Corticospinal excitability in idiopathic normal pressure hydrocephalus: A transcranial magnetic stimulation study

Jani Sirkka, Laura Säisänen, Petro Julkunen, Mervi Könönen, Elisa Kallioniemi, Ville Leinonen, Nils Danner

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease with an unknown etiology. Disturbed corticospinal inhibition of the motor cortex has been reported in iNPH and can be evaluated in a noninvasive and painless manner using navigated transcranial magnetic stimulation (nTMS). This is the first study to characterize the immediate impact of cerebrospinal fluid (CSF) drainage on corticospinal excitability. Methods: Twenty patients with possible or probable iNPH (16 women and 4 men, mean age 74.4 years, range 67-84 years), presenting the classical symptom triad and radiological findings, were evaluated with motor function tests (10-m walk test, Grooved Pegboard and Box & Block test) and nTMS (silent period, SP, resting motor threshold, RMT and input-output curve, IO-curve). Evaluations were performed at baseline and repeated immediately after CSF drainage via lumbar puncture. Results: At baseline, iNPH patients presented shorter SPs (p < 0.001) and lower RMTs (p < 0.001) as compared to normative values. Positive correlation was detected between SP duration and Box & Block test (rho = 0.64, p = 0.002) in iNPH patients. CSF drainage led to an enhancement in gait velocity (p = 0.002) and a steeper IO-curve slope (p = 0.049). Conclusions: Shorter SPs and lower RMTs in iNPH suggest impaired corticospinal inhibition and corticospinal hyperexcitability. The steeper IO-slope in patients who improve their gait velocity after CSF drainage may indicate a higher recovery potential. Corticospinal excitability correlated with the motor function of the upper limbs implying that the disturbance in motor performance in iNPH extends beyond the classically reported gait impairment.

Original languageEnglish (US)
Article number6
JournalFluids and Barriers of the CNS
Issue number1
StatePublished - Feb 17 2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Neurology
  • Developmental Neuroscience
  • Cellular and Molecular Neuroscience


  • Corticospinal excitability
  • Idiopathic normal pressure hydrocephalus
  • Inhibition
  • Lumbar puncture
  • Navigated transcranial magnetic stimulation


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