Transcranial and Rapid Magnetic Stimulation for Gait Apraxia Due to Normal Pressure Hydrocephalus and Cerebral Ischemia
Transcranial and Rapid Magnetic Stimulation for Gait Apraxia Due to Normal Pressure Hydrocephalus and Cerebral Ischemia
The investigator(neurologist) has published a study in International Congress Series, in the
 15th International Conference of Biomagnetism Vancouver Proceedings 2006,and Science Direct
 website, of 15 patients with brain ischemia and dilated ventricles who improve when treated
 with transcranial monitoring or low ultrasound wave intensity (milliwatts) and with rapid
 magnetic stimulation which is also a diagnostic tool routinely used by many
 neurophysiologists. Before, these patients will progress and may need a brain shunt called
 Ventriculo-peritoneal shunt. He and collaborators now would like to do a double study as this
 appears to be a cheap and effective alternative treatment and help patients to walk again.
The transcranial monitoring intensity would be equivalent to the well known CLOTBUST study
 (<300mw/sq cm)for one hour, using two probes.

 All will be treated as an outpatient and there is no form of infusion or interventional
 treatment.

 The rapid magnetic stimulation is at about 50a/us, 15Hz, 1000 pulses with 10 sec pause for
 ten days along the skull vault. Informed consent will be obtained. 30 patients will be
 recruited and sham treatment would be just applying probe without power for transcranial and
 for magnetic stimulation coil will be angled away. Data will be compiled by a separate
 blinded investigator and so with the statistics. VP shunt failure patients, which is common,
 will be included. Barthel's daily living index and standard cognitive tests will be used to
 assess results.
Inclusion Criteria:

 -  cerebral ischemia with our without hydrocephalus and gait apraxia

 Exclusion Criteria:

 -  all other conditions which contribute to walking difficulty e.g. bad knees; or
 spondylosis; parkinson's or paralytic strokes