Two distinct patterns of VEMP changes with age

doi:10.1016/j.clinph.2013.04.337

Clinical Neurophysiology

Volume 124, Issue 10, October 2013, Pages 2066-2068

https://doi.org/10.1016/j.clinph.2013.04.337 Get rights and content

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Cited by (28)

Age-related deterioration of saccule-related neural function is associated with decreased estimated glomerular filtration rate and increased free thyroxine
2019, Clinical Neurophysiology
Citation Excerpt :
In this study, ageing-related deterioration of saccule-related neural function was reaffirmed. Indeed, unlike the function of semicircular canal that yet remains controversial in term of ageing-effect (McGarvie et al., 2015; Kim and Kim, 2018), the deterioration of neural function originating from the saccule with ageing has been consistent across the studies (Colebatch et al., 2013; Zu Eulenburg et al., 2017). However, the different impact of ageing on the function of canal and saccule should be evaluated further.
This study attempted to identify systemic factors for age-related decline in neural function originating from the saccule using cervical vestibular-evoked myogenic potentials (cVEMP) parameters.
We recruited 129 symptomatic vertiginous patients who did not have known disorder affecting the cVEMP pathway (mean age = 52.4 ± 13.9). The indicators of saccule-related neural function were the sum of normalized cVEMP amplitude (SNA) and the average of p13 latency on both sides (average latency, AL). Any associations between cVEMP and systemic factors were evaluated using a linear regression.
SNA decreased with ageing (p < 0.001) in univariable regression. The estimated glomerular filtration rate (eGFR) was positively associated with SNA (p = 0.002). Hematocrit, C-reactive protein, vitamin D, and free thyroxine (T4) showed a trend of association with SNA (p < 0.2). SNA was associated with ageing, increased free T4, and decreased eGFR in multivariable analysis. In the subgroup analysis, SNA was significantly associated with free T4 in younger patients (mean age = 41.5 ± 9.91) but not in the older ones (mean age = 63.5 ± 6.54). AL did not show any significant associations with systemic factors.
Decreased eGFR and increased free T4 as well as aging may be risk factors for decline of saccule-related neural function.
Neural function originating from the saccule may be affected by systemic factors.
Electrode montage and gaze effects on ocular vestibular evoked myogenic potentials (oVEMPs)
2016, Clinical Neurophysiology
Citation Excerpt :
We propose therefore that the latency prolongation for the M-R1 montage using AC and BC impulses indicates that activation of the IR has become the dominant mechanism generating the oVEMP. We have previously provided evidence that the oVEMP to BC mastoid impulses is a manifestation of the tilt-evoked VOR (Colebatch et al., 2013) and depression of the eye is appropriate when the head is tilted as the eye would tend to be rotated upwards if depressed. This may also explain why the effect was less clear for the BC midline vibration – by stimulating both otoliths equally there would be no signal of head tilting.
To investigate the properties of lateral electrode locations compared to the conventional ones and to bipolar compared to chin-referenced montages for recording ocular vestibular evoked myogenic potentials (oVEMPs).
A total of 18 subjects were studied using 5 electrode locations around the eye, including the conventional location and more lateral ones (i.e. M, ML and L electrodes near the orbital margin, R₁ and R₂ electrodes below the two more medial ones). Unilateral air-conducted (AC) sound, bone-conducted (BC) impulses at the mastoid and BC vibration (500 Hz) at the forehead were used. These were applied while the subjects looked in neutral gaze and with 4 levels of increasing elevation. A subset of 10 subjects were also studied when looking downwards at 4 levels. Five bipolar montages were created offline by subtraction.
The M and ML electrodes had the largest responses but responses were seen for all 5 electrodes. The chin reference was associated with substantial pickup from the contralateral side (as judged using unilateral AC stimulation). The M-R₁ (conventional) montage showed a significantly non-linear response to gaze angle, unlike the ML montages. The ML-R₁ montage gave the largest responses. There was a clear change in latency for the conventional montage with downgaze for the AC and BC impulsive stimuli.
