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My husband is in the late stages of Normal Pressure

Customer Question
Hi, my husband is...

Hi, my husband is in the late stages of Normal Pressure Hydrocephalus. What can I expect as he gets into the very end stages of the this disorder?

Doctor's Assistant: How long have you been dealing with this? Any other symptoms?

About 6 or 7 years. He was born with the hydrocephalus. He also has. CLL, leukemia & is taking Imbruvica for it. He has been incontinent for 2 years, & has had the shuffling gait for about 4 years. He was diagnosed at Stanford.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

He is also in early stage dementia as well. Also, his balance is Very badly Impaired.

Submitted: 10 months ago.Category: Neurology
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Answered in 8 hours by:
9/27/2017
Neurologist: Dr Subbanna MD, Neurologist (MD) replied 10 months ago
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,420
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns related to your husband.

I am sorry to hear about your husband’s health situation. As a neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

I see he is in the late stage of NPH (Normal pressure hydrocephalus) and he is having gait difficulties, incontinence, and also having early stage of dementia now.

Please see the mainstay of treatment of nph is putting a shunt to drain the excess CSF (Cerebrospinal fluid)

What happens in nph patients is they develop gradual accumulation of csf and this causes the progressive enlargement of the cavities in side the brain called as ventricles, and also the enlargement of the ventricles starts putting pressure on the surrounding brain tissue and this is the cause for the various symptoms that are seen in patients having nph.

The shunt that is inserted in to the ventricles helps in draining the excessive fluid that is getting accumulated within the brain ventricles and this reduces the pressure that was exerted on the surrounding brain tissue and helps in preventing the progression of the symptoms

I am not sure whether he had this shunt placed or not, if not done then you guys please discuss this treatment option with his neurologist and neurosurgeon.

If he is already having the shunt then a follow up brain scan and also certain additional tests can tell us whether the shunt is functioning properly or not, if it is not functioning properly then it needs a revision, or other appropriate treatments

If for some reason shunt is not put, or if he already has a shunt but his disease process is progressive despite shunt treatment then we need to focus on symptomatic treatments that can help him, as discussed below further.

For example for the gait difficulties he needs aggressive physical and balance therapy to help with his gait and balance. He also needs to be using a cane or walker, and if the gait is very severe then he also need to use a wheelchair

For the bladder incontinence there are varieties of treatments available that include various medications, Pelvic muscle exercises, Neurostimulation/neuromodulation, botox injections to the bladder etc – depending the precise type of bladder problem he is having.

And for the memory loss and dementia one or more of the following treatments can be tried;

A) Trying certain dietary modifications – to consider trying what is called as Mediterranean diet - this is a diet rich with nuts, grains, fruits, vegetables, fish, lean meat, small amount if wine etc, and low in animal fat etc – to try to minimize eating processed food & bad fats that include saturated & trans fats, and to try to eat food rich in polyunsaturared and monounsaturared fats) - and this type of healthy diet has been found to be helpful in improving memory. And please see wine is mentioned above as an example of wine or other alcoholic beverages but to be used only in small amounts, if alcohol is used excessively then the beneficial effects will be lost and deleterious effects will occur; and for those people who do not eat certain food items mentioned above such as fish for example – they may try fish oil, if they do not like taking fish oil too, then there are preparations of Omega 3 fatty acids mentioned below

B) Trying Physical exercises – Physical Exercises on regular basis help in improving memory

C) Trying Mental exercises (solving tough crossword puzzles, brain teasers, communication, socialization, computer based mental exercises etc) also can considerably help in improving memory

D) Trying one or more of the nutritional supplements or OTC (Over the counter) preparations such as the following can help too;

Methyl Guard Plus (This combination pill contains Methycobalamin, Methyl folate, Pyridoxal 5 Phosohate & Riboflavin 5 phosphate – and these are active forms of Vitamin B12 -Cobalamin, Vitamin B9-Folic acid, Vitamin B6 – Pyridoxine & Vitamin B2 – Riboflavin, respectively, also the above mentioned combination pill also contains another very useful nutritional supplement called as Betaine or TrimethylGlycine)

Fish oils

Omega 3 Fatty acids (DHA & EPA)

Ginkgo Biloba

Ginseng

Choline enhancers or improving cholinergic transmission such as - Citicoline (CDP Choline), or Alpha GPC (Alpha Glycerophosphocholine), or Uridine Monophosphate, or DMAE (Dimethylaminoethanol, or Deanol), or Centrophenoxine etc

One of the Racetams like Piracetam, or Aniracetam, or Omberacetam etc

ALA (Alpha Lipoic acid)

Coenzyme Q10 (CoQ10)

Bacopa Monnieri (Brahmi) etc

E) Using one or more of the prescription medications or prescription medical foods such as the following can help too;

Medical Food such as Axona (Caprylic triglyceride)

Memantine

Rivastigmine

Donepezil

Razadyne etc

I am not telling all these above mentioned treatments are required in his case; I am trying to provide a list of the various treatment options like this so that you guys are familiar with various treatment options that are available for his condition and you guys may try to use these various treatments as necessary. If you guys see any of the above treatments he has already tried please disregard them and explore the treatment options that are not yet tried.

I earnestly hope the above treatment options will help your husband considerably!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Neurologist: Dr Subbanna MD, Neurologist (MD) replied 10 months ago

Hi, Do you have any additional health questions? Do you want to discuss this health situation of your husband further? Please let me know and I am available here.

Assuring you the best services!

Thanks & Best Regards!

Dr Subbanna MD

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