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Disturbed corticospinal inhibition of the motor cortex has been reported in iNPH and can be evaluated in a noninvasive and painless manner using navigated transcranial magnetic stimulation (nTMS). This is the first study to characterize the immediate impact of cerebrospinal fluid (CSF) drainage on corticospinal excitability.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Twenty patients with possible or probable iNPH (16 women and 4 men, mean age 74.4\u00a0years, range 67\u201384\u00a0years), presenting the classical symptom triad and radiological findings, were evaluated with motor function tests (10-m walk test, Grooved Pegboard and Box &amp; Block test) and nTMS (silent period, SP, resting motor threshold, RMT and input\u2013output curve, IO-curve). Evaluations were performed at baseline and repeated immediately after CSF drainage via lumbar puncture.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At baseline, iNPH patients presented shorter SPs (p\u2009&lt;\u20090.001) and lower RMTs (p\u2009&lt;\u20090.001) as compared to normative values. Positive correlation was detected between SP duration and Box &amp; Block test (rho\u2009=\u20090.64, p\u2009=\u20090.002) in iNPH patients. CSF drainage led to an enhancement in gait velocity (p\u2009=\u20090.002) and a steeper IO-curve slope (p\u2009=\u20090.049).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Shorter SPs and lower RMTs in iNPH suggest impaired corticospinal inhibition and corticospinal hyperexcitability. The steeper IO-slope in patients who improve their gait velocity after CSF drainage may indicate a higher recovery potential. Corticospinal excitability correlated with the motor function of the upper limbs implying that the disturbance in motor performance in iNPH extends beyond the classically reported gait impairment.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12987-020-0167-0","type":"journal-article","created":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T00:02:42Z","timestamp":1581897762000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Corticospinal excitability in idiopathic normal pressure hydrocephalus: a transcranial magnetic stimulation study"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0599-2614","authenticated-orcid":false,"given":"Jani","family":"Sirkka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"S\u00e4is\u00e4nen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petro","family":"Julkunen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mervi","family":"K\u00f6n\u00f6nen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Kallioniemi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ville","family":"Leinonen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nils","family":"Danner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,2,17]]},"reference":[{"issue":"4","key":"167_CR1","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/0022-510X(65)90016-X","volume":"2","author":"S Hakim","year":"1965","unstructured":"Hakim S, Adams RD. 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