Ocular and cervical vestibular evoked myogenic potentials in multiple sclerosis patients
Highlights
► Multiple sclerosis patients showed high frequency of abnormality in vestibular evoked myogenic potentials (VEMPs) tests, especially in ocular VEMP tests. ► VEMP abnormalities were not correlated with brainstem clinical or magnetic resonance imaging lesions. ► VEMP abnormalities were significantly correlated with expanded disability status scale (EDSS).
Introduction
Multiple sclerosis (MS) is a chronic demyelinating disease involving the white matter of the central nervous system. The signs and symptoms of the disease, clinical course and response to treatment are different in every case. Although magnetic resonance imaging (MRI) is the most important test in the diagnosis of MS, besides being an objective indicator of involvement of the related pathways, evoked potentials are also important in the diagnosis of MS in terms of demonstrating subclinical demyelination (Chiappa, 1984, Comi et al., 1999, Fuhr and Kappos, 2001).
Vestibular evoked myogenic potentials (VEMPs) are short latency electromyographic (EMG) responses that can be recorded from various muscles during the contraction phase in response to acoustic stimulus (Debatisse et al., 2005, Rosengren et al., 2010, Akin et al., 2004, Zhou and Cox, 2004, Brantberg, 2009, Cherchi et al., 2009). VEMPs recorded from ipsilateral SCM muscle known as “cervical VEMP” (cVEMP) are a clinical demonstration of vestibulo-collic reflex (Rosengren et al., 2010, Brantberg, 2009, Park et al., 2010). The cVEMP pathway is believed to originate in the saccular macula and continues through the vestibular nerve and nucleus, the vestibulospinal tracts, spinal motor nucleus and SCM muscles (Rosengren et al., 2010, Park et al., 2010, Bektas et al., 2008). cVEMP responses are characterized by biphasic waves with initial positivity (p13) followed by a negative wave (n23). Recently, myogenic response recorded from contralateral extraocular muscles in response to acoustic stimuli has been reported to be a manifestation of crossed vestibulo-ocular reflex and named “ocular VEMP” (oVEMP). The oVEMP pathway is thought to travel through the medial longitudinal fasciculus (MLF), the oculomotor nuclei and nerves and the extraocular muscles after the activation of the vestibular nerve and nucleus (Rosengren et al., 2010). oVEMP responses are characterized by biphasic waves with an initial negative peak (n1) followed by a positive peak (p1).
The cVEMP test has become an important diagnostic tool, particularly in the evaluation of peripheral vestibular disorders. VEMPs are thought to provide useful information about brainstem functions, as the neural pathway of both VEMPs pass through the brainstem. While cVEMP descends via the vestibulospinal tract through the lower brainstem, oVEMP ascends via the MLF through the upper brainstem (Rosengren et al., 2007, Rosengren et al., 2010, Itoh et al., 2001, Tu and Young, 2004, Eleftheriadou et al., 2009, Lin et al., 2010).
Several studies have described cVEMP abnormalities in brainstem lesions, including research with MS patients (Itoh et al., 2001, Versino et al., 2002, Patko et al., 2007, Shimizu et al., 2000, Sartucci and Logi, 2002, Pollak et al., 2006, Bandini et al., 2004, Alpini et al., 2004, Aidar and Suzuki, 2005). There are only a few reports about the diagnostic value of oVEMP in brainstem lesions (Rosengren et al., 2007, Rosengren and Colebatch, 2011, Su and Young, 2011). But none has evaluated the correlation of oVEMP tests with both current and past clinical and MRI findings of MS patients.
We aimed to investigate the clinical value of ocular and cervical VEMP tests in the evaluation of brainstem involvement in MS patients and their value in detecting silent brainstem lesions and to assess their relations with clinical and cranial MRI findings.
Section snippets
Subjects
Sixty-two patients with definite MS according to the McDonald criteria and 35 healthy volunteers were included (Polman et al., 2005). All patients were examined using otoscopy and audiometric testing before the study. Subjects with abnormal audiometric tests and limited neck movements were excluded. The ethical committee approved the study, and informed consent was obtained from each subject.
Clinical and MRI examinations
All patients were questioned and examined for current brainstem or cerebellar clinical involvement.
Results
The MS group consisted of 40 females and 22 males (aged 16–55; mean age 34.7 ± 9.5) and the control group of 24 females and 11 males (aged 21–54; mean age 33.6 ± 9.7). There were no significant differences in age or gender among the groups (p = 0.59 for age and p = 0.85 for gender). Fifty-five patients had relapsing remitting MS (RRMS), 3 had primary progressive MS (PPMS) and 4 had secondary progressive MS (SPMS). Median duration of the disease was 60 months (mean 75.8 ± 70.7) and mean expanded disability
Discussion
The aim of this study was to investigate the clinical value of VEMP tests in the evaluation of the brainstem involvement in MS patients. We found higher abnormality ratios of both VEMPs in MS patients compared to the controls, but no correlation was observed with the brainstem clinical or MRI findings.
Evoked potential latency prolongations suggestive of a demyelinating process are often seen in MS patients, and prolonged latencies of VEMP responses in MS patients have been reported in many
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