(From left) Normal Pressure Hydrocephalus Clinic faculty and staff: Binit Shah, MD; Michael Catalino, MD; Alissa Higinbotham, MD; Matthew Noorbakhsh, MD; and Aubrey Courville, DPT.
Clinical faculty at the UVA School of Medicine are skilled and compassionate caregivers who continuously aim to optimize care and enhance the patient’s experience. One way faculty collaborate to achieve high quality care is through multidisciplinary clinics that bring together diverse specialists to evaluate and treat complex medical conditions in one setting.
In this limited Medicine in Motion series, you will meet clinical faculty leading multidisciplinary clinics at UVA. To kick off the series, we spoke with faculty who lead the Idiopathic Normal Pressure Hydrocephalus (iNPH) Diagnostic Clinic, a specialty clinic established and directed by Alissa Higinbotham, MD, assistant professor in the Department of Neurology.
At the clinic, Dr. Higinbotham works closely with Michael Catalino, MD, assistant professor in the Department of Neurosurgery, and Aubrey Courville, DPT, clinical specialist in neurologic physical therapy, to “streamline the evaluation process and reduce the diagnostic odyssey” associated with iNPH, a neurological disorder that occurs when fluid builds up in the brain, stretching neuronal networks. The effects on patients include gait and/or balance problems, cognitive impairment, and urinary symptoms, collectively known as Hakim’s triad.
Q. Why did you start this clinic?
Higinbotham: The symptoms of iNPH are common in the elderly population and overlap with conditions across subspecialties including cognitive neurology, movement disorders, neuromuscular, orthopedics, and neurosurgery. This presents a diagnostic challenge that can result in delayed diagnosis and treatment. In fact, over the last decade at the University of Virginia, the median number of distinct clinics consulted per iNPH patient was three, indicating an opportunity to improve efficiency in the multidisciplinary evaluation process of patients with gait disorders.
Q. Why is a multidisciplinary approach to this disease needed?
Higinbotham: Gait dysfunction, the key symptom that responds best to timely intervention with a shunt surgery, is often multifactorial in the elderly population. A neurologist skilled in gait disorder mimics of iNPH, such as neuropathy, spinal stenosis, vascular brain disease, Parkinson’s disease, and other neurodegenerative conditions, is a crucial team member to identify which patients are most likely to benefit from surgery.
After a patient is identified as a possible surgical candidate, an evaluation with a physical therapist before and after a high-volume lumbar puncture helps determine whether there is still reversibility to the gait dysfunction. Patients who respond well to high-volume lumbar puncture have a better surgical prognosis and are then referred to a neurosurgeon who is highly skilled in placing the ventriculoperitoneal shunt.
Catalino: From the neurosurgical side, the collaboration with Neurology is critical because it isolates a reversible cause of functional decline in older patients. The major hurdle is getting the diagnosis correct, and that would not be possible without Dr. Higinbotham’s expertise.
Q. What excited you about offering a specialized approach?
Higinbotham: We are the only center in Virginia and one of the few centers in the country who offer an iNPH Diagnostic Clinic led by a movement disorders specialist, the experts of parkinsonism. Since parkinsonism is quite common in patients with iNPH, it makes sense to have movement disorders take the lead in diagnosing these patients. I am proud to launch this clinic model through which I can train the next generation of movement disorders specialists to be competent in the evaluation of this incredibly important disease.
Catalino: Neurological conditions, especially degenerative ones, can be hard to understand. As a surgeon, it is exciting to collaborate with a Neurology team with expertise in this area. The treatment for iNPH, which currently is a ventriculoperitoneal shunt, does have risks, especially in older patients, so my role is mitigating those risks by surgical technique and collaboration with other physicians. With Dr. Higinbotham, we are working to streamline diagnosis to shunt implantation. With Dr. Noorbakhsh, we are working to streamline the procedure itself, making it safer, minimizing anesthetic exposure, and length of hospital stay.
Q. Can you share a success story about specialized care provided through your clinic?
Higinbotham: Our clinic launched in May 2025. In our first pilot year of the clinic, 40 patients were evaluated using our multidisciplinary model. Six patients underwent shunt surgery and were at least several months post-operative at the one-year anniversary mark of our clinic in May 2026. I am thrilled to say that 100% of these patients had a significant improvement in their gait disorder!
Catalino: I am not kidding when I say we have seen patients go from wheelchairs to walking in a matter of weeks. It is one of the most rewarding experiences. We have seen atypical presentations, complicated diagnoses, and hopeless patients come to the clinic and receive care they never thought possible. I always ask patients’ family members if the whole experience — from the evaluation, to diagnosis, and then surgery— was worth it. And it is not uncommon to hear “Absolutely, I got my husband/wife back,” as their eyes well up with tears of joy.
Q. What makes your team special?
Catalino: The communication between Neurology, Neurosurgery, and General Surgery has been very efficient, while providing high level clinical expertise. Furthermore, this has not increased the logistical burden significantly in my opinion. This is important because oftentimes multidisciplinary clinics, while helpful for patients, can often lead to a stressful environment for clinicians. The opposite is true for here. I genuinely love working with everyone involved.
Higinbotham: Completely agree with Dr. Catalino!