Performance and complications of lumbar puncture in memory clinics: Results of the multicenter lumbar puncture feasibility study
Flora H. Duits
Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorPablo Martinez-Lage
Department of Neurology, Fundacion CITA-Alzheimer Fundazioa, San Sebastián, Spain
Search for more papers by this authorClaire Paquet
INSERM, U942, Paris, France
Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, France
Research Memory Center Paris North AP-HP, Hopital Lariboisière, Paris, France
Search for more papers by this authorSebastiaan Engelborghs
Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
Search for more papers by this authorAlberto Lleó
Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
Search for more papers by this authorLucrezia Hausner
Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
Search for more papers by this authorJosé L. Molinuevo
Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari and Pasqual Maragall Foundation, Barcelona, Spain
Search for more papers by this authorErik Stomrud
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
Search for more papers by this authorLucia Farotti
Centro Disturbi della Memoria, Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy
Search for more papers by this authorInez H.G.B. Ramakers
Alzheimer Center Limburg, Department of Psychiatry & NeuropsychologySchool for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
Search for more papers by this authorMagda Tsolaki
3rd Department of Neurology, Aristotle University of Thessaloniki, Macedonia, Greece
Search for more papers by this authorConstance Skarsgård
The Department of Geriatrics, Kalmar County Hospital, Kalmar, Sweden
Search for more papers by this authorRagnar Åstrand
Department of Cognitive Medicine, Karlstad Central Hospital, Karlstad, Sweden
Search for more papers by this authorAnders Wallin
Memory Clinic at Department of NeuropsychiatrySahlgrenska University Hospital, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
Search for more papers by this authorMartin Vyhnalek
Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
Search for more papers by this authorMarie Holmber-Clausen
Department of Geriatrics, Minnesmottagningen, Eskilstuna, Sweden
Search for more papers by this authorOrestes V. Forlenza
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorLaura Ghezzi
Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Ca' Grandam IRCCS Ospedale Policlinico, Milan, Italy
Search for more papers by this authorMartin Ingelsson
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
Search for more papers by this authorErik I. Hoff
Department of Neurology, Atrium Medical Center Parkstad, Heerlen, The Netherlands
Search for more papers by this authorGerwin Roks
Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
Search for more papers by this authorAlexandre de Mendonça
Department of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
Search for more papers by this authorJanne M. Papma
Department of Neurology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
Search for more papers by this authorAndrea Izagirre
Department of Neurology, Fundacion CITA-Alzheimer Fundazioa, San Sebastián, Spain
Search for more papers by this authorMariko Taga
INSERM, U942, Paris, France
Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, France
Research Memory Center Paris North AP-HP, Hopital Lariboisière, Paris, France
Search for more papers by this authorHanne Struyfs
Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
Search for more papers by this authorDaniel A. Alcolea
Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
Search for more papers by this authorLutz Frölich
Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
Search for more papers by this authorMircea Balasa
Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari and Pasqual Maragall Foundation, Barcelona, Spain
Search for more papers by this authorLennart Minthon
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
Search for more papers by this authorJos W.R. Twisk
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorStaffan Persson
Department of Clinical Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
Search for more papers by this authorHenrik Zetterberg
Department of Clinical Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
UCL Institute of Neurology, Department of Molecular Neuroscience, London, UK
Search for more papers by this authorWiesje M. van der Flier
Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorCharlotte E. Teunissen
Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorCorresponding Author
Philip Scheltens
Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
Shared last authors.
Corresponding author. Tel.: +31-20-4440816; Fax: +31-20-4448529.
E-mail address: [email protected]
Search for more papers by this authorKaj Blennow
Department of Clinical Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
Shared last authors.
