Vestibular-evoked myogenic potentials: A method to assess vestibulo-spinal conduction in multiple sclerosis patients
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.
References (34)
- et al.
Delayed visual evoked responses in optic neuritis
Lancet
(1972) - et al.
Convergence and interaction of neck and macular vestibular inputs on reticulospinal neurons
Neuroscience
(1984) - et al.
Vestibulocollic reflexes: Normal values and the effect of age
Clin. Neurophysiol.
(2001) - Aminoff, M. J. Electrodiagnosis in clinical neurology, 4th ed. New York: Churchill Livingstone;...
- et al.
Nature of average evoked responses to sound and other stimuli in man
Ann. N. Y. Acad. Sci.
(1964) - et al.
Averaged evoked myogenic potentials to sound in man
Ann. Otol. Rhinol. Laryngol.
(1964) - et al.
Vestibular evoked potential in human neck muscles before and after unilateral vestibular deafferentation
Neurology
(1992) - et al.
Vestibular-evoked EMG responses in human neck muscles
J. Physiol.
(1993) - et al.
Myogenic potentials generated by a click-evoked vestibulocollic reflex
J. Neurol. Neurosurg. Psychiatr.
(1994) Click-evoked vestibulocollic reflexes: Normal values and age-related changes
Aust. N Z J. Med.
(1994)
Vestibular evoked potentials
Curr. Opin. Neurol.
Acoustic responses from the saccular bundle on the eight nerve of the guinea pig
Hear Res.
Vestibular evoked myogenic potentials in human: A review
Acta Otolaryngol. (Stockh)
Pathophysiology of demyelinating disease
Br. Med. Bull.
Vestibular evoked myogenic potential in the sternomastoid muscles are not of lateral canal origin
Acta Otolaryngol. (Stockh)
Click-evoked myogenic potentials in the differential diagnosis of acute vertigo
J. Neurol. Neurosurg. Psychiatr.
Neck muscle response to abrupt free fall of the head: Comparison of normal with labyrinthine-defective human subjects
J. Physiol.
Cited by (59)
Why and when to refer patients for vestibular evoked myogenic potentials: A critical review
2019, Clinical NeurophysiologyThe role of vestibular evoked myogenic potentials in multiple sclerosis-related vertigo. A systematic review of the literature
2019, Multiple Sclerosis and Related DisordersCitation Excerpt :The presence of vertigo and presence of WMHs was significantly correlated when the lesions were in the brain (Spearman: p < 0.001) both in early and late stage MS; in late stage MS, the correlation was statistically significant only for lesions in the peripheral pathways such as the IAC (Spearman: p < 0.01). Twenty out of 76 articles (26.3%, for a total of 512 patients) reported details on VEMPs in MS patients (Hellmann et al., 2011; Dispenza and De Stefano, 2012; Zhou et al., 2004; Eleftheriadou et al., 2009; Escorihuela Garcia et al., 2013; Itoh et al., 2001; Sartucci and Logi, 2002; Gazioglu and Boz, 2012; Patkò et al., 2007; Alpini et al., 2004; Parsa et al., 2015; Murofushi et al., 2001; Güven et al., 2014; Gabelic et al., 2015; Versino et al., 2002; Magnano et al., 2014; Ivankovic et al., 2013; Crnošija et al., 2017; Ferber-Viart et al., 1999; Oh et al., 2016). One-hundred seventy-nine patients (34.9%) reported vertigo and 333 (65.1%) reported dizziness.
Aging and wave-component latency delays in oVEMP and cVEMP: a systematic review with meta-analysis
2017, Brazilian Journal of OtorhinolaryngologyVestibular evoked myogenic potentials (VEMPs) in central neurological disorders
2016, Clinical NeurophysiologyCitation Excerpt :The variation in sensitivity between the studies could be explained by a difference in patients’ disease characteristics (some studies contain substantially more multiple sclerosis patients with a longer disease duration, or have more patients with progressive forms of multiple sclerosis than other studies). Most studies (Alpini et al., 2004; Bandini et al., 2004; Güven et al., 2014; Harirchian et al., 2013; Ivankovic et al., 2013; Patkó et al., 2007; Sartucci and Logi, 2002) also did not correct the cVEMP amplitudes (i.e. by using the rectified mean pre-stimulus EMG background signal at the desired level of sternocleidomastoid muscle contraction to correct the raw p13n23 amplitude from the unrectified EMG signal), or by standardizing the level of sternocleidomastoid muscle contraction (for instance with a pressure gauge to assure that the same level of force is applied during muscle contraction at both sides and between measurements as described by Vanspauwen et al. (2006)). The raw p13n23 cVEMP amplitudes of groups, sides within the same patient, or measurements within the same patient at different moments cannot be reliably compared unless standardization and correcting methods, as described above, are used (i.e. changes in the level of muscle contraction will influence the raw p13n23 amplitude) (Colebatch et al., 1994; Rosengren et al., 2010).
Cervical and ocular vestibular evoked potentials in Machado–Joseph disease: Functional involvement of otolith pathways
2015, Journal of the Neurological SciencesThe effect of alcohol on cervical and ocular vestibular evoked myogenic potentials in healthy volunteers
2014, Clinical Neurophysiology