Jos Th J Tans

Medisch Centrum Haaglanden, 's-Gravenhage, South Holland, Netherlands

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Publications (14)64.29 Total impact

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    ABSTRACT: Objective The objective was to determine the sensitivity, specificity, and positive and negative predictive values of the CSF Tap Test (CSF TT) and resistance to CSF outflow (Rout) for the outcome of shunting in a sample of patients with idiopathic normal pressure hydrocephalus (iNPH). Methods 115 patients were included in this European multicentre study. Diagnosis was based on clinical symptoms and signs, and MRI changes. All patients were treated with programmable ventriculoperitoneal shunts and re-examined 12 months after surgery. Outcomes were measures with a newly developed iNPH Scale and the modified Rankin Scale (mRS). Before surgery, a CSF TT and measurement of Rout was performed, with the results blinded to all caregivers. The 12 month outcome was correlated with Rout and the result of the CSF TT. Results Rout and the results of the CSF TT showed no correlation with outcome measured by either domain, or with total iNPH score or mRS score. Only an increase in the gait task (10 m of walking at free speed) of the CSF TT correlated significantly (r=0.22, p=0.02) with improvement in iNPH score. The positive predictive value of both tests was >90% and the negative predictive value <20%. Rout >12 had an overall accuracy of 65% and the CSF TT 53%. Combining both tests did not improve their predictive power. No correlation was found between Rout and the results of the CSF TT. Conclusions Rout and the results of the CSF TT did not correlate with outcome after 12 months. Rout and CSF TT can be used for selecting patients for shunt surgery but not for excluding patients from treatment. Trial registration The study has been registered at clinicaltrials.gov, identifier NCT00874198.
    No preview · Article · Dec 2012 · Journal of neurology, neurosurgery, and psychiatry
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    ABSTRACT: To present a new, continuous, calibrated and norm-based scale for the grading of severity and assessment of treatment outcome in idiopathic normal pressure hydrocephalus (iNPH). A scale designed for the assessment of the four domains, gait, neuropsychology, balance and continence, using ordinal ratings and continuous measures, was developed. Data from a series of 181 consecutive iNPH patients were used to calibrate the continuous parts of the scale and to describe the distributional properties of the ordinal ratings. Data from normative studies were used to determine the limits for normal scores. The construction of the scale made it well equipped to separate iNPH patients at baseline, and the total scores assumed a bell-shaped, approximately normal distribution. All four domain scores correlated significantly with each other, underscoring the well-known syndromatic nature of iNPH, and justifying the use of a total score to describe the patients. Reliability [Cronbach's α for the total score = 0.74, and for the domains of gait and neuropsychology, 0.86 and 0.89, respectively) and validity estimates (convergent validity evaluated by Spearman rank correlations for the scale and the modified Rankin scale (ρ = -0.61) and the mini mental state examination (ρ = 0.57)] are satisfying. The iNPH scale covers the four most important symptom domains and the full range of severity of the iNPH syndrome. The scale is sensitive, reliable, valid and feasible. We recommend that it should be used in future iNPH research.
    Full-text · Article · May 2012 · Acta Neurologica Scandinavica
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    ABSTRACT: To assess the 1-year outcome after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). Patients (n = 142) were prospectively included in the European multicentre study by 13 centres. Diagnoses were based solely on clinical and radiological findings. All received a programmable ventriculoperitoneal shunt. Re-examinations, 12 months after surgery, were performed in 115 patients, and the outcome was assessed by the modified Rankin scale (mRs) and a new iNPH grading scale. Improvement was defined as ≥1 step on the mRs and ≥5 points on the iNPH scale. The scores on both scales were significantly improved after 1 year of shunt treatment (Ps < 0.001). Sixty-nine per cent of the patients were improved according to the mRs and 84% according to the iNPH scale. The proportion able to live independently (scores 0-2 on the mRs) was increased from 53% before to 82% 12 months after surgery (P < 0.001). Neither classification (typical or questionable) nor comorbidity affected the level of improvement. Patients not completing the study were worse off with regard to their clinical condition at entry than completers. Twenty-eight per cent of the patients experienced complications and were either conservatively (13%) or surgically (15%) treated. The results of this prospective multicentre study on patients with iNPH diagnosed solely on clinical and radiological criteria support shunt surgery in patients presenting with symptoms and signs and MRI findings suggestive of iNPH.
