Myogenic Potential Testing Research Articles

Electrode Montage for Bilateral Cervical Vestibular-Evoked Myogenic Potential Testing.

Cervical vestibular-evoked myogenic potentials (cVEMPs) are predominantly ipsilateral, myogenic responses originating from saccular activation. Some individuals have contralateral-crossed cVEMP responses with monaural air-conducted stimulation (ACS) which can contaminate cVEMP responses with bilateral stimulation. While the origin of the contralateral-crossed response is under debate, its presence has implications for cVEMP testing with midline bone conduction vibration (BCV). The purpose of this study was to determine the origin of the contralateral-crossed cVEMP response. It was hypothesized that the crossed response is due to electrode contamination and would disappear with a modified electrode montage. This is a cross-sectional research study. Fifteen healthy participants (30 ears; mean age: 27.4 19-39; 10 females). Participants completed cVEMP testing using three stimulation methods (monoaural ACS, binaural ACS, and midline BCV) and two electrode montages (sternum reference and Fp reference). In the monoaural ACS with sternum reference condition, 53.3% ears had contralateral-crossed cVEMP responses that were in-phase with the ipsilateral response for all but three ears. Whereas in the monoaural ACS with Fp reference condition, 3% had a contralateral-crossed cVEMP response. ACS and BCV cVEMP corrected amplitudes were significantly larger in the sternum reference conditions, which is attributed to artificial enhancement from the in-phase contralateral-crossed responses. The significant reduction of contralateral-crossed responses in the Fp reference condition suggests that the contralateral-crossed cVEMP response is due to reference electrode contamination and may be a more appropriate reference placement when completing cVEMPs with midline BCV.

Is the Otolithic Function Affected in Patients with Obstructive Sleep Apnea Syndrome?

While cardiovascular and neurological diseases induced by obstructive sleep apnea syndrome (OSAS) hypoxia are well established, the association between neuro-otological diseases and OSAS is not entirely understood. Vestibular and audiological tests have been used to evaluate the degeneration of neurons in the brainstem caused by recurrent hypoxia. Evaluation of the vestibular-evoked myogenic potential (VEMP) test findings applied to detect the possible influence on the vestibular reflex arc due to hypoxia in patients diagnosed with OSAS using Activity-Specific Balance Confidence (ABC) and Berg Balance Scale (BBS) scales determination of scores. This was a cross-sectional study. Participants aged 18 to 60 who underwent polysomnography due to snoring/sleep apnea were divided into an OSAS, and a control group of subjects were also included. Each group consisted of 20 participants. All participants were evaluated with cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests. The groups were compared regarding variables such as the rate of oVEMP and cVEMP waves obtained, the interval between the waves, and the latency and amplitude. Also, BBS and ABC scales were applied to all participants. The cVEMP (50%) and oVEMP (45%) response rates and amplitudes were significantly lower in the OSAS group. No significant difference was found between the groups when comparing other VEMP parameters. However, a statistically significant decrease was observed in the ABC and BBS scores in the OSAS group. The identification of VEMP alterations in the OSAS group is a clear indication that the vestibular reflex pathways may be adversely affected by hypoxia. Personal rehabilitation programs can be created by evaluating activities of daily living with the ABC and static and dynamic balances with BBS in patients with OSAS.

Comparative Analysis of Vestibular Dysfunction and Compensation in Ramsay-Hunt Syndrome and Vestibular Neuritis.

To investigate vestibular loss and compensation in Ramsay-Hunt syndrome with dizziness (RHS-D) and vestibular neuritis (VN). Retrospective cohort study from 2019 to 2023. Tertiary care neurotology practice. Patients with RHS-D or VN who underwent videonystagmography, including cervical vestibular evoked myogenic potential (cVEMP), caloric stimulation, rotary chair, and oculomotor testing, were reviewed and stratified by vertigo etiology. The main outcome measures were rates and severity of vestibular loss, as measured by cVEMP and caloric stimulation, and of vestibular compensation, as measured by rotary chair and oculomotor testing. Ten patients were found to have RHS-D and 22 with VN. Caloric and cVEMP abnormalities were noted in 100 and 70% of RHS-D patients compared to 60 and 20% with VN (P = .029 and P = .034, respectively). RHS-D patients were significantly more likely to present with concurrent caloric and cVEMP abnormalities compared to VN (70 and 13%, respectively; P = .009). Vestibular loss appeared more severe in RHS-D compared to VN suggested by significantly lower mean bithermal slow phase velocity sum (3.8 and 21 degrees per second, respectively), greater canal paresis (78.7 and 40.2%, respectively), and greater cVEMP amplitude asymmetry (64 and 31%, respectively) (P = .014, P < .001, and P = .053, respectively). Regarding vestibular compensation, abnormal gain asymmetry was present in 88% of RHS-D patients with a mean asymmetry of 31.2 compared to 11% in VN with a mean of 14.0 (P = .019 and P = .003, respectively). Compared to VN, RHS-D patients appear to suffer from a more profound vestibular loss and a worsened ability to compensate for such deficits.