Search for more papers by this authorFlora H. Duits
Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorPablo Martinez-Lage
Department of Neurology, Fundacion CITA-Alzheimer Fundazioa, San Sebastián, Spain
Search for more papers by this authorClaire Paquet
INSERM, U942, Paris, France
Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, France
Research Memory Center Paris North AP-HP, Hopital Lariboisière, Paris, France
Search for more papers by this authorSebastiaan Engelborghs
Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
Search for more papers by this authorAlberto Lleó
Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
Search for more papers by this authorLucrezia Hausner
Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
Search for more papers by this authorJosé L. Molinuevo
Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari and Pasqual Maragall Foundation, Barcelona, Spain
Search for more papers by this authorErik Stomrud
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
Search for more papers by this authorLucia Farotti
Centro Disturbi della Memoria, Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy
Search for more papers by this authorInez H.G.B. Ramakers
Alzheimer Center Limburg, Department of Psychiatry & NeuropsychologySchool for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
Search for more papers by this authorMagda Tsolaki
3rd Department of Neurology, Aristotle University of Thessaloniki, Macedonia, Greece
Search for more papers by this authorConstance Skarsgård
The Department of Geriatrics, Kalmar County Hospital, Kalmar, Sweden
Search for more papers by this authorRagnar Åstrand
Department of Cognitive Medicine, Karlstad Central Hospital, Karlstad, Sweden
Search for more papers by this authorAnders Wallin
Memory Clinic at Department of NeuropsychiatrySahlgrenska University Hospital, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
Search for more papers by this authorMartin Vyhnalek
Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
Search for more papers by this authorMarie Holmber-Clausen
Department of Geriatrics, Minnesmottagningen, Eskilstuna, Sweden
Search for more papers by this authorOrestes V. Forlenza
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorLaura Ghezzi
Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Ca' Grandam IRCCS Ospedale Policlinico, Milan, Italy
Search for more papers by this authorMartin Ingelsson
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
Search for more papers by this authorErik I. Hoff
Department of Neurology, Atrium Medical Center Parkstad, Heerlen, The Netherlands
Search for more papers by this authorGerwin Roks
Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
Search for more papers by this authorAlexandre de Mendonça
Department of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
Search for more papers by this authorJanne M. Papma
Department of Neurology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
Search for more papers by this authorAndrea Izagirre
Department of Neurology, Fundacion CITA-Alzheimer Fundazioa, San Sebastián, Spain
Search for more papers by this authorMariko Taga
INSERM, U942, Paris, France
Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, France
Research Memory Center Paris North AP-HP, Hopital Lariboisière, Paris, France
Search for more papers by this authorHanne Struyfs
Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
Search for more papers by this authorDaniel A. Alcolea
Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
Search for more papers by this authorLutz Frölich
Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
Search for more papers by this authorMircea Balasa
Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari and Pasqual Maragall Foundation, Barcelona, Spain
Search for more papers by this authorLennart Minthon
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
Search for more papers by this authorJos W.R. Twisk
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorStaffan Persson
Department of Clinical Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
Search for more papers by this authorHenrik Zetterberg
Department of Clinical Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
UCL Institute of Neurology, Department of Molecular Neuroscience, London, UK
Search for more papers by this authorWiesje M. van der Flier
Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorCharlotte E. Teunissen
Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
Search for more papers by this authorCorresponding Author
Philip Scheltens
Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
Shared last authors.
Corresponding author. Tel.: +31-20-4440816; Fax: +31-20-4448529.
E-mail address: [email protected]
Search for more papers by this authorKaj Blennow
Department of Clinical Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
Shared last authors.
Search for more papers by this authorC.E.T. is a member of international advisory boards of Fujirebio and Roche and has performed contract research for Probiodrug, IBL, Shire. S.E. is/was consultant for Fujirebio Europe, ADx Neurosciences, and Roche diagnostics. P.S. serves/has served on the advisory boards of: Novartis, Pfizer, Roche, Danone, Jansen AI, Baxter, and Lundbeck. He has been a speaker at symposia organized by Lundbeck, Lilly, Merz, Pfizer, Jansen AI, Danone, and Roche. He is co-editor-in-chief of Alzheimer's Research & Therapy. He is a member of the scientific advisory board of the EU Joint Programme on Neurodegenerative Disease Research (JPND) and the French National Plan Alzheimer. He acts as vice-chair of the Dutch Deltaplan Dementia. He receives no personal compensation for the activities mentioned previously. F.H.D., P.M.-L., C.P., J.L.M., A.L., L.H., E.S., L.F., I.H.G.B.R., M.T., C.S., R.Å., A.W., M.V., M.H.-C., O.V.F., L.G., E.H., G.R., A.D.M., J.M.P., A.I., M.T., H.S., D.A.A., L.F., M.B., L.M., J.W.R.T., S.P., H.Z., W.M.V.D.F., and K.B. report no conflicts of interest.