    Full-text · Article · May 2012 · Acta Neurologica Scandinavica
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    ABSTRACT: Neuropsychological dysfunction is common in patients with idiopathic normal pressure hydrocephalus (iNPH). Shunt treatment is beneficial, some patients reaching complete or almost complete recovery, while others show only minor improvement. We aimed to assess the efficacy of a small selection of well characterized and sensitive neuropsychological tests in the context of the European multicentre study on iNPH (Eu-INPH). One hundred and forty-two iNPH patients included in Eu-iNPH were tested with the Rey Auditory Verbal Learning Test (RAVLT), the Grooved Pegboard and the Stroop test before and after three and twelve months of treatment with a ventriculoperitoneal shunt. Their performance was compared to that of 108 healthy individuals (HI). INPH patients performed significantly worse than HI on all of the neuropsychological measures at entry. The discriminative capacities of the eight variables were similar, with areas under the curve (AUC; ROC analysis) ranging between .86 (Delayed Recall) and .95 (Grooved Pegboard). The most usable test was RAVLT (Learning and Delayed Recall), administered to ≥90% of the patients at all occasions. However, the Grooved Pegboard and the Stroop test were more sensitive to treatment effects. The three neuropsychological tests used in the Eu-iNPH are expedient, highly diagnostically discriminative, and well suited to evaluate changes following shunt treatment.
    Full-text · Article · Feb 2012 · Clinical neurology and neurosurgery
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    ABSTRACT: We present the baseline characteristics of 101 patients with normal pressure hydrocephalus (NPH), entering a study that evaluates the diagnostic reliability of CSF outflow resistance. Patients were assessed by a gait scale consisting of 10 features of walking and the number of steps and seconds necessary for 10 m, a dementia scale comprising the 10 word test, trail making, digit span and finger tapping, the modified Mini Mental State Examination (3MSE) and the modified Rankin scale (MRS). Inclusion criteria were a gait and dementia scale ≥ 12 (range 2–40), a MRS ≥ 2 and a communicating hydrocephalus on CT. Gait disorder and dementia varied from mild to severe leading to MRS 2 in 17%, MRS 3 in 34%, MRS 4 in 21%, MRS 5 in 16% and MRS 6, including akinetic mutism, in 12%. Only one patient showed both normal tandem walking and turning. Small steps, reduced foot floor clearance and wide base were also frequently seen in the 67 patients walking independently; 34 needed assistance or could not walk at all. Applying the 3MSE, 64% were demented; the remaining 36% exhibited a milder cognitive deficit. The 10 word test and trail making decreased with increasing dementia. Digit span and finger tapping declined in the most demented patients. This group of elderly patients with NPH, mostly of the idiopathic type, proved to be vulnerable because of considerable disability and comorbidity.
    No preview · Article · Jan 2011 · European Journal of Neurology
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    ABSTRACT: To evaluate the interobserver agreement on magnetic resonance imaging (MRI) evaluation of herniated discs, spondylotic neuroforaminal stenosis, and root compression in patients with recent onset cervical radiculopathy and in addition, to assess the added value of disclosure of clinical information to interobserver agreement. The MRI images of 82 patients with less than 1 month of symptoms and signs of cervical radiculopathy were evaluated independently by two neuroradiologists who were unaware of clinical findings. MRI analysis was repeated after disclosure of clinical information. Interobserver agreement was calculated using kappa statistics. The kappa score for evaluation of herniated discs and of spondylotic foramen stenosis was 0.59 and 0.63, respectively. A kappa score of 0.67 was found for the presence of root compression. After disclosure of clinical information kappa scores increased slightly: from 0.59 to 0.62 for the detection of herniated discs, from 0.63 to 0.66 for spondylotic foramen stenosis, and from 0.67 to 0.76 for root compression. Interobserver reliability of MRI evaluation in patients with cervical radiculopathy was substantial for root compression, with or without clinical information. Agreement on the cause of the compression, i.e., herniated disc or spondylotic foraminal stenosis, was lower.
