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To the Editor:
We read with interest the paper by Strupp et al.1 The authors have largely confirmed (yet not cited) our double-blind controlled study on 100 patients2 using the atraumatic cannula, which was designed by Sprotte some years ago.3
As the principal result of our study, the incidence of the post–lumbar puncture headache syndrome was dramatically reduced, even more so than described by Strupp et al.1 In our subsequent open label–type use of the Sprotte cannula, it became clear that post–lumbar puncture headache syndrome is further reduced with continuous practice.4
We have a number of concerns with the study design and the interpretation of data:
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It is not indicated exactly how and at what time the randomization of patients took place during their hospital stay, nor is it clear how many patients were actually randomized. The numbers are given only for the patients “included in the final analysis.” There is also no stratification for, nor is there an account of disorders that are prone to cause headache.
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The evaluation sheet given to patients for eligibility to participate in the study seems to have included items that were only available post–lumbar puncture such as caffeine intake post–lumbar puncture and medication post–lumbar …
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