Abstract
Introduction
Lumbar puncture (LP) is increasingly performed in memory clinics. We investigated patient-acceptance of LP, incidence of and risk factors for post-LP complications in memory clinic populations.
Methods
We prospectively enrolled 3868 patients (50% women, age 66 ± 11 years, mini mental state examination 25 ± 5) at 23 memory clinics. We used logistic regression analysis using generalized estimated equations to investigate risk factors for post-LP complications, such as typical postlumbar puncture headache (PLPH) and back pain.
Results
A total of 1065 patients (31%) reported post-LP complaints; 589 patients (17%) reported back pain, 649 (19%) headache, of which 296 (9%) reported typical PLPH. Only few patients needed medical intervention: 11 (0.3%) received a blood patch, 23 (0.7%) were hospitalized. The most important risk factor for PLPH was medical history of headache. An atraumatic needle and age >65 years were preventive. Gender, rest after LP, or volume of cerebrospinal fluid had no effect.
Discussions
The overall risk of complications is relatively low. If risk factors shown in this study are taken into account, LPs can be safely performed in memory clinics.
Supporting Information
| Filename | Description |
|---|---|
| alzjjalz201508003-sup-0001.pdfPDF document, 27.3 KB | Supplementary Figure 1 |
| alzjjalz201508003-sup-0002.pdfPDF document, 28.5 KB | Supplementary Figure 2 |
| alzjjalz201508003-sup-0003.pdfPDF document, 32.4 KB | Supplementary Form 1 |
| alzjjalz201508003-sup-0004.pdfPDF document, 20.8 KB | Supplementary Form 2 |
| alzjjalz201508003-sup-0005.docxapplication/docx, 30.8 KB | Supplementary Tables 1-5 and Legends for Supplementary Figures 1 and 2 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1Mulder C, Verwey NA, van derFlier WM, Bouwman FH, Kok A, vanElk EJ, et al. Amyloid-beta(1-42), total tau, and phosphorylated tau as cerebrospinal fluid biomarkers for the diagnosis of Alzheimer disease. Clin Chem. 2010; 56: 248–253
- 2Blennow K, deLeon MJ, Zetterberg H. Alzheimer's disease. Lancet. 2006; 368: 387–403
- 3Schoonenboom NS, Reesink FE, Verwey NA, Kester MI, Teunissen CE, van deVen PM, et al. Cerebrospinal fluid markers for differential dementia diagnosis in a large memory clinic cohort. Neurology. 2012; 78: 47–54
- 4McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CRJr., Kawas CH, et al. The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7: 263–269
- 5Dubois B, Feldman HH, Jacova C, Hampel H, Molinuevo JL, Blennow K, et al. Advancing research diagnostic criteria for Alzheimer's disease: The IWG-2 criteria. Lancet Neurol. 2014; 13: 614–629
- 6Albert MS, Dekosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7: 270–279
- 7Spies PE, Slats D, Ramakers I, Verhey FR, Olde Rikkert MG. Experiences with cerebrospinal fluid analysis in Dutch memory clinics. Eur J Neurol. 2011; 18: 1014–1016
- 8Duits FH, Prins N, Lemstra AW, Pijnenburg Y, Bouwman F, Teunissen C, et al. Diagnostic impact of CSF biomarkers for Alzheimer's disease in a tertiary memory clinic. Alzheimers Dement. 2015; 11: 523–532
- 9Troussiere AC, Wallon D, Mouton-Liger F, Yatimi R, Robert P, Hugon J, et al. Who needs cerebrospinal biomarkers? A national survey in clinical practice. J Alzheimers Dis. 2014; 40: 857–861
- 10Blennow K, Dubois B, Fagan AM, Lewczuk P, deLeon MJ, Hampel H. Clinical utility of cerebrospinal fluid biomarkers in the diagnosis of early Alzheimer's disease. Alzheimers Dement. 2015; 11: 58–69
