Elsevier

Brain Research Bulletin

Volume 59, Issue 1, 15 October 2002, Pages 59-63
Brain Research Bulletin

Vestibular-evoked myogenic potentials: A method to assess vestibulo-spinal conduction in multiple sclerosis patients

https://doi.org/10.1016/S0361-9230(02)00842-0Get rights and content

Abstract

Vestibular-evoked myogenic potentials (VEMPs), elicited by acoustic stimulation, have been proposed in the assessment of the vestibulo-cervical reflex pathways. The procedure has been previously validated in several otovestibular disorders. The aim of this study was to investigate patients affected by multiple sclerosis (MS) in the attempt to clarify the underlying physiopathogenetic mechanisms and the clinical utility of VEMPs in detecting vestibulospinal involvement in this disease.

VEMPs were obtained according to the technique described by Colebatch and Halmagyi [Neurology 42 (1992) 1635]. We averaged the surface tonic electromyogram from right and left sternocleidomastoid muscle, after bilateral click stimulation (click duration 0.1 ms, repetition rate 3 Hz, intensity 140 dBSPL, 256 stimuli, repeated at least twice).

In all cases, we obtained the biphasic, initially positive, p13–n23 wave pattern. P13 peak latency was bilaterally or unilaterally delayed in 8 out of 15 patients (mean delay: 2.2 ms; p<0.01 on right and <0.05 on left side) and peak-to-peak amplitude significantly reduced (mean amplitude loss: 130 μV; p<0.01 on right and <0.05 on left side). Their overall diagnostic yield resulted in 60%.

In conclusion, the present findings prove that VEMPs are delayed in p13 component and altered in amplitude in MS patients. We hypothesise that these changes might be the result of a conduction impairment in vestibulo-spinal fibres, producing a morphologic alteration of the myogenic responses.

Section snippets

INTRODUCTION

The vestibular system provides the most important afferents for the control of head movements. Signals detected by the vestibular organs are conveyed to neck motoneurons with a minimum of one interneuron in the vestibular nuclei, the vestibulocollic neuron. The most basic circuitry for the vestibulocollic reflexes (VCRs) is, therefore, a three neuron arc that consists of primary vestibular afferents, vestibulocollic neurons and neck motoneurons; the two major components of vestibulocollic

MATERIALS AND METHODS

We examined 15 patients recruited consecutively from the inpatients of our institute, 10 females and 5 males (mean age 44.5±10.3; range 26–59 years), affected by definite (n=9) and probable (n=6) MS, according to Poser et al.’s criteria [25].

Among all, 9 (60%) complained about vertigo, 10 (66.7%) showed electronystagmographic abnormalities, consistent with brainstem vestibular involvement. Brainstem auditory-evoked responses (BAERs) suggesting ponto-mesencephalic involvement was found in 8 out

RESULTS

VEMPs were obtained in all patients and results are summarised in Table 1. Examples of responses recorded in a control subject and in a MS patient are reported in Fig. 1.

For both groups, the main response component was a well-defined biphasic, initially positive, p13–n23 waveform, which was taken as the click-evoked myogenic potentials. Individual p13 latency was beyond normal upper limits in 8 out of 15 patients (53.3%), bilaterally in 5, unilaterally in 3; 2 of the latter exhibited also a

DISCUSSION

The aim of the present study was primarily to determine the changes of VEMPs in MS and their physiopathogenetic mechanism; secondly if they could represent a sensitive tool, to be employed for clinical purposes, to detect vestibulospinal involvement in MS patients.

As regards the first point, we found that in most patients VEMPs were altered in p13 latency (mean delay: 2.2 ms) or p13–n23 amplitude (mean loss: 131.6 μV); they had values beyond normal ranges of latency in 8 out of 15 patients

Acknowledgements

This study was, in part, supported by the Grant No. 99.00627.CT12 of the Italian National Research Council.

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