Motor network neurophysiological (TMS-EEG) markers as predictors of outcomes of ventriculoperitoneal shunt sustained for over a year in normal pressure hydrocephalus.

@article{davidy2026motor,
  title = {{Motor network neurophysiological (TMS-EEG) markers as predictors of outcomes of ventriculoperitoneal shunt sustained for over a year in normal pressure hydrocephalus.}},
  author = {Tal Davidy and Alexandra Suminski and Yakov Zauberman and Tsvia Fay-Karmon and Saar Anis and Adi Saar and Noa Zifman and Hilla Fogel and Ofri Levy-Lamdan and Orit Lesman-Segev and Sharon Hassin-Baer},
  journal = {Fluids and barriers of the CNS},
  year = {2026},
  month = jul,
  doi = {10.1186/s12987-026-00844-z},
  url = {https://europepmc.org/article/MED/42902404},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Motor network neurophysiological (TMS-EEG) markers as predictors of outcomes of ventriculoperitoneal shunt sustained for over a year in normal pressure hydrocephalus.
AU  - Tal Davidy
AU  - Alexandra Suminski
AU  - Yakov Zauberman
AU  - Tsvia Fay-Karmon
AU  - Saar Anis
AU  - Adi Saar
AU  - Noa Zifman
AU  - Hilla Fogel
AU  - Ofri Levy-Lamdan
AU  - Orit Lesman-Segev
AU  - Sharon Hassin-Baer
PY  - 2026
DA  - 2026/07/01
JO  - Fluids and barriers of the CNS
DO  - 10.1186/s12987-026-00844-z
UR  - https://europepmc.org/article/MED/42902404
AB  - Background and objectives  Current practice for normal pressure hydrocephalus (NPH) relies on clinical presentation, imaging, and various clinical procedures to determine the need for neurosurgical intervention, specifically the installation of a ventriculoperitoneal shunt (VPS). This study aimed to evaluate the utility of a TMS-evoked potential (TEP)-based assessment (Delphi-MD) for predicting sustained response (over one year) to VPS, serving as an ancillary test to the cerebrospinal fluid tap test (CTT).Methods  Forty-one patients with possible iNPH underwent Delphi-MD evaluation of wave form adherence (WFA), a composite measure assessing how closely their TEPs resembled an ideal benchmark TEP. Of these, 18 patients received VPS treatment following a multidisciplinary team decision based on standard practice, blinded to the TEP results. Response to the intervention was evaluated over a period of more than one year using the clinical global impression of change (CGIC) scale, in addition to assessments with a 10-meter timed up and go test and the modified Rankin scale.Results  Responders had higher M1L WFA values at baseline (prior to VPS) than non-responders (median 0.51 [95% CI 0.36-0.76], median 0.14 [95% CI -0.02-0.38], respectively p = 0.012). M1L WFA was successful in distinguishing responders (11/18) from non-responders (7/18) with an ROC-AUC of 0.935 [bootstrap 95% CI 0.792-1.00], p < 0.0001. M1L WFA cutoff was established with LOOCV and produced 90.9% sensitivity, 85.7% specificity and 88.9% accuracy. In contrast the CTT result was unsuccessful in predicting shunt responsiveness.Conclusion  This study indicates that higher M1L WFA obtained through Delphi-MD (TMS-EEG), signifies better preservation and functional integrity of the motor network in patients with probable iNPH that had a sustained response to VPS than those that did not. Given replication of results in future independent cohorts, Delphi-MD shows promise as an objective, accurate, and accessible ancillary screening tool for iNPH candidates, prior to referral for VPS treatment.Trial registration  Registration number: MOH_2021-12-08_010449. Registration date: 11.09.2021. https://clinicaltrial.health.gov.il/clinicaltrials/?sort=experimentapproveddate_tdt+desc&page=1&searchQuery=MOH_2021-12-08_010449 .
SN  - 2045-8118
ER  -