    No preview · Article · Jan 2011 · Clinical Radiology
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    ABSTRACT: To evaluate the occurrence of symptomatic and asymptomatic root compression caused by herniated discs and spondylotic foraminal stenosis by MRI in patients with recent onset cervical radiculopathy. 78 patients with symptoms and signs of cervical radiculopathy of less than one month's duration. The authors determined the clinically suspected level of root compression in each patient. Two neuroradiologists independently evaluated MRIs, blinded for the clinical findings. For each patient, the level of root compression on MRI was compared with the clinically affected level. The authors also examined the cause of compression: herniated disc, spondylotic foraminal stenosis or both. In 73% of patients, the clinically affected root was compressed on MRI. In 45%, MRI showed root compression without clinical substrate together with, or to a lesser extent without, the coexistence of compression of the clinically affected root. MRIs were assessed as normal in 13-15% of cases, and in 9-10% only asymptomatic roots were compressed. Herniated discs without spondylosis were more often responsible for root compressions only at the clinically affected level and spondylotic foraminal stenosis for multiple root compression including compression of clinically unaffected roots. MRI findings in patients with cervical radiculopathy should be interpreted together with the clinical findings, as false-positive and false-negative MRIs occur rather frequently.
    Full-text · Article · Nov 2010 · Journal of neurology, neurosurgery, and psychiatry
  • B. Kuijper · J.Th.J. Tans · A. Beelen · F. Nollet · M. De Visser

    No preview · Article · Mar 2010 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: Objective To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy.Design Randomised controlled trial.Setting Neurology outpatient clinics in three Dutch hospitals.Participants 205 patients with symptoms and signs of cervical radiculopathy of less than one month’s durationInterventions Treatment with a semi-hard collar and taking rest for three to six weeks; 12 twice weekly sessions of physiotherapy and home exercises for six weeks; or continuation of daily activities as much as possible without specific treatment (control group).Main outcome measures Time course of changes in pain scores for arm and neck pain on a 100 mm visual analogue scale and in the neck disability index during the first six weeks.Results In the wait and see group, arm pain diminished by 3 mm/week on the visual analogue scale (β=−3.1 mm, 95% confidence interval −4.0 to −2.2 mm) and by 19 mm in total over six weeks. Patients who were treated with cervical collar or physiotherapy achieved additional pain reduction (collar: β=−1.9 mm, −3.3 to −0.5 mm; physiotherapy: β=−1.9, −3.3 to −0.8), resulting in an extra pain reduction compared with the control group of 12 mm after six weeks. In the wait and see group, neck pain did not decrease significantly in the first six weeks (β=−0.9 mm, −2.0 to 0.3). Treatment with the collar resulted in a weekly reduction on the visual analogue scale of 2.8 mm (−4.2 to −1.3), amounting to 17 mm in six weeks, whereas physiotherapy gave a weekly reduction of 2.4 mm (−3.9 to −0.8) resulting in a decrease of 14 mm after six weeks. Compared with a wait and see policy, the neck disability index showed a significant change with the use of the collar and rest (β=−0.9 mm, −1.6 to −0.1) and a non-significant effect with physiotherapy and home exercises.Conclusion A semi-hard cervical collar and rest for three to six weeks or physiotherapy accompanied by home exercises for six weeks reduced neck and arm pain substantially compared with a wait and see policy in the early phase of cervical radiculopathy.Trial registration Clinical trials NCT00129714.
