Vestibular Evoked Myogenic Potentials in Patients with Idiopathic Bilateral Vestibulopathy

Matsuzaki, Masaki; Murofushi, Toshihisa

doi:10.1159/000055772

Cited by 34 publications

(25 citation statements)

References 15 publications

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“…For example, lesions of the semicircular canals cause ipsilaterally enhanced VEMP amplitudes in the superior canal dehiscence syndrome [5,30], and labyrinth hydrops due to Menière's disease causes decreased or absent amplitudes in later stages [1,12,27,32,46]. VEMPs were reported to be bilaterally absent in two of three patients with peripheral bilateral vestibulopathy [28]. However, in central disorders such as brainstem stroke the situation of the VEMPs is far from clear.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, VEMPs have become increasingly accepted as a reliable method of assessing otolith function [45,47]. They have been applied in cases of peripheral vestibular diseases such as Menière's disease [1,12,27,32,46], vestibular neuritis [8,35], vestibular schwannomas [31,40], bilateral vestibulopathy [28], and superior semicircular canal dehiscence [5,30].…”

Section: Introductionmentioning

confidence: 99%

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Vestibular-evoked myogenic potentials in vestibular migraine

2009

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Sound-induced vestibular-evoked myogenic potentials (VEMPs) can be used to investigate saccular function, measured from the tonically contracted sternocleidomastoid muscles (SCM) in response to loud sound stimuli. The aim of the present study was to assess VEMPs in patients with vestibular migraine and to determine whether saccular function is affected by the disease. Furthermore, tests such as tilts of subjective visual vertical (SVV) and caloric testing were conducted to test whether deficits in the various tests are associated with each other. The amplitude and latency of VEMPs were measured from the SCM in 63 patients with vestibular migraine (median age 47 years; range 24-70 years) and compared with those of 63 sex- and age-matched healthy controls (median age 46 years; range 17-73 years). Of the 63 patients with vestibular migraine, 43 (68%) had reduced EMG-corrected VEMP amplitudes compared to the controls. Thus, the mean of the p13-n23 amplitudes of the vestibular migraine patients were 1.22 (SE +/-0.09) for the right and 1.21 (SE +/-0.09) for the left side, whereas the averaged amplitudes of the 63 healthy controls showed a mean of 1.79 (SE +/-0.09) on the right and of 1.76 (SE +/-0.09) on the left. No difference was seen in the latencies and there was no correlation between VEMP amplitudes, tilts of SVV and caloric testing. Our data on patients with vestibular migraine indicate that the VEMP amplitudes are significantly and bilaterally reduced compared to those of controls. This electrophysiological finding suggests that both peripheral vestibular structures, such as the saccule, but also central vestibular structures are affected. Thus, beside the brainstem, structures in the inner ear also seem to contribute to vertigo in vestibular migraine.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vestibular-evoked myogenic potentials in vestibular migraine

2009

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“…In one study [21] 2 out of the 3 patients showed a bilateral absence of VEMPs and one patient a unilateral absence; in the other study the 2 patients examined revealed a unilateral absence of VEMPs with both acoustic and short-duration galvanic stimuli [12]. We assessed saccular function with VEMPs and horizontal SCC function with caloric irrigation and head-thrust test in 84 patients with BV in order to (1) evaluate the frequency and extent of saccular dysfunction in BV and (2) to correlate the saccular with the horizontal SCC dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…Only a few case reports are available on VEMPs in patients with BV [12,21]. In one study [21] 2 out of the 3 patients showed a bilateral absence of VEMPs and one patient a unilateral absence; in the other study the 2 patients examined revealed a unilateral absence of VEMPs with both acoustic and short-duration galvanic stimuli [12].…”

Section: Introductionmentioning

confidence: 99%

Saccular function less affected than canal function in bilateral vestibulopathy

et al. 2008

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Bilateral vestibulopathy (BV) is characterized by impaired or lost function of both labyrinths or eighth nerves. The diagnosis is routinely established by the head-thrust test, caloric irrigation and rotational testing with electronystagmography to determine the high- and low-frequency deficit of the vestibulo-ocular reflex. All three methods evaluate semicircular canal function only. Vestibular-evoked myogenic potentials (VEMPs) provide a measure of saccular otolith function. The aim of this study was to evaluate the frequency and extent of saccular dysfunction in patients with BV and to correlate saccular with horizontal semicircular canal dysfunction. A total of 84 BV-patients (23 females, mean age 62 +/- 15 (SD) years at the time of diagnosis assessment) were examined with VEMPs, electronystagmography with caloric irrigation and a standardized neuro-ophthalmological and -otological examination; 47 healthy subjects (18 females, mean 56 +/- 19 years) served as controls. Amplitudes P1-N1 were significantly lower in patients with BV compared to controls (mean P1-N1 of all ears 82.1 +/- 50.7 microV in the patients vs. 130.8 +/- 85.9 microV in healthy volunteers). VEMPs were absent unilaterally in four patients with BV and in none bilaterally. In contrast, caloric responses were absent bilaterally in 40 patients. There was no correlation between amplitude P1-N1 and caloric-induced nystagmus. The latencies P1 and N1 were not significantly different between patients and controls. Thus, in our study population saccular function appeared to be less affected than horizontal semicircular canal function.

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“…In severely affected cases, patients have oscillopsia while moving their body or the head. Some patients with IBV have been reported to show an absence of VEMP [14,21], suggesting that IBV affects not only the SVN but also IVN systems. However, so far there have been no reported idiopathic cases whose bilateral IVN systems are affected in spite of sparing the bilateral SVN systems.…”

Section: Introductionmentioning

confidence: 99%

Novel subtype of idiopathic bilateral vestibulopathy: bilateral absence of vestibular evoked myogenic potentials in the presence of normal caloric responses

et al. 2009

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To characterize clinical features of those patients who showed an absence of vestibular evoked myogenic potential (VEMP) responses in the presence of normal caloric responses bilaterally, we reviewed clinical records of 1,887 consecutive outpatients who complained of balance problems, and identified three patients, who showed absent VEMPs in the presence of normal caloric responses bilaterally with unknown causes. All three patients had episodes of recurrent vertigo without spontaneous, gaze-evoked, or positional nystagmus at the time of examination. They complained of oscillopsia while moving their body or head and showed positive Romberg's signs. Drawing on these cases, we underscore the importance of examining the function of the inferior vestibular nerve system, even with no nystagmus and normal caloric findings, in patients complaining of dizziness or oscillopsia during locomotion.

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Vestibular Evoked Myogenic Potentials in Patients with Idiopathic Bilateral Vestibulopathy

Cited by 34 publications

References 15 publications

Vestibular-evoked myogenic potentials in vestibular migraine

Vestibular-evoked myogenic potentials in vestibular migraine

Saccular function less affected than canal function in bilateral vestibulopathy

Novel subtype of idiopathic bilateral vestibulopathy: bilateral absence of vestibular evoked myogenic potentials in the presence of normal caloric responses

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