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>> The legacy of Cushing and Dandy at Hopkins relates to
Harvey Cushing's great contribution of establishing
the first surgical experimental laboratory in the United States,
where he trained neurosurgeons and
also explored questions about neurologic diseases.
The most important one was with
his first pupil and later colleague,
Walter Dandy, who studied the flow of
CSF and ultimately what goes wrong and how to fix it.
A Hydrocephalus and Cerebral Fluid Center at
Johns Hopkins carries on the tradition of Cushing and Dandy in
using the laboratory to explore the challenges of
cerebral spinal fluid disorders
and they develop new understanding and
new treatments which are directly
applicable and available for patient care.
>> The research that we do
starts with some stuff that's very basic.
We have experimental studies where we
put in tracers and look at the flow of fluid when
it's put in different places and how
it moves naturally and how it moves under abnormal conditions.
We also do research to
help the neurosurgeon regulate that fluid drainage better.
Also, there's a lot of advances that have
to be made in how we diagnose and how we follow patients.
For example, we have a project
where the normal burr hole that every neurosurgeon makes in
a patient's head can be used as a window using
ultrasound in the clinic as
an outpatient to look in and see the brain.
Treatment, evaluation and diagnosis are
all things that we were working on to make it better
for the patients with hydrocephalus.
>> It's important for hydrocephalus to
emerge as a more prominent focus of
study because there's still so
much we don't know about the condition.
It is actually a very complex condition
in and of itself and there are
close to a million people in the United States who are living with
hydrocephalus who have brain surgery
as their only treatment option.
From a patient perspective,
that's a big burden to liquid as
most patients need multiple brain surgeries to survive.
For those patients who were living
with normal pressure hydrocephalus,
there's still so much unknown about the condition
and there's still controversy in the field of the condition.
Many seniors who may be experiencing
symptoms of normal pressure hydrocephalus are often
misdiagnosed because the symptoms can mimic
other conditions like Alzheimer's disease or Parkinson's disease
and this really puts them down a road where they might not receive
the proper diagnosis for years even I have heard.
>> I was having terrible incontinence problems.
I'd fallen five times,
my balance was completely off and I was losing my memory.
>> If somebody could just do something
simple like a spinal tap which I know is not simple,
but it can be done safely,
why not do that instead of putting
a person through the agony of thinking that
they have a permanent disability like Parkinson's
when this is a condition that could be fixed and healed?
>> I don't know where I would be if I didn't have the surgery.
>> When I first went to
neurological facility and they wanted to do a spinal tap
at Johns Hopkins to see if I was eligible for
a shunt and I was very satisfied with the treatment that I got.
>> He was experiencing balance issues.
He was experiencing memory and speech issues
before he was diagnosed with a hydrocephalus.
But after the treatment his balance is a lot better.
He has not had any falls since the surgery.
His memory is clear though and his speech is improved.
>> There's many neurologists around the country,
general practitioners and even neurosurgeons that hesitate to make
the diagnosis for normal pressure hydrocephalus
and urge to treat the patients.
We feel that there's as few as 20 percent of
the patients that should be even thought having
PHR ever considered for NPH treatment.
We feel that it's very
likely we might be able to help more people.
But we also believe that we need the first-class evidence,
which is a placebo controlled trial to say without subjectivity,
without bias, that this is a physiological effect.
>> The penstral is the first
double-blind randomized controlled trial
of shunt surgery in patients with
idiopathic normal pressure hydrocephalus.
In this study, patients are going to be randomized either to
an open setting or a closed setting for the first three months.
The group in which the shunt
was closed is going to be opened up for
the next 9-12 months to see if
shunt's really improved get outcomes at that one-year bond.
As part of funs, we are collecting CSF from these patients.
We will be comparing the group
of patients who improved versus the group
of patients who don't improve,
add their biomarkers in CSF that differentiate these groups.
Because at the end of the day,
what we want to know is who will have
a sustained and doable and effective improvement
in their gate at one year.
>> I think that in the next years,
the treatment of hydrocephalus is going to be
transformed and that we're going to
be looking back at our years of surgical treatment with
shunting and knowing that we've made
a major step forward to make this disease,
in a sense, be very well treatable.
In the meantime, we're going to learn
how to treat many other types of diseases.
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