Normal Pressure Hydrocephalus research
A small research team is making big strides in the diagnosis of normal pressure hydrocephalus.
The team, based at the Royal Preston Hospital in Lancashire, began its work in 2003 studying NPH which usually occurs in people aged 60 and over.
Many of its symptoms are the same as those of dementia, Alzheimer's and Parkinson's Disease - making it difficult to diagnose. As a result, the condition may go untreated.
Link met Mr G. Balamurali, a registrar in the Neurosurgery department, the main researcher leading the study to learn more about the man and his pioneering research
Where did you do your medical training?
I did my training and qualified in India. I came to the UK in 1997 and since then I've trained as a surgeon and now as a neurosurgeon at Hope Hospital, Manchester.
Why did this field interest you?
Some of my predecessors were dealing with patients with suspected NPH. They were trying to identify the most appropriate tests.
When I did a review to see what practices were used throughout the UK and the rest of the world we found very different methods were used to diagnose NPH.
Most of the work was research based which was very expensive and cannot be done at smaller centres. So we devised a protocol which could be used in any centre with minimal expertise and equipment. Because of the difficulty in diagnosis it makes it more challenging.
What other studies have you carried out?
We've carried out mainly three tests in this research. One is the gait assessment with balance and walking problems.
The second are the memory assessments to differentiate NPH memory problems from other conditions such as Alzheimer's and other dementias.
The final test we do concerns the lumber pressure studies and drainage of fluid from the spinal space. We repeat all three tests to try and identify which patients may respond to a shunt.
What has your research achieved or shown so far?
Of the 50 patients involved we have been able to identify a group who would respond to a shunt.
Of course we can't be 100% sure if they will respond, but we are trying to identify the ones who are more likely to respond and those who aren't.
I think that is one of our biggest achievements because fitting a shunt can have serious complications and if you do this operation on someone inappropriately, they could be left with serious damage if complications occur.
How many people are in your research team?
The research team is mainly a multidisciplinary team made up of people from the Royal Preston Hospital and the University of Central Lancashire. I coordinate everyone and get advice from all.
Where does the funding for the research come from?
The funding has mainly come from the Sidney Discroll Foundation in Preston. We have received good funding so far, but we haven't carried out any expensive tests, so costs are minimal.
How much contact do you have with people with NPH?
We have a good relationship with the patient and their family. All the patients in our research have a card showing what pressure the programmable valves are set at so if they have problems they can always contact the hospital.
Can you describe a typical day?
It's more of a typical week because these patients stay in hospital for three or four days.
We tend to bring them in on a Monday morning for gait and memory tests. We then perform pressure studies and insert a drain into their back to drain fluid from the spinal space. We take 100mls of fluid every 24 hours for a couple of days then retest their gait and memory. Depending on the results we try to determine whether they will benefit from a shunt. Discussion with the family and patients takes place at every stage.
What do you find enjoyable?
My patients are a very nice group of people. If you sit and talk to them for more than ten minutes, you begin to build up a good relationship with them.
What are the most rewarding aspects of your job?
Achieving good results. It is very rewarding when patients and their family tell us they can now walk properly or remember things which they had forgotten.
It really makes me think I am doing something worth while.
What are your hopes for the future of managing and treating Hydrocephalus?
Improving awareness of NPH is my main hope. Once we can identify NPH patients we can test them and help them. Developing a simple methodology which can diagnose NPH is another of my hopes.
ASBAH Research