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2d ago

NEJM Trial Shows Shunt Surgery Improves Walking and Reduces Falls in Older Adults With iNPH

The NEJM study provides definitive evidence that adjustable cerebrospinal-fluid shunts improve mobility in idiopathic normal pressure hydrocephalus.

The shunt used to help patient Jill Knaus was photographed at the University of Calgary on Tuesday, September 16, 2025.
Dr. Mark Hamilton, professor of neurosurgery at Cummings School of Medicine, holds the shunt used to help patient Jill Knaus. They were photographed at the University of Calgary on Tuesday, September 16, 2025.
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Overview

  • In the randomized, double-blind, placebo-controlled PENS trial, 99 patients across 21 centers in the U.S., Canada, and Sweden received adjustable shunts and were assigned to valves turned on or off.
  • Participants with activated valves increased gait speed by more than 0.2 meters per second, with 80% surpassing the clinically meaningful threshold, while the placebo group showed no improvement.
  • Patients with functioning shunts reported fewer falls, better balance, and improved quality of life after three months, and investigators described the safety profile as acceptable.
  • An institutional release reported the study was halted early for efficacy; placebo-group valves have since been activated and longer-term follow-up is assessing durability, cognition, and MRI correlations.
  • iNPH affects an estimated 1.5% of people in their 70s and up to about 7–7.7% in their 80s, and the trial was supported by NINDS and the NIH Trial Innovation Network.