Abstract:Vestibular-evoked myogenic potentials (VEMPs) are short-latency muscle reflexes typically recorded from the neck or eye muscles with surface electrodes. They are used clinically to assess otolith function, but are also interesting as they can provide information about the vestibular system and its activation by sound and vibration. Since the introduction of VEMPs more than 25 years ago, VEMPs have inspired animal and human research on the effects of acoustic vestibular stimulation on the vestibular organs, the… Show more
“…Although there are still some controversies, oVEMPs may represent activation of the contralateral vestibulo-ocular reflex and reflect predominantly utricular and superior vestibular nerve functions (7). Consequently, VEMPs have become a popular evaluation measure of the otolith function over the past 20 years (8).…”
Objective: The objective of our study was to investigate the potential association between the occurrence of benign paroxysmal positional vertigo (BPPV) and saccular dysfunction using cervical vestibular evoked myogenic potentials (cVEMP) testing.Methods: The databases including Pubmed, Embase, and CENTRAL were systemically searched for case-control literatures investigating saccular dysfunction using cVEMP testing in BPPV patients compared with healthy controls. The literatures were published up to 16 April 2019 and were limited to the English language. All statistical processes were carried out using software Review Manager, version 5.3. Subgroup analysis and sensitive analysis were performed simultaneously.Results: Of the 12 case-control studies confirmed for meta-analysis, p13 latency of cVEMP was assessed in 8 studies, n23 latency in 6 studies, amplitude in 5 studies, asymmetry ratio (AR) in 3 studies, proportion of absent response in 9 studies, and abnormal cVEMP in 8 studies. Compared with healthy controls, the p13 mean latency of cVEMP was longer (MD = 0.88, 95% CI = 0.64–1.12, p < 0.00001), the mean amplitude was lower (SMD = −0.60, 95% CI = −0.80 to −0.41, p < 0.00001), and the proportions of absent response (OR = 8.76, 95% CI = 2.28–33.61, p = 0.002), and abnormal cVEMP (OR = 7.47, 95% CI = 4.65–12.01, p < 0.00001) were higher in BPPV patients. But there was no significant difference in the n23 mean latency (MD = 0.37, 95% CI = −0.23–0.98, p = 0.22) and the AR of cVEMP (MD = 3.95, 95% CI = −4.75–12.65, p = 0.37) between BPPV patients and healthy controls. In the sub-group analysis based on age, only the result of the proportion of absent response of cVEMP indicated a significant difference existed (p = 0.002) between the studies with age-matched controls (OR = 2.78, 95% CI = 1.09–7.10, p = 0.03) and the studies without age-matched controls (OR = 53.85, 95% CI = 10.09–287.13, p < 0.00001). In the sub-group analysis of the proportion of abnormal cVEMP according to the diagnostic criteria of abnormal cVEMP, the result indicated no significant difference existed between the four groups (p = 0.61, I2 = 0%). In the sensitivity analysis, we obtained the consistent results after removing each study sequentially.Conclusion: The meta-analysis reveals that saccular dysfunction may be associated with BPPV occurrence, and neural degeneration in the saccular macula may be a potential pathogenesis for BPPV.
“…Although there are still some controversies, oVEMPs may represent activation of the contralateral vestibulo-ocular reflex and reflect predominantly utricular and superior vestibular nerve functions (7). Consequently, VEMPs have become a popular evaluation measure of the otolith function over the past 20 years (8).…”
Objective: The objective of our study was to investigate the potential association between the occurrence of benign paroxysmal positional vertigo (BPPV) and saccular dysfunction using cervical vestibular evoked myogenic potentials (cVEMP) testing.Methods: The databases including Pubmed, Embase, and CENTRAL were systemically searched for case-control literatures investigating saccular dysfunction using cVEMP testing in BPPV patients compared with healthy controls. The literatures were published up to 16 April 2019 and were limited to the English language. All statistical processes were carried out using software Review Manager, version 5.3. Subgroup analysis and sensitive analysis were performed simultaneously.Results: Of the 12 case-control studies confirmed for meta-analysis, p13 latency of cVEMP was assessed in 8 studies, n23 latency in 6 studies, amplitude in 5 studies, asymmetry ratio (AR) in 3 studies, proportion of absent response in 9 studies, and abnormal cVEMP in 8 studies. Compared with healthy controls, the p13 mean latency of cVEMP was longer (MD = 0.88, 95% CI = 0.64–1.12, p < 0.00001), the mean amplitude was lower (SMD = −0.60, 95% CI = −0.80 to −0.41, p < 0.00001), and the proportions of absent response (OR = 8.76, 95% CI = 2.28–33.61, p = 0.002), and abnormal cVEMP (OR = 7.47, 95% CI = 4.65–12.01, p < 0.00001) were higher in BPPV patients. But there was no significant difference in the n23 mean latency (MD = 0.37, 95% CI = −0.23–0.98, p = 0.22) and the AR of cVEMP (MD = 3.95, 95% CI = −4.75–12.65, p = 0.37) between BPPV patients and healthy controls. In the sub-group analysis based on age, only the result of the proportion of absent response of cVEMP indicated a significant difference existed (p = 0.002) between the studies with age-matched controls (OR = 2.78, 95% CI = 1.09–7.10, p = 0.03) and the studies without age-matched controls (OR = 53.85, 95% CI = 10.09–287.13, p < 0.00001). In the sub-group analysis of the proportion of abnormal cVEMP according to the diagnostic criteria of abnormal cVEMP, the result indicated no significant difference existed between the four groups (p = 0.61, I2 = 0%). In the sensitivity analysis, we obtained the consistent results after removing each study sequentially.Conclusion: The meta-analysis reveals that saccular dysfunction may be associated with BPPV occurrence, and neural degeneration in the saccular macula may be a potential pathogenesis for BPPV.
