Evaluation of vestibular system using c-VEMP and o-VEMP in patients with relapsing-remitting multiple sclerosis

Abstract

Objectives:This study aims to evaluate the role of vestibular evoked myogenic potentials (VEMPS; the cervical VEMP [cVEMP] and the ocular VEMP [oVEMP]) in the vestibular system in patients with relapsing-remitting multiple sclerosis (RRMS). Patients and Methods:Between December 2016 and December 2017, a total of 42 ears of 21 RRMS patients (8 males, 13 females; mean age 41 years; range, 25 to 57 years) and 42 ears of 21 healthy controls (7 males, 14 females; mean age 44 years; range, 38 to 62 years) were included. All participants underwent neurological evaluation, brain magnetic resonance imaging (MRI), audiometry, tympanometry, and stapedial reflex testing. Their oVEMPs and cVEMPs were recorded.Results: For cVEMP testing, the mean P1 and N1 latencies of the left ears of RRMS patients were significantly higher compared to the controls. There was no significant difference between patients and controls in terms of the P1-N1 interval or mean amplitude of the left ear (p>0.05). The P1 and N1 latencies and the mean P1-N1 interval of the right ears of RRMS patients were significantly higher than the controls (p=0.019, p=0.001, p=0.004; p<0.05, respectively). There was no significant difference in the amplitudes or amplitude asymmetry ratios (AARs) of either ear between patients and controls (p>0.05 for all). The P1 and N1 latencies were prolonged in 13 (42%) of 42 RRMS ears and 27 ears (64%), respectively. For oVEMP testing, eight patients (19%) had no response in the oVemp test of the right ear (n=4) and left ear (n=4) of RRMS patients. There was no significant difference in P1 or N1 latencies or the P1-N1 interval, amplitude or AAR of right ears between the patients and controls (p>0.05 for all). The P1 and N1 latencies were prolonged in 26 (62%) of RRMS ears and 27 ears (64%), respectively. Conclusion:Based on our study results, VEMPs are useful for the evaluation of central vestibulopathies. The VEMP testing can diagnose brainstem lesions in RRMS patients quickly, easily, and safely without pain, although MRI shows no brainstem involvement. The VEMP testing is an electrophysiological test which can detect early stage pathologies of the vestibular system.

Relation Between Cervical and Ocular Vestibular Evoked Myogenic Potentials and Brainstem Symptoms and Mri Lesions in Multiple Sclerosis Patients

“…In cVEMP testing of 42 ears of 21 relapsing-remitting multiple sclerosis (RRMS) patients, Tutar et al [17] found that the mean P1 and N1 latencies of the left ears of RRMS patients were significantly higher compared to the controls. There was no significant difference between patients and controls in terms of the P1-N1 interval or mean amplitude of the left ear (p>0.05).…”

“…For oVEMP testing, Tutar et al [17] found that 8 RRMS patients (19%) had no response in the oVEMP test of the right ear (n = 4) and left ear (n = 4). There was no significant difference in P1 or N1 latencies or the P1-N1 interval, amplitude of right ears, or amplitude asymmetry ratio between the patients and controls (p>0.05 for all).…”

“…Abnormal results of both types of VEMP in patients with MS implicate lesions of the brainstem, despite normal MRI and/or neurological examination [35,36]. Tutar et al [17] concluded that VEMPs are useful for the evaluation of central vestibulopathies. VEMP testing can diagnose brainstem lesions in RRMS patients quickly, easily, and safely without pain, even when MRI shows no brainstem involvement.…”