Consensus guidelines for lumbar puncture in patients with neurological diseases

Sebastiaan Engelborghs; Ellis Niemantsverdriet; Hanne Struyfs; Kaj Blennow; Raf Brouns; Manuel Comabella; Irena Dujmovic; Wiesje van der Flier; Lutz Frölich; Daniela Galimberti; Sharmilee Gnanapavan; Bernhard Hemmer; Erik Hoff; Jakub Hort; Ellen Iacobaeus; Martin Ingelsson; Frank Jan de Jong; Michael Jonsson; Michael Khalil; Jens Kuhle; Alberto Lleó; Alexandre de Mendonça; José Luis Molinuevo; Guy Nagels; Claire Paquet; Lucilla Parnetti; Gerwin Roks; Pedro Rosa-Neto; Philip Scheltens; Constance Skårsgard; Erik Stomrud; Hayrettin Tumani; Pieter Jelle Visser; Anders Wallin; Bengt Winblad; Henrik Zetterberg; Flora Duits; Charlotte E Teunissen

doi:10.1016/j.dadm.2017.04.007

Consensus guidelines for lumbar puncture in patients with neurological diseases

Alzheimers Dement (Amst). 2017 May 18:8:111-126. doi: 10.1016/j.dadm.2017.04.007. eCollection 2017.

Authors

Sebastiaan Engelborghs^{1

2}, Ellis Niemantsverdriet¹, Hanne Struyfs¹, Kaj Blennow³, Raf Brouns⁴, Manuel Comabella⁵, Irena Dujmovic⁶, Wiesje van der Flier⁷, Lutz Frölich⁸, Daniela Galimberti⁹, Sharmilee Gnanapavan¹⁰, Bernhard Hemmer^{11

12}, Erik Hoff¹³, Jakub Hort^{14

15}, Ellen Iacobaeus¹⁶, Martin Ingelsson¹⁷, Frank Jan de Jong¹⁸, Michael Jonsson¹⁹, Michael Khalil²⁰, Jens Kuhle²¹, Alberto Lleó^{22

23}, Alexandre de Mendonça²⁴, José Luis Molinuevo²⁵, Guy Nagels^{4

26

27}, Claire Paquet²⁸, Lucilla Parnetti²⁹, Gerwin Roks³⁰, Pedro Rosa-Neto^{31

32}, Philip Scheltens⁷, Constance Skårsgard³³, Erik Stomrud³⁴, Hayrettin Tumani³⁵, Pieter Jelle Visser^{36

37}, Anders Wallin¹⁹, Bengt Winblad³⁸, Henrik Zetterberg^{3

39}, Flora Duits⁷, Charlotte E Teunissen³⁶

Affiliations

¹ Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
² Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium.
³ Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
⁴ Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
⁵ Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
⁶ Clinic of Neurology, Clinical Centre of Serbia, Department of Neurology, Faculty of Medicine, University of Belgrade School of Medicine, Belgrade, Serbia.
⁷ Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
⁸ Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty, Mannheim/Heidelberg University, Mannheim, Germany.
⁹ Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy.
¹⁰ Department of Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom.
¹¹ Department of Neurology, Technische Universität München, Munich, Germany.
¹² Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
¹³ Department of Neurology, Atrium Medisch Centrum Parkstad, Heerlen, The Netherlands.
¹⁴ Memory Disorders Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
¹⁵ International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
¹⁶ Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
¹⁷ Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
¹⁸ Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
¹⁹ Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
²⁰ Department of Neurology, Medical University Graz, Graz, Austria.
²¹ Department of Neurology, University Hospital Basel, Basel, Switzerland.
²² Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
²³ Centro de Investigación Biomédica en Red en enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain.
²⁴ Laboratory of Neurosciences, Department of Molecular Medicine and Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
²⁵ Alzheimer's disease and other cognitive disorders unit, Neurology Service, Hospital Clinic i Universitari, IDIBAPS, Barcelona, Spain.
²⁶ Faculté de Psychologie et des sciences de l'éducation, UMons, Mons, Belgium.
²⁷ National MS Center Melsbroek, Brussels, Belgium.
²⁸ Research Memory Center Lariboisière Hospital University Paris Diderot INSERMU942, Paris, France.
²⁹ Section of Neurology, Centre for Memory Disturbances, Department of Medicine, University of Perugia, Perugia, Italy.
³⁰ Department of Neurology, St Elisabeth Ziekenhuis, Tilburg, The Netherlands.
³¹ Departments of Neurology & Neurosurgery and Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada.
³² Departments of Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada.
³³ Department of Geriatrics, Kalmar County Hospital, Kalmar, Sweden.
³⁴ Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
³⁵ CSF Laboratory and Multiple Sclerosis Outpatient Unit, Department of Neurology, University of Ulm, Ulm, Germany.
³⁶ Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
³⁷ Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
³⁸ Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden.
³⁹ UCL Institute of Neurology, Department of Molecular Neuroscience, London, United Kingdom.

Abstract

Introduction: Cerebrospinal fluid collection by lumbar puncture (LP) is performed in the diagnostic workup of several neurological brain diseases. Reluctance to perform the procedure is among others due to a lack of standards and guidelines to minimize the risk of complications, such as post-LP headache or back pain.

Methods: We provide consensus guidelines for the LP procedure to minimize the risk of complications. The recommendations are based on (1) data from a large multicenter LP feasibility study (evidence level II-2), (2) systematic literature review on LP needle characteristics and post-LP complications (evidence level II-2), (3) discussion of best practice within the Joint Programme Neurodegenerative Disease Research Biomarkers for Alzheimer's disease and Parkinson's Disease and Biomarkers for Multiple Sclerosis consortia (evidence level III).

Results: Our consensus guidelines address contraindications, as well as patient-related and procedure-related risk factors that can influence the development of post-LP complications.

Discussion: When an LP is performed correctly, the procedure is well tolerated and accepted with a low complication rate.

Keywords: Back pain; Cerebrospinal fluid; Consensus guidelines; Evidence-based guidelines; Headache; Lumbar puncture; Post-LP complications.