Ziya SALTÜRK, Ömür Biltekin TUNA, Güler BERKİTEN, Canan EMİR, Belgin TUTAR, Yavuz UYAR, Ayça BAŞKADEM YILMAZER, Enis EKİNCİOĞLU

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

Objectives: This study aims to evaluate the role of vestibular evoked myogenic potentials (VEMPS; the cervical VEMP [cVEMP] andthe ocular VEMP [oVEMP]) in the vestibular system in patients with relapsing-remitting multiple sclerosis (RRMS).Patients and Methods: Between December 2016 and December 2017, a total of 42 ears of 21 RRMS patients (8 males,13 females; mean age 41 years; range, 25 to 57 years) and 42 ears of 21 healthy controls (7 males, 14 females; mean age 44 years;range, 38 to 62 years) were included. All participants underwent neurological evaluation, brain magnetic resonance imaging (MRI),audiometry, tympanometry, and stapedial reflex testing. Their oVEMPs and cVEMPs were recorded.Results: For cVEMP testing, the mean P1 and N1 latencies of the left ears of RRMS patients were significantly higher comparedto the controls. There was no significant difference between patients and controls in terms of the P1-N1 interval or mean amplitudeof the left ear (p>0.05). The P1 and N1 latencies and the mean P1-N1 interval of the right ears of RRMS patients were significantlyhigher than the controls (p=0.019, p=0.001, p=0.004; p0.05 for all). The P1 and N1 latencies wereprolonged in 13 (42%) of 42 RRMS ears and 27 ears (64%), respectively. For oVEMP testing, eight patients (19%) had no response inthe oVemp test of the right ear (n=4) and left ear (n=4) of RRMS patients. There was no significant difference in P1 or N1 latencies orthe P1-N1 interval, amplitude or AAR of right ears between the patients and controls (p>0.05 for all). The P1 and N1 latencies wereprolonged in 26 (62%) of RRMS ears and 27 ears (64%), respectively.Conclusion: Based on our study results, VEMPs are useful for the evaluation of central vestibulopathies. The VEMP testing candiagnose brainstem lesions in RRMS patients quickly, easily, and safely without pain, although MRI shows no brainstem involvement.The VEMP testing is an electrophysiological test which can detect early stage pathologies of the vestibular system.

PDF

___

1. Ivanković A, Nesek Mađarić V, Starčević K, Krbot Skorić M, Gabelić T, Adamec I, et al. Auditory evoked potentials and vestibular evoked myogenic potentials in evaluation of brainstem lesions in multiple sclerosis. J Neurol Sci 2013;328:24-7.
2. Harirchian MH, Karimi N, Nafisi S, Akrami S, Ghanbarian D, Gharibzadeh S. Vestibular evoked myogenic potential for diagnoses of multiple sclerosis: is it beneficial? Med Glas (Zenica) 2013;10:321-6.
3. Escorihuela García V, Llópez Carratalá I, Orts Alborch M, Marco Algarra J. Vestibular evoked myogenic potential findings in multiple sclerosis. Acta Otorrinolaringol Esp 2013;64:352-8.
4. Williams NP, Roland PS, Yellin W. Vestibular evaluation in patients with early multiple sclerosis. Am J Otol 1997;18:93-100.
5. Barkhof F. The clinico-radiological paradox in multiple sclerosis revisited. Curr Opin Neurol 2002;15:239-45.
6. Gazioglu S, Boz C. Ocular and cervical vestibular evoked myogenic potentials in multiple sclerosis patients. Clin Neurophysiol 2012;123:1872-9.
7. Güven H, Bayır O, Aytaç E, Ozdek A, Comoğlu SS, Korkmaz H. Vestibular-evoked myogenic potentials, clinical evaluation, and imaging findings in multiple sclerosis. Neurol Sci 2014;35:221-6.
8. Brantberg K. Vestibular evoked myogenic potentials (VEMPs): usefulness in clinical neurotology. Semin Neurol 2009;29:541-7.
9. Colebatch JG, Rosengren SM, Welgampola MS. Vestibular-evoked myogenic potentials. Handb Clin Neurol 2016;137:133-55.
10. Nakashima I, Fujihara K, Okita N, Takase S, Itoyama Y. Clinical and MRI study of brain stem and cerebellar involvement in Japanese patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 1999;67:153-7.
11. Gabelić T, Krbot Skorić M, Adamec I, Barun B, Zadro I, Habek M. The vestibular evoked myogenic potentials (VEMP) score: a promising tool for evaluation of brainstem involvement in multiple sclerosis. Eur J Neurol 2015;22:261-9, e21.
12. Versino M, Colnaghi S, Callieco R, Bergamaschi R, Romani A, Cosi V. Vestibular evoked myogenic potentials in multiple sclerosis patients. Clin Neurophysiol 2002;113:1464-9.
13. Eleftheriadou A, Deftereos SN, Zarikas V, Panagopoulos G, Sfetsos S, Karageorgiou CL, et al. The diagnostic value of earlier and later components of Vestibular Evoked Myogenic Potentials (VEMP) in multiple sclerosis. J Vestib Res 2009;19:59-66.
14. Bandini F, Beronio A, Ghiglione E, Solaro C, Parodi RC, Mazzella L. The diagnostic value of vestibular evoked myogenic potentials in multiple sclerosis. J Neurol 2004;251:617-21.
15. Comi G, Leocani L, Medaglini S, Locatelli T, Martinelli V, Santuccio G, et al. Measuring evoked responses in multiple sclerosis. Mult Scler 1999;5:263-7.
16. Oh SY, Kim HJ, Kim JS. Vestibular-evoked myogenic potentials in central vestibular disorders. J Neurol 2016;263:210-220.
17. Crnošija L, Krbot Skorić M, Gabelić T, Adamec I, Habek M. Vestibular evoked myogenic potentials and MRI in early multiple sclerosis: Validation of the VEMP score. J Neurol Sci 2017;372:28-32.
18. Isaradisaikul S, Navacharoen N, Hanprasertpong C, Kangsanarak J. Cervical vestibular-evoked myogenic potentials: norms and protocols. Int J Otolaryngol 2012;2012:913515.
19. Patko T, Vidal PP, Vibert N, Tran Ba Huy P, de Waele C. Vestibular evoked myogenic potentials in patients suffering from an unilateral acoustic neuroma: a study of 170 patients. Clin Neurophysiol 2003;114:1344-50.
20. Murofushi T, Shimizu K, Takegoshi H, Cheng PW. Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg 2001;127:1069-72.
21. Alpini D, Pugnetti L, Caputo D, Cornelio F, Capobianco S, Cesarani A. Vestibular evoked myogenic potentials in multiple sclerosis: clinical and imaging correlations. Mult Scler 2004;10:316-21.
22. Shimizu K, Murofushi T, Sakurai M, Halmagyi M. Vestibular evoked myogenic potentials in multiple sclerosis. J Neurol Neurosurg Psychiatry 2000;69:276-7.