concentrations of NPY were increased in 12 of the 14 patients studied. The

clinical condition of 13 of the 14 patients was significantly improved 6

months after surgery. This improvement was more pronounced in gait

disturbances and sphincter dysfunction than in cognitive impairment. No

significant differences in any of the neuropsychological tests were seen for

the group of patients as a whole despite the increased neuropeptide

concentrations. CONCLUSIONS: Shunting can restore SOM, NPY, and CRF

concentrations even in patients with longstanding normal pressure

hydrocephalus. However, despite the biochemical and clinical improvement in

some areas such as ambulation and daily life activities, cognitive

performance did not significantly improve. The role of neuropeptides in the

diagnosis and treatment of patients with normal pressure hydrocephalus

syndrome is discussed.

MeSH

Aged; Cerebrospinal Fluid Shunts; Corticotropin-Releasing Hormone; Female;

Human; Hydrocephalus, Normal Pressure; Male; Middle Age; Neuropeptide Y;

Neuropsychological Tests; Somatostatin; Support, Non-U.S. Gov't

CAS Registry Number (Substance Name)

0  (Neuropeptide Y)

51110-01-1  (Somatostatin)

9015-71-8  (Corticotropin-Releasing Hormone)

Author Address

Department of Neurosurgery, Vall d'Hebron University Hospitals, Barcelona,

Spain. 26382app@...

Abstracted by Journal Article Publication Type Journal Article

ISSN 0022-3050 Country England

Language eng Journal Code JBB

Date of Entry 20010222 Entry Month 200102

Journal Subset IM Class Update Date

Last Revision Date Unique Identifier 21103983