From the Research
Non-surgical treatment options for Normal Pressure Hydrocephalus (NPH) patients who cannot undergo surgery are limited and primarily focus on symptom management rather than addressing the underlying condition. These patients should be managed with a multidisciplinary approach including:
- Physical therapy to improve gait and balance problems
- Occupational therapy to assist with daily activities
- Cognitive rehabilitation for memory and thinking difficulties Medications may include acetazolamide (Diamox) at doses of 250-500 mg twice daily, which can temporarily reduce cerebrospinal fluid production, though its effectiveness for NPH is modest and side effects like tingling, fatigue, and kidney stones may limit long-term use 1. For urinary incontinence, anticholinergics such as oxybutynin (5-10 mg daily) or tolterodine (2-4 mg daily) may help, while scheduled voiding programs are also beneficial 2. Cognitive symptoms might be addressed with medications like memantine or cholinesterase inhibitors, though these have limited evidence specifically for NPH 1. Regular monitoring is essential as NPH typically progresses without shunt surgery. Unfortunately, these conservative measures generally provide only temporary or partial relief since they don't address the fundamental problem of cerebrospinal fluid accumulation and altered dynamics that characterize NPH. Patients and families should understand that while these approaches may improve quality of life, they typically cannot halt disease progression as effectively as surgical intervention 3.
Given the most recent and highest quality study available 1, a multidisciplinary approach focusing on symptom management is the most appropriate course of action for NPH patients who cannot undergo surgery. This approach should prioritize the patient's quality of life and aim to manage symptoms effectively, even if it cannot halt disease progression. It is essential to weigh the potential benefits and limitations of each treatment option and to continuously monitor the patient's condition to adjust the treatment plan as needed. In the context of real-life clinical medicine, prioritizing the patient's quality of life and taking a cautious approach to management is crucial.