O4‐11‐04: Performance and complications of lumbar puncture in memory clinics: Results of the multicenter lp feasibility study

Abstract

Lumbar puncture (LP) is increasingly used as ancillary investigation in memory clinics. The invasive nature of this procedure is however hampering widespread implementation. We aimed to investigate patient-acceptance of LP, and the incidence of and risk factors for post-LP complications in memory clinic populations across Europe. All patients presenting at the memory clinic were prospectively included, whenever an LP was considered. Patients were included from November 2010 until March 2014 in twenty-three memory clinics across Europe. We included 3868 patients (50% women, mean age 66±11 years, mean MMSE 25±5). Three hundred ten patients (8%) refused to undergo LP and 102 patients (3%) could not be contacted for follow-up. Prior to LP various patient and LP procedure characteristics were recorded. Within two weeks after LP patients were asked about their complaints. Main outcome measures were typical post-LP headache (PLPH) and local back pain. Logistic regression analysis using generalized estimated equations was used to investigate risk factors for post-LP complications. In total, 1065 patients (31%) reported complaints of any kind after the LP; 589 patients (17%) reported back pain, 649 (19%) headache, of which 296 (9%) reported typical PLPH. There were only few complications needing medical intervention; 11 patients (0.3%) received a blood patch, 23 (0.7%) were hospitalized. The most important risk factor for PLPH was history of headache (OR [95%CI] 1.8 [1.2-2.6] for mild headache; 2.7 [1.9-3.7] for chronic/severe headache). An atraumatic needle (OR [95%CI] 0.4 [0.2-0.8]) and age >65 years (OR [95%CI] 0.7 [0.5-1.0]) were preventive. A small needle diameter was associated with less severe headache (OR [95%CI] 0·6 [0·4-0·9]). The most important risk factor for post-LP back pain was number of LP attempts (OR [95%CI] 2.1 [1.7-2.7] for 2-4 attempts; 5.4 [2.9-10.2] for >4 attempts). There was no effect of gender, rest after LP or volume of CSF withdrawn. LPs can be safely performed in memory clinics. Complaints were mostly mild in nature; complications needing medical intervention were rare. Risk factors should be taken into account and if possible modified when performing LPs.