By Leigh Farmer

As a consultant in high demand, Bill Hobgood has traveled a well-beaten path across the United States, quite literally. He loves to walk and makes a point of taking at least one jaunt during each trip. It’s a way to explore the city and stretch his legs before hopping back on the plane.

But in 2023, during a walk in New York, his legs began to rebel, spontaneously speeding up.

“Your mind says you need to slow down, or you need to stop, and I couldn't. I was literally running,” recalled Bill. In desperation, he grabbed a park bench and fell into it.

A few months later, the same thing happened except there was no park bench to grab. He fell to the ground so hard he hit his head. It was at that point when Bill and his family became a little scared.

The first doctor they saw attributed the issue to old age.

“That diagnosis was unacceptable to me,” said Bill – a fit, 69-year-old man. He decided to get a second opinion at VCU Health, where the neurological team promptly diagnosed him with normal pressure hydrocephalus, better known as NPH.

NPH is an excess buildup of cerebrospinal fluid at the base of the neck, causing pressure on the brain. The symptoms of NPH can range from changes in gait to incontinence and even cognitive decline. It’s often mistaken for Alzheimer’s disease.

“It’s being underdiagnosed and misdiagnosed. Sometimes it’s Parkinson's, sometimes it’s old age,” said John Ward, M.D., clinical director of VCU Health NPH clinic.

The condition develops in approximately 700,000 adults over the age of 60, only 20% of people with the disease are properly diagnosed with the condition.

Bill is one of the fortunate ones to be under the care of VCU Health NPH clinic. Their unbreakable resolve to better understand this condition through research and involvement in innovative clinical trials make the clinic an international leader in caring for patients who are often left undiagnosed.

Early NPH research at VCU Health

Ward took the reins of the VCU Health NPH clinic in 2017, following in the footsteps of the very dynamic and world-renowned research duo of Harold F. Young, M.D., and Anthony Marmarou, MD.

Young and Marmarou established the clinic in 2000 when little was known about NPH. By 2005, the duo published their first case study, which encompassed more than 150 patients treated in their clinic. A few years later, with funding from the Virginia legislature, they discovered that up to 14% of people in nursing home facilities they studied had NPH, though they were being treated for other chronic mobility and memory conditions.

“(Marmarou) was an interesting guy,” Ward recalled. “He would take a big problem, and he would chop it down into individual bites, then solve all of the individual bites and then put it all together.”

What the team discovered was that by providing these patients with the correct diagnosis, he could also resolve their symptoms. The first international clinical guidelines for the diagnosis and treatment of NPH were developed with the help of these providers.

VCU Health operates one of the longest-running NPH clinics in the country, with the work of Marmarou and Young shaping the current global standard of care. As a result, the program was invited to participate in a study exploring a new approach to treat NPH with a less-invasive procedure.

Investigating a new way to tackle NPH

The symptoms of NPH can often be effectively treated with surgery, though the procedure is invasive and carries certain risks. Used for decades, the standard treatment for NPH involves the surgical implantation of a ventricular peritoneal (VP) shunt into the ventricle of the brain. This requires drilling a hole in the patient’s skull to insert the shunt, followed by placement of a permanent drain that runs from the shunt to the abdomen.

Anytime you drill into the skull there is a risk of complications. And the older the patient, the more complicated the surgery becomes.

“People in their twilight years have other things going on. They’ve got heart disease and arthritis,” Ward said.

He, along with the VCU Health’s neurosurgical team, are exploring a new, investigational device designed to improve the procedure for draining CSF fluid buildup in patients.

They are involved in a groundbreaking clinical trial evaluating the safety and efficacy of the CereVasc® eShunt® Implant.

“The eShunt implant is designed to be delivered to the site of the fluid buildup by making a tiny incision in upper thigh. Everything is done within the blood vessels themselves and the excess fluid absorbed by the body,” said John Reavey-Cantwell, M.D., a VCU Health neurosurgeon involved in the study.

The trial aims to determine whether this approach could lead to reduced recovery time and complications compared to the traditional VP Shunt method. VCU Health is one of 12 clinics nationwide participating in this clinical trial. It’s also the only participating site based in the mid-Atlantic region of the East Coast.

A new path to care for NPH

When Bill sought out care at VCU Health, his neurology team provided him with two options for treatment: the traditional VP Shunt implanted or to join a clinical trial for the eShunt System.

He decided to join the trial in hopes that his involvement could benefit many others in the future. Just a few weeks after surgery, Bill has reported feeling better.

“It might not be 100% yet, but I almost feel that it's 100% in my mind. And we also know that that it's still going to continue to get better,” Bill said.

VCU Health’s team of neurologists are encouraged by the short-term results of this new device. However, they emphasize that the device is still under investigation, with full-scale usage dependent on the completion of the trial and FDA approval.

Ward says the team is honored to be part of the continued improvement of care.

“We’ve been at this for a long time, and we have been one of the leading clinics in NPH. It would make sense that we would be involved in something that can push the envelope, the frontier, forward,” Ward said.