    Preview · Article · Oct 2009 · BMJ: British medical journal
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    ABSTRACT: Degenerative cervical radiculopathy: clinical diagnosis and conservative treatment. A review. To provide a state-of-the-art assessment of diagnosis and non-surgical treatment of degenerative cervical radiculopathy a literature search for studies on epidemiology, diagnosis including electrophysiological examination and imaging studies, and different types of conservative treatment was undertaken. The most common causes of cervical root compression are spondylarthrosis and disc herniation. Diagnosis is made mainly on clinical grounds, although there are no well-defined criteria. Provocative tests like the foraminal compression test are widely used but not properly evaluated. The clinical diagnosis of degenerative cervical radiculopathy can be confirmed by magnetic resonance imaging. The role of electromyography is mainly to rule out other conditions. Cervical radiculopathy is initially treated conservatively, although no treatment modality has been evaluated in a randomized controlled trial. Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review.
    No preview · Article · Feb 2009 · European Journal of Neurology
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    ABSTRACT: To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy. Randomised controlled trial. Neurology outpatient clinics in three Dutch hospitals. 205 patients with symptoms and signs of cervical radiculopathy of less than one month's duration Treatment with a semi-hard collar and taking rest for three to six weeks; 12 twice weekly sessions of physiotherapy and home exercises for six weeks; or continuation of daily activities as much as possible without specific treatment (control group). Time course of changes in pain scores for arm and neck pain on a 100 mm visual analogue scale and in the neck disability index during the first six weeks. In the wait and see group, arm pain diminished by 3 mm/week on the visual analogue scale (beta=-3.1 mm, 95% confidence interval -4.0 to -2.2 mm) and by 19 mm in total over six weeks. Patients who were treated with cervical collar or physiotherapy achieved additional pain reduction (collar: beta=-1.9 mm, -3.3 to -0.5 mm; physiotherapy: beta=-1.9, -3.3 to -0.8), resulting in an extra pain reduction compared with the control group of 12 mm after six weeks. In the wait and see group, neck pain did not decrease significantly in the first six weeks (beta=-0.9 mm, -2.0 to 0.3). Treatment with the collar resulted in a weekly reduction on the visual analogue scale of 2.8 mm (-4.2 to -1.3), amounting to 17 mm in six weeks, whereas physiotherapy gave a weekly reduction of 2.4 mm (-3.9 to -0.8) resulting in a decrease of 14 mm after six weeks. Compared with a wait and see policy, the neck disability index showed a significant change with the use of the collar and rest (beta=-0.9 mm, -1.6 to -0.1) and a non-significant effect with physiotherapy and home exercises. A semi-hard cervical collar and rest for three to six weeks or physiotherapy accompanied by home exercises for six weeks reduced neck and arm pain substantially compared with a wait and see policy in the early phase of cervical radiculopathy. Trial registration Clinical trials NCT00129714.
    Full-text · Article · Jan 2009 · BMJ (online)
  • B Kuijper · J T J Tans · A Beelen · F Nollet · M de Visser
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    ABSTRACT: OBJECTIVE: To compare the effectiveness of 3 non-surgical treatment strategies in patients with recent-onset cervical radiculopathy. DESIGN: Randomised controlled trial. METHOD: 205 outpatients with less than 1 month of symptoms and signs of cervical radiculopathy were treated with a semi-hard cervical collar and as much rest as possible for 3-6 weeks, or 12 two-weekly sessions of physiotherapy and home exercises for 6 weeks, or a continuation of daily activities as much as possible without specific treatment (wait-and-see; control treatment). The primary outcome measures were changes in the scores for arm and neck pain on a 100 mm visual analogue scale (VAS) and of the Neck Disability Index (NDI) during the first 6 weeks. Differences in trends between the treatment groups were analysed using generalised estimating equations. RESULTS: In the control group arm pain diminished 3 mm per week on the VAS (19 mm in 6 weeks). Additional pain reduction was achieved with the cervical collar and with physiotherapy: extra reduction of 12 mm in arm pain in 6 weeks compared to the control treatment. In the control group, neck pain did not significantly decrease. Treatment with the cervical collar resulted in a reduction of 2.8 mm per week on the VAS (17 mm in 6 weeks), whereas physiotherapy gave a reduction of 2.4 mm per week (14 mm in 6 weeks). Compared to the control treatment, only treatment with the cervical collar resulted in a significant improvement to the NDI. CONCLUSION: For patients with a recent onset cervical radiculopathy, both treatment with a semi-hard cervical collar and physiotherapy led to a substantial reduction in neck and arm pain in the first 6 weeks compared to a wait-and-see policy.
