Vestibular Migraine Patients Show Lack of Habituation in Auditory Middle Latency Responses to Repetitive Stimuli: Comparison With Meniere's Disease Patients

Abstract

Objectives: To compare habituation in auditory middle latency response (AMLR) to repetitive stimuli of vestibular migraine (VM) patients with Meniere's disease (MD) patients and healthy controls (HC) and to assess usefulness of AMLR for diagnosis of VM.Subjects: Thirteen unilateral definite MD patients (2 men, 11 women, mean age 50.6), 13 definite VM patients (3 men, 10 women, mean age 45.5), and 8 HC subjects (2 men, 6 women, mean age 37.1) were enrolled. Methods:The electrodes were placed on the vertex and the spinal process of the fifth cervical vertebra. Binaural click stimulation (0.1 ms, 70 dBnHL) was presented. A total of 800 responses were averaged. Averaged responses were divided into four sets (S1 to S4) according to the temporal order. No, Po, Na, and Pa were identified, and amplitudes and latencies were measured.Results: Concerning latencies, HC subjects showed a tendency of shorter latencies. However, there was no clear effect of repetitive stimulation. Concerning No-Po amplitudes, no significant differences were observed. Raw amplitudes of Na-Pa showed statistically significant differences in S1 and S2 among the groups (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM in S1 (smaller in VM) (p < 0.01 Bonferroni's test) and in MD vs. VM in S2 (smaller in VM) (p < 0.01 Bonferroni test). Relative amplitudes of Na-Pa to S1 showed statistically significant differences in S4 (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM (larger in VM) (p < 0.01 Bonferroni's test). Differences of Na-Pa amplitudes in S2 to S4 from Na-Pa amplitude in S1 were significant in S4 of VM patients (Dunnett's test).Conclusions: VM patients showed lack of habituation (potentiation) of Na-Pa amplitude in AMLR to repetitive stimuli while MD patients and HC subjects showed habituation. Observation of lack of habituation has high diagnostic accuracy for differential diagnosis of VM from MD.

Red ear syndrome presenting with vestibular migraine: case study and review of the literature

“…Middle latency response testing was reported as useful for diagnosing vestibular migraine in 13 definite Ménière's disease patients, 13 vestibular migraine patients and 8 control subjects. 7 The potentiation of middle latency responses was positive in our case. Therefore, such testing may also be useful for the diagnosis of this type of red ear syndrome with vestibular migraine.…”

Diagnosis of Patients Presenting with Vertigo, Headache, and Epileptic Seizure: Evaluating Vestibular Patients by Using Cervical Vestibular Evoked Myogenic Potential and Auditory Middle Latency Responses in the Clinical Setting

“…Because headache is often absent during acute attacks, other migraine features have to be identified by thorough history taking, and vestibular testing serves mainly to exclude other diagnoses. 13 On this point, Murofushi et al 4 showed that migraine patients lack habituation (are potentiated) to repetitive stimuli in AMLR. Potentiation to repetitive stimuli has been reported with various evoked potentials in migraine patients.…”

“…Auditory mid-latency responses were recorded by using the Neuropack system, following the same method as that described by Murofushi et al 4 No was defined as the largest negative deflection that followed wave 5 of the auditory brain response and was earlier than 15 ms. Po was defined as the largest positive deflection that followed No and was earlier than 20 ms. Na was defined as the largest negative deflection that followed Po and was earlier than 25 ms. When No was not found, the earliest negative deflection that followed wave 5 and was earlier than 25 ms was regarded as Na.…”

“…According to Murofushi et al 4 the Na-Pa amplitude in S4 relative to that in S1 of >1.11 times can be regarded as indicating potentiation (lack of habituation).…”

“…Another tool used in the clinical setting is auditory mid-latency response (AMLR) which is used to investigate habituation to repetitive stimuli in VM patients with MD. 4 …”