“…Since its first description by Colebatch and Halmagyi in 1992, VEMP has become a significant part of the vestibular test battery as an objective measurement tool. Although VEMP testing is mainly used for assessing otolith functions in clinical settings, it has also been used to evaluate the effects of sound stimuli on vestibular reflexes and otolithic projections to various muscular groups and the brain (Rosengren and Colebatch, 2018).…”
“…Cervical VEMP (cVEMP) measures the inhibitory myogenic potentials of the ipsilateral tensed sternocleidomastoid muscle (sacculo-collic reflex) and is considered to evaluate saccular vestibular signals conducted via the vestibulospinal tract (Rosengren et al., 2010; Rosengren and Kingma, 2013; Rosengren and Colebatch, 2018). Ocular VEMP (oVEMP) obtains the excitatory contralateral inferior oblique muscle potentials (utriculo-ocular reflex) and is considered to measure vestibular functions from the utricle to the oculomotor nucleus, including the superior vestibular nerve and the contralateral medial longitudinal fasciculus (Rosengren et al., 2010; Rosengren and Kingma, 2013; Rosengren and Colebatch, 2018; Bayram et al., 2018). Fig.…”
Although the exact mechanism and most involved region of the vestibular system have not yet been fully clarified, vestibular dysfunction has been demonstrated in patients with diabetes mellitus (DM). Vestibular evoked myogenic potential (VEMP) is a short latency electromyographic response to sound or vibration stimuli that may reflect otolith organ or related reflex functions. Since its first description in 1992, VEMP has become a significant part of the vestibular test battery as an objective measurement tool. In diabetic patients, VEMP responses have been studied in order to determine any otolith organ or related reflex dysfunctions. Here, we review the literature with regard to VEMP findings representing any peripheral vestibular end-organ dysfunction in patients with DM. Distinctive vestibular end-organ impairments seem to be demonstrated in patients with DM either with or without DNP via objective vestibular testing tools including VEMP recordings according to relevant studies. However, further studies with larger sample sizes are required to reveal the more definitive findings of VEMP recordings regarding the vestibular pathologies in patients with DM.
“…Vestibular evoked myogenic potentials (VEMPs) have been widely adopted as a practical and effective measure of function of otolith pathway in central and peripheral vestibular disorders (1,2). VEMPs can be recorded from the contracted sternocleidomastoid muscle (cervical VEMPs or cVEMPs) (3) and the inferior oblique muscle (ocular VEMPs or oVEMPs) (4).…”
Objective: To compare utricular dysfunction with saccular dysfunction in benign paroxysmal positional vertigo (BPPV), based on ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP), respectively. Materials and Methods: We performed a literature search exploring utricular and saccular dysfunction in BPPV patients through June 2020 using oVEMP and cVEMP, respectively. The databases included Pubmed, Embase, CENTRAL, CNKI, Wan Fang Data, and CBM. The literatures were limited to Chinese and English. Inclusion criteria and exclusion criteria were defined. We adopted abnormal rate as the outcome. All statistical processes were conducted through software Review Manager. Considering the air-conducted sound (ACS) and bone conducted vibration (BCV) may have different mechanisms, and three types of diagnostic criteria for abnormal VEMP were available, subgroup analysis was performed simultaneously according to the sound stimuli and the diagnostic criteria of abnormal VEMP. Results: We retrieved 828 potentially relevant literatures, and finally 12 studies were included for meta-analysis of abnormal rate after duplication removal, titles and abstracts screening, and full-text reading. The abnormal rate of oVEMP was not significantly different from cVEMP (OR = 1.59, 95% CI = 0.99-2.57). But the abnormal rate was obviously different between the subgroups adopting ACS oVEMP and BCV oVEMP. In studies adopting ACS oVEMP, the abnormal rate of oVEMP was higher than cVEMP (OR = 1.85, 95% CI = 1.38-2.49). The abnormal rate of oVEMP was also higher than cVEMP when adopting asymmetry ratio (AR) and no response (NR) as diagnostic criteria (OR = 2.16, 95% CI = 1.61-2.89). Conclusion: The meta-analysis reveals that utricular dysfunction may be more predominant in BPPV compared with saccular dysfunction.
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