Challenges of Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a diagnostic and therapeutic challenge because in over two-thirds of cases, no underlying cause is identified. In addition, cases of secondary NPH (e.g. after meningitis or trauma) are underestimated due to a lack of robust diagnostic tools. 

Under-diagnosed and under-treated

Evidence shows that NPH is under-diagnosed and under-treated in both the UK and in France, resulting in avoidable health problems and costs. It is a particularly difficult problem in the elderly, who are likely to have multiple concurrent co-morbidities. In addition, there are currently no European guidelines for optimal NPH management. 

REVERT is improving the rate of NPH diagnosis, which will help reverse the associated dementia symptoms in many patients across the project region.

What novel diagnostic methods does REVERT use?

Lumbar CSF infusion testing
Developed and promoted by the University of Cambridge and Cambridge University Hospitals, constant rate, computer-supported lumbar CSF infusion testing forms part of the national best practice guidelines for NPH (NICE – National Institute of Clinical Excellence, UK), but it remains under-utilised compared to clinical assessment in isolation.

The test can also be used to assess the performance of shunts that have already been implanted, helping to avoid unnecessary revision surgeries.

Phase-contrast magnetic resonance imaging (PC-MRI)
The University of Picardie Jules Verne and Amiens University Hospital pioneered the analysis of PC-MRI of CSF and blood flows for diagnosing hydrocephalus. This non-invasive technique allows for precise measurement of blood and CSF fluid movement in and out of the cranium over one heartbeat. Part of REVERT’s work is devoted to combining PC-MRI flow measurements with the infusion test pressure recordings to help increase the predictive power of the combined test to select suitable treatment candidates. 

REVERT is training the project partners in lumbar infusion testing and PC-MRI analysis, gathering data and experience to expand their use to other hospitals beyond the project regions.

Hydrocephalus patient referrals

NPH expertise is centred around tertiary neuroscience centres, with multiple barriers preventing timely referrals of potential patients with NPH from the community or secondary centres. The Orion platform developed by Obex Technologies has streamlined neurosurgical referrals across the East of England over the last 10 years, and has recently been demonstrated to reduce the time from diagnosis to specialist referral for patients with brain tumours.

REVERT is building on this with a dedicated web-based hydrocephalus management platform, developed by Obex Technologies. 

How REVERT is improving NPH diagnosis and treatment

We are making the most of the combined expertise and innovations of the REVERT partners to transform the current care pathway of NPH within the region, including timely referral, accurate diagnosis, monitoring of treatment outcomes, and supporting future research. 

The REVERT team are: 

  • Implementing novel diagnostic approaches and guidelines in the partner hospitals (North, North-West France, South and South-East UK), and will seek to expand this to other centres beyond the project Area
  • Creating a web-based hydrocephalus management platform to allow diagnostic techniques to be rapidly disseminated and evaluated long-term but also to ensure that suspected NPH cases are rapidly referred to a tertiary centre for evaluation
  • Developing novel methods to improve the accuracy and robustness of the diagnostic tests

Sharing best practice across borders

By sharing best practice between partners in France and the UK, we will establish the crucial first step in wider dissemination of advanced hydrocephalus diagnostics in the project Area, the EU and internationally.