    No preview · Article · Jan 2009 · Nederlands tijdschrift voor geneeskunde
  • J Th J Tans · A J W Boon
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    ABSTRACT: The objective was to compare predictive values of clinical and CT findings, co-existing cerebrovascular disease (CVD) and CSF outflow resistance (Rcsf) for outcome of shunting in NPH. A group of 95 NPH patients was shunted and followed for one year. Gait disturbance and dementia were quantified by an NPH scale (NPHS) and handicap by the modified Rankin scale (MRS). Improvement was defined as a change of at least 15% in NPHS and one grade in MRS at last follow-up. Clinical and CT findings at entry were classified as typical or not typical for NPH. CVD was defined as a history of stroke or CT-scans showing infarcts or moderate to severe white matter hypodense lesions. Clinical and CT findings typical for NPH, absence of CVD and Rcsf > 18 mmHg/ml/min were positive tests and the reciprocal outcomes negative tests. Typical clinical and CT findings were found in 69% and 68%, CVD (history of stroke n = 14, infarcts on CT n = 13, leucoaraiosis n = 32) in 47% and Rcsf > 18 in 38% of patients. The ratio of patients classified as improved in both scales was significantly greater for those with positive than negative tests. Mean improvement differed the most between patients with and without CVD. Using logistic regression analysis Rcsf > 18 was the only significant predictor of improvement in NPHS (OR 4.4, 95% CI 1.3-16.7) and typical CT findings in MRS (OR 5.6, 95% CI 1.8-17.9). We conclude that CVD is an important predictor of poor outcome. The best strategy is to shunt NPH patients if Rcsf is > 18 mmHg/ml/min or, when Rcsf is lower, if CT findings are typical for NPH and there is no or limited CVD.
    No preview · Article · Jan 2002 · Acta neurochirurgica. Supplement
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    ABSTRACT: The value of the measurements of CSF outflow resistance (Rcsf) relative to predicting outcome after shunting was studied. In a group of 101 patients with mainly idiopathic normal pressure hydrocephalus (NPH) Rcsf was obtained by lumbar constant flow infusion. Gait disturbance and dementia were quantified using an NPH scale (NPHS) and disability by the Modified Rankin scale (MRS). Patients were assessed before and at 1, 3, 6, 9 and 12 months after surgery. Outcome measures were differences between the preoperative and last NPHS and MRS scores. Improvement was defined as a change of ≥15% in NPHS and ≥1 grade in MRS. Intention-to-treat analysis of all patients at one year yielded improvement of 57% in NPHS and 59% in MRS. Efficacy analysis, excluding comorbidity unrelated to NPH, revealed positive predictive values of around 80% at Rcsf <18, and between 90% and 100% at Rcsf ≥18 mm Hg/ml/min. For Rcsf ≥18, the likelihood ratios were also higher. We conclude that the best predictor of the response to shunting is an Rcsf ≥18 mm Hg/ml/min. Since two-thirds of the patients with Rcsf <18 showed improvement as well, these patients should not be denied shunting.
    No preview · Article · Feb 1998 · Acta neurochirurgica. Supplement