Vestibular-evoked myogenic potentials, clinical evaluation, and imaging findings in multiple sclerosis

Abstract

Vestibular-evoked myogenic potentials (VEMP), short-latency electromyographic responses elicited by acoustic stimuli, evaluate the function of vestibulocollic reflex and may give information about brainstem function. The aim of the present study is to evaluate the potential contribution of VEMP to the diagnosis of multiple sclerosis (MS). Fifty patients with MS and 30 healthy control subjects were included in this study. The frequency of VEMP p1-n1 and n2-p2 waves; mean p1, n1, n2, and p2 latency; and mean p1-n1 and n2-p2 amplitude were determined. The relation between clinical and imaging findings and VEMP parameters was evaluated. The p1-n1 and n2-p2 waves were more frequently absent in MS than in control subjects [p1-n1 wave absent: MS, 25 (25 %) ears; control, 6 (10 %) ears; P ≤ 0.02] [n2-p2 wave absent: MS, 44 (44 %) ears; control, 7 (12 %) ears; P ≤ 0.001]. The mean p1-n1 amplitude was lower in MS than in control subjects (MS, 19.1 ± 7.2 μV; control, 23.3 ± 7.4 μV; P ≤ 0.002). A total of 24/50 (48 %) MS patients had VEMP abnormalities (absent responses and/or prolonged latencies). VEMP abnormalities were more frequent in patients with than without vestibular symptoms (P ≤ 0.02) and with brainstem functional system score (FSS) ≥ 1 than FSS = 0 (P ≤ 0.02). In patients with MS, absence of p1-n1 wave was more frequent in patients with than without vestibular symptoms [absence of p1-n1 wave: vestibular symptoms, 9 (45 %) ears; no vestibular symptoms, 16 (20 %) ears; P ≤ 0.03] and patients with Expanded Disability Status Scale (EDSS) score ≥ 5.5 [absence of p1-n1 wave: EDSS ≥ 5.5, 7 (70 %) ears; EDSS <5.5, 18 (20 %) ears; P ≤ 0.001]. Abnormal VEMP may be noted in MS patients, especially those with vestibular symptoms and greater disability. The VEMP test may complement other studies for diagnosis and follow-up of patients with MS.

The vestibular evoked myogenic potentials (VEMP) score: a promising tool for evaluation of brainstem involvement in multiple sclerosis

“…Also none of the patients had history/current symptoms/signs of peripheral vestibular disease that could influence VEMP results. Two studies have shown that conduction block is the most frequent pathology amongst MS patients and that conduction block of the cVEMP is more frequent in patients with vestibular symptoms and a higher EDSS . The current study has shown that MS patients with clinically evident brainstem involvement have a significantly higher percentage of conduction block in both oVEMP and cVEMP responses compared with MS patients without clinically evident brainstem involvement.…”

Aplicações dos potenciais evocados miogênicos vestibulares: revisão sistemática de literatura

“…Regarding the design, eight (29%) studies were descriptive (5)(6)(16)(17)(18)28,(30)(31) ,19 (68%) were comparative cross-secti onal (7)(8)(9)(10)(12)(13)(14)(15)(19)(20)(21)29,(32)(33)(34)(35)(36)(37)(38) , and one (3%) was longitudinal cohort (39) .…”

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

“…Some reports described abnormal VEMP responses in MS patients, including latency extensions and even non-responses. [3][4][5][6][7][8]11,12,18] However, latency extension in the VEMP test and unresponsiveness also occur in those with acoustic neurinomas and Meniere's disease; such abnormalities are not specific to MS. Thus, the proportion of MS patients exhibiting abnormal VEMP responses widely varies (i.e., from 18 to 100%).…”

“…The cVEMP is a marker for the integrity of the vestibulocollic reflex (VCR) pathway and the oVEMP denotes the integrity of the vestibuloocular reflex (VOR) pathway. [7][8][9] The VEMPs show a problem in the reflex pathway, even in the absence of a topographic analysis.…”

“…The VEMPs can be used to diagnose various otological and neurological diseases including Meniere's disease, superior semicircular canal dehiscence, vestibular migraine, brainstem involvement due to cerebrovascular disease. [6,7] A reflex response evident in the SCM is considered a cervical VEMP (cVEMP), while a response in the extraocular muscles is considered an ocular VEMP (oVEMP). The cVEMP is a marker for the integrity of the vestibulocollic reflex (VCR) pathway and the oVEMP denotes the integrity of the vestibuloocular reflex (VOR) pathway.…”