The ML active electrode has a more stable n1 latency, a larger and a more linear response to gaze angle than the conventional recording site, probably due to contamination by pickup of inferior rectus activity when using the conventional site.
The ML location is a better site for the active pickup for recording oVEMPs if the main object of study is the inferior oblique muscle and particularly if subjects have difficulty with upgaze.
Properties of 500 Hz air- and bone-conducted vestibular evoked myogenic potentials (VEMPs) in superior canal dehiscence
2016, Clinical Neurophysiology
To compare threshold and amplitude properties for air- (AC) and mastoid bone-conducted (BC) cervical (cVEMP) and ocular (oVEMP) vestibular evoked myogenic potentials in superior canal dehiscence (SCD).
Thirteen patients (53 ± 14 yrs) clinically diagnosed with SCD were tested using AC 500 Hz sound and BC 500 Hz transmastoid vibration. Baseline intensities of 135 dB pSPL and 138 dB pFL respectively were used and reduced until the response amplitudes were less than 2.5 standard deviations of the prestimulus baseline mean. SCD VEMP amplitudes, response gradients and threshold parameters for the initial peaks for the cVEMP (ipsilateral) and the oVEMP (contralateral) were compared with results for normal subjects over a range of intensities.
Despite higher amplitudes, reflex gradients against intensity for AC and BC cVEMPs were significantly less in SCD than normals (P ≪ 0.001) while AC and BC oVEMP gradients were not significantly different between the groups. Abnormally low thresholds for AC 500 Hz were present for 85% of cVEMPs and 62% of oVEMPs. Abnormally low BC 500 Hz thresholds were seen for 33% of cVEMPs and 83% of oVEMPs. Amplitudes for AC 500 Hz were compared over the 135–105 dB pSPL intensity range. The cVEMP showed more pathologically large amplitude responses with the lower stimulus intensities (135 dB pSPL: 5%, 105 dB pSPL: 100%) whereas the oVEMP demonstrated high rates of amplitude increases for all intensities (129–111 dB pSPL: 92%). The pattern of pathologically large amplitudes evoked by BC 500 Hz was similar for both reflexes such that both cVEMPs and oVEMPs showed maximum prevalence of abnormally large responses around 117 dB pFL (cVEMP: 58%, oVEMP: 83%).
In SCD, both AC and BC evoked cVEMPs show evidence of saturation but this is not evident for oVEMPs. Both cVEMPs and oVEMPs show frequent abnormalities of amplitudes and thresholds in SCD compared to normal subjects but the sensitivities differed between measures.
Previous evidence of saturation of cVEMP responses in SCD was confirmed. For diagnosis, AC cVEMP amplitudes at 105 dB pSPL or AC-evoked oVEMP amplitudes both have over 90% sensitivity in separating SCD from normal responses.
Vestibular-evoked myogenic potentials
2016, Handbook of Clinical Neurology
Citation Excerpt :
Age effects have also been shown for oVEMPs evoked by BC stimulation, but appear to depend upon the type of stimulus. oVEMPs evoked by tendon hammer taps and low-frequency pulses delivered with a minishaker are relatively robust against age effects (Nguyen et al., 2010; Colebatch et al., 2013), while those evoked by sine waves and short-duration square waves appear to be more susceptible (Iwasaki et al., 2008; Chang et al., 2012). Effects of age have also been found on oVEMP latency (i.e., prolonged peak latency with increasing age: Rosengren et al., 2011; Chang et al., 2012), but not symmetry (Tseng et al., 2010; Piker et al., 2011).
The vestibular-evoked myogenic potential (VEMP) is a short-latency potential evoked through activation of vestibular receptors using sound or vibration. It is generated by modulated electromyographic signals either from the sternocleidomastoid muscle for the cervical VEMP (cVEMP) or the inferior oblique muscle for the ocular VEMP (oVEMP). These reflexes appear to originate from the otolith organs and thus complement existing methods of vestibular assessment, which are mainly based upon canal function. This review considers the basis, methodology, and current applications of the cVEMP and oVEMP in the assessment and diagnosis of vestibular disorders, both peripheral and central.