- 11 The headache classification subcommittee of the International Headache Society. The international classification of headache disorders, 2nd edition. Cephalalgia. 24(suppl 1): 2004
- 12Peskind ER, Riekse R, Quinn JF, Kaye J, Clark CM, Farlow MR, et al. Safety and acceptability of the research lumbar puncture. Alzheimer Dis Assoc Disord. 2005; 19: 220–225
- 13Alcolea D, Martinez-Lage P, Izagirre A, Clerigue M, Carmona-Iragui M, Alvarez RM, et al. Feasibility of lumbar puncture in the study of cerebrospinal fluid biomarkers for Alzheimer's disease: A multicenter study in Spain. J Alzheimers Dis. 2014; 39: 719–726
- 14Zetterberg H, Tullhog K, Hansson O, Minthon L, Londos E, Blennow K. Low incidence of post-lumbar puncture headache in 1,089 consecutive memory clinic patients. Eur Neurol. 2010; 63: 326–330
- 15Blennow K, Wallin A, Hager O. Low frequency of post-lumbar puncture headache in demented patients. Acta Neurol Scand. 1993; 88: 221–223
- 16Kleyweg RP, Hertzberger LI, Carbaat PA. Significant reduction in post-lumbar puncture headache using an atraumatic needle. A double-blind, controlled clinical trial. Cephalalgia. 1998; 18: 635–637
- 17Lavi R, Rowe JM, Avivi I. Traumatic vs. atraumatic 22 G needle for therapeutic and diagnostic lumbar puncture in the hematologic patient: A prospective clinical trial. Haematologica. 2007; 92: 1007–1008
- 18Tourtellotte WW, Henderson WG, Tucker RP, Gilland O, Walker JE, Kokman E. A randomized, double-blind clinical trial comparing the 22 versus 26 gauge needle in the production of the post-lumbar puncture syndrome in normal individuals. Headache. 1972; 12: 73–78
- 19Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: Prevention of post-lumbar puncture headaches: Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2000; 55: 909–914
- 20Vilming ST, Kloster R, Sandvik L. The importance of sex, age, needle size, height and body mass index in post-lumbar puncture headache. Cephalalgia. 2001; 21: 738–743
- 21Leibold RA, Yealy DM, Coppola M, Cantees KK. Post-dural-puncture headache: Characteristics, management, and prevention. Ann Emerg Med. 1993; 22: 1863–1870
- 22Lybecker H, Moller JT, May O, Nielsen HK. Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Analg. 1990; 70: 389–394
- 23Keeling D, Baglin T, Tait C, Watson H, Perry D, Baglin C, et al. Guidelines on oral anticoagulation with warfarin—Fourth edition. Br J Haematol. 2011; 154: 311–324
- 24Kuntz KM, Kokmen E, Stevens JC, Miller P, Offord KP, Ho MM. Post-lumbar puncture headaches: Experience in 501 consecutive procedures. Neurology. 1992; 42: 1884–1887
- 25Arevalo-Rodriguez I, Ciapponi A, Munoz L, Figuls M, Bonfill Cosp X. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev. 2013; 7: CD009199
- 26deJesus Guirro RR, deOliveira Guirro EC, deSousa NT. The sensory and motor thresholds of transcutaneous electrical stimulation are influenced by gender and age. PM R. 2015; 7: 42–47
10.1016/j.pmrj.2014.07.004 Google Scholar
- 27Vilming ST, Schrader H, Monstad I. The significance of age, sex, and cerebrospinal fluid pressure in post-lumbar-puncture headache. Cephalalgia. 1989; 9: 99–106
- 28Scherder EJ, Sergeant JA, Swaab DF. Pain processing in dementia and its relation to neuropathology. Lancet Neurol. 2003; 2: 677–686
- 29Kaplan G. The psychogenic etiology of headache post lumbar puncture. Psychosom Med. 1967; 29: 376–379
- 30 The headache classification committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013; 33: 629–808
