Herbal prescription Siryeongtang and acupuncture treatment for gait disturbance due to idiopathic normal pressure hydrocephalus: A case report

Background: Idiopathic normal-pressure hydrocephalus (iNPH), characterized by unexplained normal-pressure hydrocephalus, primarily presents with symptoms such as gait disturbances, cognitive impairment, and urinary incontinence. Currently, cerebrospinal fluid (CSF) drainage via shunting is the only effective treatment for iNPH.

Case presentation: A 56-year-old Asian woman visited our hospital with a worsening gait disturbance and a history of recurrent falls over the past 2 years. She was diagnosed with iNPH using brain computed tomography. Notably, her gait disturbances continued to worsen despite undergoing a ventriculoperitoneal (VP) shunt. The patient was prescribed the herbal medicine Siryeongtang along with acupuncture and electroacupuncture. Subsequently, the changes in gait balance and speed were objectively assessed during the treatment period using the WIN-TRACK evaluation tool. The symmetry index for step length improved after 42 days of treatment, reaching 111 %, 71 %, and 37 % on days 15, 24, and 42, respectively. The symmetry index for step speed also decreased from 77 % on day 15 to 5 % on day 42. In addition, the time required to walk 5 m was reduced to 13, 10, and 9 s on days 15, 24, and 42, respectively.

Conclusions: Treatment with Korean medicine improved gait balance and speed in a patient with iINPH whose symptoms did not improve following shunt surgery.