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8h ago

Placebo-Controlled Trial Confirms Shunt Surgery Improves Mobility in iNPH

The NEJM report provides blinded, placebo-controlled evidence that adjustable brain shunts are effective for 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 multicenter PENS study, all participants received implanted, magnetically adjustable valves that were randomized to open or closed in a double-blind design across sites in the U.S., Canada and Sweden.
  • Patients with activated shunts increased gait speed by more than 0.2 meters per second on average, with 80% surpassing the 0.1 m/s threshold for a clinically meaningful gain.
  • Those with closed valves showed no improvement in gait and reported more falls, while treated participants reported better quality of life and everyday functioning.
  • University releases report the randomized phase was halted early for efficacy, after which placebo-group valves were turned on, with ongoing follow-up assessing durability, cognition, imaging correlates and safety.
  • Investigators note that iNPH is common yet under-recognized in older adults, with estimated prevalence of about 1.5% in the 70s and up to roughly 7–7.7% in the 80s, and relatively few diagnosed patients receiving shunt treatment.