Lumbar puncture well-accepted by memory clinic patients

Sep 25 2015

By Lucy Piper, Senior medwireNews Reporter

Researchers support the increasing use of lumbar punctures (LPs) by memory clinics to collect cerebrospinal fluid, as long as certain risk factors are taken into account.

They found that the procedure was accepted by 92% of 3868 patients from 23 memory clinics, increasing to 98% if the procedure was performed for clinical indications rather than research purposes.

The rate of complaints 2 weeks after the procedure was higher than expected, at 31%, but the team attributes this to the fact that the participants were actively asked questions on the matter. Severe complications requiring medical intervention, such as a blood patch or hospitalisation, were rare, at just 1%, and the interventions were successful in all cases.

The researchers note that one patient died of an intracerebral haemorrhage shortly after restarting anticoagulation medication and recommend against interrupting such therapy in dementia patients when using LP for diagnostic or research purposes.

The most common complaint after LP was headache in 19% of patients, 9% of whom reported typical post-LP headache, followed by back pain in 17%.

The chances of patients developing typical post-LP headache were heightened significantly if they had a history of either mild or severe headache, at 1.8- and 2.7-fold, respectively, while being older than 65 years of age and a diagnosis of dementia both reduced the risk by 30%.

The only significant procedure-related factor was the type of needle used, with an atraumatic needle reducing the risk by 60%, while in the case of severe-to-moderate post-LP headache free flow versus active withdrawal of cerebrospinal fluid, a smaller needle diameter and a supine position of the patient reduced the risk by 50%, 40% and 40%, respectively.

Similar patient characteristics were associated with the onset of back pain and the only procedure-related risk factor was the need for multiple attempts to successfully withdraw cerebrospinal fluid.

“[T]hese findings suggest that patient characteristics are as important as LP-procedure characteristics for predicting post-LP complaints”, researcher Philip Scheltens (VU University Medical Center, Amsterdam, the Netherlands) and colleagues comment in Alzheimer’s & Dementia.

They failed to find a gender difference in the onset of post-LP headache, despite previous reports of a substantially higher rate in women than men younger than 40 years of age, and put this down to gender effects disappearing with increasing age.

The researchers believe that “LPs can be safely performed in the memory clinic”, adding that “[t]his study can be used for recommendations on performing LPs.”

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