Shunt surgery and lecanemab therapy in patients with idiopathic normal pressure hydrocephalus and alzheimer’s disease: a report of two cases - Report - MDSpire
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Shunt surgery and lecanemab therapy in patients with idiopathic normal pressure hydrocephalus and alzheimer’s disease: a report of two cases
Combined Shunt Surgery and Lecanemab in iNPH with Alzheimer's Disease
Overview
This report presents two cases of idiopathic normal pressure hydrocephalus (iNPH) comorbid with Alzheimer's disease (AD) treated with shunt surgery and lecanemab therapy in different sequences. Both patients tolerated combined treatment without adverse events, including amyloid-related imaging abnormalities (ARIA), and showed cognitive improvements.
Background
Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome in elderly patients characterized by cognitive impairment and gait disturbance, commonly treated with ventriculoperitoneal (VP) or lumboperitoneal (LP) shunt surgery. iNPH frequently coexists with Alzheimer's disease (AD), necessitating simultaneous treatment. Anti-amyloid-β antibody therapies like lecanemab have recently become available for early-stage AD but may increase the risk of intracranial bleeding and ARIA. The safety and timing of combining shunt surgery with lecanemab therapy have not been previously reported.
Data Highlights
Case
Age
Shunt Type
Lecanemab Timing
MMSE Before Treatment
MMSE After Treatment
Adverse Events
1
84
LP Shunt
Lecanemab before surgery
23
27 (1 year post)
None (no ARIA)
2
84
VP Shunt
Shunt before lecanemab
Not specified
Not specified
None reported
Key Findings
iNPH and AD frequently coexist, requiring combined therapeutic approaches.
Case 1 received lecanemab prior to LP shunt surgery without interruption; cognitive function improved post-surgery with no ARIA observed.
Case 2 underwent VP shunt surgery prior to initiation of lecanemab therapy; no complications reported.
LP shunt was preferred over VP shunt in Case 1 to minimize brain invasion and potential ARIA risk.
Both cases tolerated combined treatment well, suggesting safety of concurrent shunt surgery and anti-amyloid antibody therapy.
Clinical Implications
Clinicians managing patients with comorbid iNPH and AD can consider combined treatment with shunt surgery and lecanemab. LP shunt may be preferred to reduce brain invasion and bleeding risk, especially when lecanemab is administered. Careful monitoring for ARIA is essential, but these cases suggest that combined therapy can be safely performed without interruption of antibody treatment.
Conclusion
Combined shunt surgery and lecanemab therapy in patients with iNPH and AD appears safe and effective, with no observed ARIA or perioperative complications. These findings support integrated management strategies for this comorbid population.
References
Article Source 2024 -- Combined Shunt Surgery and Lecanemab Treatment in iNPH with AD: A Case Report
