Kiefer Scale
A generally accepted grading system for patients suffering from chronic hydrocephalus has not been established yet. Therefore we designed a new grading system, which focuses on five symptom categories: gait disturbances, mental disorder, incontinence, headache, dizziness. For each category clearly circumscribed degrees of handicaps are defined. For each degree a value between 0-6 points is assigned in concordance to the severity of handicap. To get a generally accepted validation of the obstruction, the assigned values were oriented on the values provided in Germany to evaluate the degree of obstruction for insurances.[nl]In contrast to the established gradings of Stein and Langfitt and the Black Rating Scale our grading allows a more exact acquisition of the clinical presentation of a patient. Our experiences with the grading seemingly indicate also, that it is reliable. Because the grading allows an incorporation of measurable data such as psychometric analysis or gait analysis, our grading is useful as well for everydays' practice as for scientific purpose 1).
1: Skalický P, Mládek A, Vlasák A, Whitley H, Bradáč O. First experiences with Miethke M.blue® valve in iNPH patients. J Clin Neurosci. 2022 Feb 15;98:127-132. doi: 10.1016/j.jocn.2022.02.004. Epub ahead of print. PMID: 35180501.
2: Wolfsegger T, Hauser A, Wimmer S, Neuwirth K, Assar H, Topakian R. A comprehensive clinico-radiological, neuropsychological and biomechanical analysis approach to patients with idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg. 2021 Feb;201:106402. doi: 10.1016/j.clineuro.2020.106402. Epub 2020 Dec 4. PMID: 33348122.
3: Wetzel C, Goertz L, Noé P, von Spreckelsen N, Penner M, Kabbasch C, Goldbrunner R, Krischek B. Flow-regulated versus differential pressure valves for idiopathic normal pressure hydrocephalus: comparison of overdrainage rates and neurological outcome. Acta Neurochir (Wien). 2020 Jan;162(1):15-21. doi: 10.1007/s00701-019-04088-9. Epub 2019 Nov 12. PMID: 31713158.
4: Grahnke K, Jusue-Torres I, Szujewski C, Joyce C, Schneck M, Prabhu VC, Anderson DE. The Quest for Predicting Sustained Shunt Response in Normal- Pressure Hydrocephalus: An Analysis of the Callosal Angle's Utility. World Neurosurg. 2018 Jul;115:e717-e722. doi: 10.1016/j.wneu.2018.04.150. Epub 2018 May 1. PMID: 29723726.
5: Mahr CV, Dengl M, Nestler U, Reiss-Zimmermann M, Eichner G, Preuß M, Meixensberger J. Idiopathic normal pressure hydrocephalus: diagnostic and predictive value of clinical testing, lumbar drainage, and CSF dynamics. J Neurosurg. 2016 Sep;125(3):591-7. doi: 10.3171/2015.8.JNS151112. Epub 2016 Jan 29. PMID: 26824377.
6: Gölz L, Ruppert FH, Meier U, Lemcke J. Outcome of modern shunt therapy in patients with idiopathic normal pressure hydrocephalus 6 years postoperatively. J Neurosurg. 2014 Oct;121(4):771-5. doi: 10.3171/2014.6.JNS131211. Epub 2014 Jul 25. PMID: 25061869.
7: Gölz L, Lemcke J, Meier U. Indications for valve-pressure adjustments of gravitational assisted valves in patients with idiopathic normal pressure hydrocephalus. Surg Neurol Int. 2013 Oct 15;4:140. doi: 10.4103/2152-7806.119879. PMID: 24231878; PMCID: PMC3814988.
8: Lemcke J, Meier U, Müller C, Fritsch MJ, Kehler U, Langer N, Kiefer M, Eymann R, Schuhmann MU, Speil A, Weber F, Remenez V, Rohde V, Ludwig HC, Stengel D. Safety and efficacy of gravitational shunt valves in patients with idiopathic normal pressure hydrocephalus: a pragmatic, randomised, open label, multicentre trial (SVASONA). J Neurol Neurosurg Psychiatry. 2013 Aug;84(8):850-7. doi: 10.1136/jnnp-2012-303936. Epub 2013 Mar 1. PMID: 23457222; PMCID: PMC3717598.
9: Wikkelsø C, Hellström P, Klinge PM, Tans JT; European iNPH Multicentre Study Group. The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 2013 May;84(5):562-8. doi: 10.1136/jnnp-2012-303314. Epub 2012 Dec 18. PMID: 23250963.
10: Lemcke J, Meier U. Idiopathic normal pressure hydrocephalus (iNPH) and co- morbidity: an outcome analysis of 134 patients. Acta Neurochir Suppl. 2012;114:255-9. doi: 10.1007/978-3-7091-0956-4_50. PMID: 22327704.
11: Lemcke J, Meier U, Müller C, Fritsch M, Kiefer M, Eymann R, Kehler U, Langer N, Schuhmann MU, Speil A, Weber F, Remenez V, Rohde V, Ludwig HC, Stengel D. On the method of a randomised comparison of programmable valves with and without gravitational units: the SVASONA study. Acta Neurochir Suppl. 2012;114:243-6. doi: 10.1007/978-3-7091-0956-4_48. PMID: 22327702.
12: Meier U, Lemcke J. Co-morbidity as a predictor of outcome in patients with idiopathic normal-pressure hydrocephalus. Acta Neurochir Suppl. 2010;106:127-30. doi: 10.1007/978-3-211-98811-4_22. PMID: 19812934.
13: Lemcke J, Meier U, Müller C, Fritsch M, Eymann R, Kiefer M, Kehler U, Langer N, Rohde V, Ludwig HC, Weber F, Remenez V, Schuhmann M, Stengel D. Is it possible to minimize overdrainage complications with gravitational units in patients with idiopathic normal pressure hydrocephalus? Protocol of the randomized controlled SVASONA Trial (ISRCTN51046698). Acta Neurochir Suppl. 2010;106:113-5. doi: 10.1007/978-3-211-98811-4_19. PMID: 19812931.
14: Hailong F, Guangfu H, Haibin T, Hong P, Yong C, Weidong L, Dongdong Z. Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study. J Neurosurg. 2008 Nov;109(5):923-30. doi: 10.3171/JNS/2008/109/11/0923. PMID: 18976086.
15: Meier U, Lemcke J. The influence of co-morbidity on the postoperative outcomes of patients with idiopathic normal pressure hydrocephalus (iNPH). Acta Neurochir Suppl. 2008;102:141-4. doi: 10.1007/978-3-211-85578-2_29. PMID: 19388306.
16: Kiefer M, Eymann R, Komenda Y, Steudel WI. Ein Graduierungssystem für den chronischen Hydrozephalus [A grading system for chronic hydrocephalus]. Zentralbl Neurochir. 2003;64(3):109-15. German. doi: 10.1055/s-2003-41881. PMID: 12975745.
17: Meier U. The grading of normal pressure hydrocephalus. Biomed Tech (Berl). 2002 Mar;47(3):54-8. doi: 10.1515/bmte.2002.47.3.54. PMID: 11977443.
18: Meier U, Kiefer M, Bartels P. The ICP-dependency of resistance to cerebrospinal fluid outflow: a new mathematical method for CSF-parameter calculation in a model with H-TX rats. J Clin Neurosci. 2002 Jan;9(1):58-63. doi: 10.1054/jocn.2001.0930. PMID: 11749020.