Unilateral Vestibular Hypofunction in an Adolescent: Case Report and Literature Review

Objective − The report presents a case of an adolescent girl with vertigo resulting from unilateral vestibular hypofunction, diagnosed after extensive pediatric and otorhinolaryngological evaluations.Case Report − A seventeen-year-old female adolescent sought medical assistance at the pediatric emergency hospital service on several occasions within one year due to feelings of weakness and darkened vision occurring during abrupt standing, exposure to heat, and stress. Symptoms were initially attributed to school obligations, low blood pressure, and the menstrual cycle. After an episode that also involved a brief loss of consciousness, an extensive neurological evaluation was conducted, excluding epileptogenic causes. Subsequent diagnostic procedures included evoked visual potential tests, psychological assessments, laboratory blood tests, thyroid hormone assays, and Borrelia burgdorferi serology, all yielding normal results. Finally, otorhinolaryngological examinations were performed, including pure tone audiometry, tympanometry, video head impulse tests, videonystagmography, and vestibular evoked myogenic potential tests. These tests indicated symptoms arising from unilateral labyrinthine hypofunction of the inner ear. The patient underwent vestibular rehabilitation, resulting in symptom resolution and confirmed functional recovery.Conclusion − Diagnosing vertigo in adolescence is challenging, as impaired balance can manifest as a symptom of various diseases. Presentation with atypical symptoms for peripherally caused balance disorders complicates diagnosis. Otorhinolaryngologists and audio-vestibular diagnosticians play pivotal roles in establishing accurate diagnoses.

Detecting endolymphatic hydrops in patients with cranial nerve VIII schwannoma using hydrops MR examination.

This study utilized Hydrops MRI in patients with cranial nerve (CN) VIII schwannoma to assess the concomitance with endolymphatic hydrops (EH), aiming to elucidate the mechanism of hydrops formation in these patients. Twenty-six patients diagnosed as CN VIII schwannoma including vestibular schwannoma (VS) in 24 and intracochlear schwannoma (ICS) in 2 were enrolled. Fifteen patients received radiosurgery and 11 patients opted for a wait-and-scan approach. All patients underwent an inner ear test battery, followed by Hydrops MRI. Based on Hydrops MRI, 6 patients (23%) with positive EH were assigned to Group A, while the other 20 patients showing negative EH were assigned to Group B. The abnormality rates of inner ear test battery in Group A ran from the audiometry (100%), cervical vestibular-evoked myogenic potential (cVEMP) test (83%), ocular VEMP (oVEMP) test (67%) to the caloric test (33%), exhibiting a significantly declining sequence. This declining sequence is consistent with the decreasing order in the prevalence of EH from the cochlea (83%), saccule (50%) to utricle (50%). However, Group B did not show such decreasing trend, indicating that Groups A and B did not share the common mechanism. The mean tumor size prior to radiosurgery was 1.91 ± 0.89cm, which significantly reduced to 1.53 ± 0.60cm at a mean interval of 6years following radiosurgery. In contrast, tumor size remained unchanged in those opted for a wait-and-scan approach. It is recommended to utilize Hydrops MRI for patients with CN VIII schwannoma during annual follow-up, particularly those experienced episodic vertigo and/or deteriorated hearing. The Hydrops MRI can not only monitor tumor size, but also detect the presence of EH, so as to guide treatment decision.

Comparison of Air Conduction and Bone Conduction Masseter Vestibular Evoked Myogenic Potential Between Neurotypical Young Adults and Individuals With Conductive Hearing Loss.

Introduction Masseter vestibular evoked myogenic potential (mVEMP) is an acoustically evoked potential recorded from the masseter muscle. It is a recent tool in the vestibular assessment battery that checks the integrity of the vestibulomasseteric reflex pathway, specifically for saccular function. Need of the study There is a small pool of subjects with cervical spondylitis and anomalies in the eye muscle where cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) tests cannot be performed. In such conditions, mVEMP is considered an appropriate tool to assess the vestibular function. Bone conduction (BC) mVEMP assesses vestibular function in individuals with conductive hearing loss having a significant air-bone gap (ABG). Hence, it is essential to establish a comparative normal range of values for air conduction (AC) and BC mVEMP. Aim of the study The study aimed to evaluate the vestibulomasseteric reflex pathway using AC and BC mVEMP for click and 500 Hz tone burst stimuli in neurotypical young adults and compare it to individuals with conductive hearing loss. Method Ten neurotypical (20 ears) young adults and five (10 ears) individuals with conductive hearing loss in the age range of 15-40 years without vestibular complaints were recruited for the study. The AC and BC mVEMP were recorded monaurally using click and 500 Hz tone burst stimuli for all the participants. Results For neurotypical young adults, the mean latencies of P1 and N1 for AC and BC mVEMP using click were 13.87±1.86 ms and 19.78±2.14 ms and 13.79±2.06 ms and 21.30±1.48 ms, respectively. The P1 and N1 mean latencies for AC and BC mVEMP using 500 Hz tone burst were 14.90±1.50 ms and 21.03±1.30 ms and 14.18±0.95 ms and 19.75±1.71 ms, respectively. For individuals with conductive hearing loss, the P1 and N1 mean latencies for AC and BC mVEMP using click were 15.37±1.46 ms and 20.65±2.65 ms and 15.41±0.68 ms and 21.07±1.45 ms, respectively. AC mVEMP responses were absent for 500 Hz tone burst stimuli. The P1 and N1 mean latencies for BC mVEMP using 500 Hz tone burst stimuli were 14.96±0.6 ms and 22.72±1.42 ms, respectively. Conclusion AC mVEMP was absent for 500 Hz tone burst stimulus but present for click stimulus in individuals with conductive hearing loss as there was a larger ABG at the low frequencies than at the mid-high frequencies. BC mVEMP was present for click and 500 Hz tone burststimuli in all individuals with conductive hearing loss and latencies of P1 and N1 were similar to results obtained for neurotypical young adults and no significant difference was seen.

