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

Consensus guidelines for lumbar puncture in patients with neurological diseases.

Author information

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

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