Editing Normal pressure hydrocephalus (section)

==Treatment==

=== Ventriculoperitoneal shunts ===
[[File:Diagram showing a brain shunt CRUK 052.svg|thumb|249x249px|Diagram demonstrating surgical placement of a VP shunt used to manage NPH]]
For suspected cases of NPH, CSF shunting is the first-line treatment. The most common type used to treat NPH is [[Cerebral shunt#Shunt routing|ventriculoperitoneal (VP) shunts]], which drain CSF fluid to the [[peritoneal cavity]]. Adjustable valves allow fine-tuning of CSF drainage. NPH symptoms reportedly improve in 70–90% of patients with CSF shunt. Risk-benefit analyses have shown beyond any doubt that surgery for NPH is far better than conservative treatment or the natural course.<ref name="The differential diagnosis and trea"/> VP shunt is less likely to be recommended in those who have severe dementia at time of NPH diagnosis, regardless of findings found on MRI or CT.<ref name=":4" /><ref>{{Cite journal |last=Vanneste |first=J. A. |date=January 2000 |title=Diagnosis and management of normal-pressure hydrocephalus |url=https://pubmed.ncbi.nlm.nih.gov/10701891 |journal=Journal of Neurology |volume=247 |issue=1 |pages=5–14 |doi=10.1007/s004150050003 |issn=0340-5354 |pmid=10701891|s2cid=12790649 }}</ref>

Gait symptoms improve in at least 85% of patients. Cognitive symptoms improve in up to 80%, when surgery is performed early in the disease course. Urgency and incontinence improve in up to 80% of patients, but only up to 50–60% if the shunt is implanted late in the disease course. The patients most likely to show improvement are those who show only gait deviation, mild or no incontinence, and mild dementia. The risk of adverse events related to shunt placement is 11%; this includes shunt failure, infections such as [[ventriculitis]], shunt obstruction, over- or under-drainage, and development of a [[subdural hematoma]].<ref name="pmid17613187">{{cite journal | vauthors = Marmarou A, Young HF, Aygok GA | title = Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities | journal = Neurosurgical Focus | volume = 22 | issue = 4 | pages = E1 | date = April 2007 | pmid = 17613187 | doi = 10.3171/foc.2007.22.4.2 | doi-access = free }}</ref><ref name="pmid1734324">{{cite journal | vauthors = Vanneste J, Augustijn P, Dirven C, Tan WF, Goedhart ZD | title = Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? A multicenter study and literature review | journal = Neurology | volume = 42 | issue = 1 | pages = 54–59 | date = January 1992 | pmid = 1734324 | doi = 10.1212/wnl.42.1.54 | s2cid = 29656326 }}</ref><ref name="pmid15137605">{{cite journal | vauthors = Poca MA, Mataró M, Del Mar Matarín M, Arikan F, Junqué C, Sahuquillo J | title = Is the placement of shunts in patients with idiopathic normal-pressure hydrocephalus worth the risk? Results of a study based on continuous monitoring of intracranial pressure | journal = Journal of Neurosurgery | volume = 100 | issue = 5 | pages = 855–66 | date = May 2004 | pmid = 15137605 | doi = 10.3171/jns.2004.100.5.0855 }}</ref>

=== Medications ===
No medications are effective for primary NPH. Lasting reductions in ICP have not been demonstrated with [[acetazolamide]].<ref name=":1">{{Cite journal |last1=Miyake |first1=H. |last2=Ohta |first2=T. |last3=Kajimoto |first3=Y. |last4=Deguchi |first4=J. |date=1999-11-15 |title=Diamox ® Challenge Test to Decide Indications for Cerebrospinal Fluid Shunting in Normal Pressure Hydrocephalus |url=http://link.springer.com/10.1007/s007010050417 |journal=Acta Neurochirurgica |volume=141 |issue=11 |pages=1187–1193 |doi=10.1007/s007010050417 |issn=0001-6268 |pmid=10592119 |s2cid=2819074|url-access=subscription }}</ref> Transient reduction in ICP after administration of an [[acetazolamide]] bolus has been shown to be a positive predictor for good response after VP shunt placement in NPH patients.

Research is currently aimed at finding other medication options for the management of NPH symptoms. [[Steroid]]s have demonstrated decreased production of CSF in animal studies on healthy rabbits and dogs, however further testing is required to determine if this is an effective treatment option in humans.<ref name=":3">{{Cite journal |last1=Del Bigio |first1=Marc R. |last2=Di Curzio |first2=Domenico L. |date=2016-02-05 |title=Nonsurgical therapy for hydrocephalus: a comprehensive and critical review |journal=Fluids and Barriers of the CNS |volume=13 |pages=3 |doi=10.1186/s12987-016-0025-2 |doi-access=free |issn=2045-8118 |pmc=4743412 |pmid=26846184}}</ref><ref>{{Cite journal |last1=Lindvall-Axelsson |first1=M. |last2=Hedner |first2=P. |last3=Owman |first3=C. |date=October 1989 |title=Corticosteroid action on choroid plexus: Reduction in Na+?K+-ATPase activity, choline transport capacity, and rate of CSF formation |url=http://link.springer.com/10.1007/BF00249613 |journal=Experimental Brain Research |language=en |volume=77 |issue=3 |pages=605–610 |doi=10.1007/BF00249613 |pmid=2553468 |s2cid=44019348 |issn=0014-4819|url-access=subscription }}</ref><ref>{{Cite journal |last1=Weiss |first1=Martin H. |last2=Nulsen |first2=Frank E. |date=April 1970 |title=The Effect of Glucocorticoids on CSF Flow in Dogs |url=https://thejns.org/view/journals/j-neurosurg/32/4/article-p452.xml |journal=Journal of Neurosurgery |volume=32 |issue=4 |pages=452–458 |doi=10.3171/jns.1970.32.4.0452 |pmid=5417941 |issn=0022-3085|url-access=subscription }}</ref> A trial of [[triamterene]] in adults with chronic hydrocephalus has also shown improvement of symptoms within 12 weeks, however further research is needed to support this as a non-surgical option for NPH.<ref name=":3" />