Vestibular evoked myogenic potentials (VEMPs) in central neurological disorders
2016, Clinical Neurophysiology
Citation Excerpt :
Recently, international guidelines were published concerning the clinical application as well as standardization of cVEMPs (Papathanasiou et al., 2014) in both research and clinical testing. In addition, we would like to advise the acquisition of data from a healthy age-matched control group, particularly as amplitudes in acoustically elicited VEMPs decrease at advanced ages (Colebatch et al., 2013; Papathanasiou et al., 2014; Rosengren et al., 2011). As was discussed in the previous sections, most studies have the same methodological and technical concerns: (a) the control group is sometimes not correctly matched for age to the patient group, (b) most case-series do not have a control group at all resulting in laboratory’s own reference values being used, (c) the VEMP amplitudes are often not standardized for force of contraction, nor corrected by the raw mean pre-stimulus EMG background signal, and (d) most studies consist of small sized case-series or case–control studies with a few exceptions (mostly concerning diagnostic studies in Multiple Sclerosis, vestibular schwannomas, and vertebrobasilar stroke).
Several types of acoustic stimulation (i.e. tone bursts or clicks), bone-conducted vibration, forehead taps, and galvanic stimulation elicit myogenic potentials. These can be recorded in cervical and ocular muscles, the so called vestibular evoked myogenic potentials (VEMPs). The cervical VEMP (cVEMP) resembles the vestibulo-collic reflex and the responses can be recorded from the ipsilateral sternocleidomastoid muscle. The ocular VEMP resembles the vestibulo-ocular reflex and can be recorded from extra-ocular muscles by a surface electrode beneath the contralateral infraorbital margin. Initially, the literature concerning VEMPs was limited to peripheral vestibular disorders, however, the field of VEMP testing is rapidly expanding, with an increasing focus on central neurological disorders. The current literature concerning VEMP abnormalities in central neurological disorders is critically reviewed, especially regarding the methodological aspects in relation to quality as well as the clinical interpretation of the VEMP results. Suggestions for further research are proposed as well as some clinically useful indications.
Vestibular evoked myogenic potentials (VEMPs) evoked by air- and bone-conducted stimuli in vestibular neuritis
2015, Clinical Neurophysiology
Citation Excerpt :
The responses to both modalities of 500 Hz stimuli decrease at a similar rate with age. BC impulses may as a consequence be more useful in older patients in whom the reflex responses are preserved (Colebatch et al., 2013). Despite more bilaterally absent responses, AC 500 Hz was still more sensitive than BC 500 Hz in demonstrating oVEMP abnormalities.
To compare and characterise abnormalities for short latency vestibular evoked myogenic potentials (VEMPs) elicited by air- (AC) and two differing types of bone-conducted (BC) stimuli during vestibular neuritis (VN).
AC (500 Hz short tone bursts) and two BC stimuli (500 Hz at the forehead and impulses at the mastoids) were used to evoke cervical and ocular potentials (cVEMPs and oVEMPs) in VN patients (n = 22) and healthy subjects.
More abnormalities were observed for the oVEMP than the cVEMP when using either AC 500 Hz or BC 500 Hz. The AC stimulus showed slightly more abnormalities than the BC 500 Hz stimulus. In contrast, BC impulses produced frequent abnormalities for both oVEMPs and cVEMPs. The findings were modelled, based upon presumed selective lesions of the superior nerve.
AC 500 Hz stimulation was slightly better than BC 500 Hz in demonstrating abnormalities in patients with VN. BC impulses behave as expected for a predominantly utricular stimulus. The relative contributions of saccular and utricular fibres differ for stimulus type and target reflex.
AC 500 Hz is as effective as BC 500 Hz for investigating VN. BC impulses act most strongly on utricular afferents.

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Letter to the EditorTwo distinct patterns of VEMP changes with age

Brain Res Bull

Clin Neurophysiol

Clin Neurophysiol

Letter to the Editor
Two distinct patterns of VEMP changes with age