Feasibility and safety of lumbar puncture in the Parkinson's disease research participants

Parkinson's Progression Marker Initiative (PPMI)

Neha Prakash, Chelsea Caspell-Garcia, Christopher Coffey, Andrew Siderowf, Caroline M. Tanner, Karl Kieburtz, Brit Mollenhauer, Douglas Galasko, Kalpana Merchant, Tatiana Foroud, Lana M. Chahine, Daniel Weintraub, Cindy Casaceli, Ray Dorsey, Renee Wilson, Margaret Herzog, Nichole Daegele, Vanessa Arnedo, Mark Frasier, Todd Sherer & 5 others Ken Marek, Samuel Frank, Danna Jennings, Tanya Simuni*, Parkinson's Progression Markers Initiative

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)


Objective: To determine the feasibility, safety and tolerability of lumbar punctures (LPs) in research participants with early Parkinson disease (PD), subjects without evidence of dopaminergic deficiency (SWEDDs) and healthy volunteers (HC). Background: Cerebrospinal fluid (CSF) analysis is becoming an essential part of the biomarkers discovery effort in PD with still limited data on safety and feasibility of serial LPs in PD participants. DESIGN/METHODS: Parkinson's Progression Marker Initiative (PPMI) is a longitudinal observation study designed to identify PD progression biomarkers. All PPMI participants undergo LP at baseline, 6, 12 months and yearly thereafter. CSF collection is performed by a trained investigator using predominantly atraumatic needles. Adverse events (AEs) are monitored by phone one week after LP completion. We analyzed safety data from baseline LPs. Results: PPMI enrolled 683 participants (423 PD/196 HC/64 SWEDDs) from 23 study sites. CSF was collected at baseline in 97.5% of participants, of whom 5.4% underwent collection under fluoroscopy. 23% participants reported any related AEs, 68% of all AE were mild while 5.6% were severe. The most common AEs were headaches (13%) and low back pain (6.5%) and both occurred more commonly in HC and SWEDDs compared to PD participants. Factors associated with higher incidence of AEs across the cohorts included female gender, younger age and use of traumatic needles with larger diameter. AEs largely did not impact compliance with the future LPs. Conclusions: LPs are safe and feasible in PD research participants. Specific LP techniques (needle type and gauge) may reduce the overall incidence of AEs.

Original languageEnglish
Pages (from-to)201-209
Number of pages9
JournalParkinsonism and Related Disorders
Publication statusPublished - May 2019


  • Adverse events
  • Lumbar puncture
  • Parkinson's disease
  • Safety

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