Balance Impairment in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis.

Balance weaknesses related to mobility and fall risk in patients with rheumatic diseases are well-known. Vestibular dysfunction could negatively contribute to the balance ability of this patient population. This study aims to investigate the effects of Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS), among the most common rheumatic diseases, on postural balance related to vestibular function. Seventy-eight participants were grouped as RA (n=34, 43%), AS (n=24, 30.7%), and the control group consisted of healthy individuals (n=20, 25.6%). Cervical Vestibular Evoked Myogenic Potentials (cVEMP) test, which assesses the vestibular function objectively, Dizziness Handicap Inventory (DHI), which evaluates vertigo subjectively, and Berg Balance Scale (BBS) were performed. Different degrees of VEMP latency prolongations were found in the AS and RA groups. Right, and left ear N1 latencies were significantly longer in the AS group than in RA and control. Right ear P1 latency prolongation was statistically significant in the RA group. Amplitude asymmetry ratio (AAR) was found to be considerably higher in the RA and AS groups than in the control group (p<0.05). The mean BBS score in the AS group was below the fall risk score of 45. A negative statistically significant effect was observed between latency prolongation and BBS in AS groups. The abnormal VEMP findings in individuals with RA and AS shows inner ear vestibular system dysfunction. This vestibular impairment strictly contributes to their postural imbalance and requires a focused vestibular rehabilitation program for balance treatment.

Relationship Between Motion Sickness Susceptibility and Vestibular Test Results.

There is no test parameter with high sensitivity and specificity for the diagnosis of motion sickness. The aim of this study was to demonstrate a correlation between vestibular function tests and motion sickness. In addition, our secondary aim is to evaluate the sensitivity of the skull vibration-induced nystagmus test (SVINT) in the diagnosis of motion sickness. A total of 44 young adults aged 19-25 who had no hearing loss, complaints of dizziness/vertigo, or any diagnosed neurological disease were included. According to the motion sickness susceptibility questionnaire-short form (MSSQ-SF), participants were divided into the motion sickness group (21±1.38 years) and control group (20.5±1.18 years). Mean MSSQ-SF score for the motion sickness group is 78.18±12.2 and for control group 19.09±17.08. Ocular and cervical vestibular evoked myogenic potential tests, SVINT, video head impulse test, and oculomotor tests were performed. The only significant difference between the groups was in n1-p1 amplitudes in the left ocular vestibular evoked myogenic potential test (p=0.014). None of the other parameters differed between the two groups (p>0.05). There was no significant relationship between motion sickness susceptibility and the results of any vestibular function test. Performing diagnostic tests for motion sickness in an environment that creates significant sensory conflict may yield different results. This study contributes to the literature in terms of evaluating the vestibular system using a comprehensive test battery and is the first to use the SVINT test in motion sickness.

Relationship between vestibular schwannoma and endolymphatic hydrops

BackgroundBoth vestibular schwannoma (VS) and Meniere's disease (MD) patients underwent hydrops MRI to clarify the relationship between VS and endolymphatic hydrops (EH). MethodsEighty patients with VS or MD underwent an inner ear test battery followed by hydrops MRI, and were then divided into 3 groups. Group A comprised 58 MD patients (62 ears) with positive EH but negative VS. Group B included 18 VS patients (18 ears) with negative EH, while Group C consisted of 4 patients (4 ears) who had VS concomitant with EH. Another 14 MD patients who tested negative for EH on hydrops MRI were initially excluded from this cohort, but were later included for comparison. ResultsThe decreasing prevalence of EH at the cochlea, saccule and utricle in Group A was identified in 59 (95%), 42 (68%) and 40 (65%) ears, respectively, mimicking a declining sequence of abnormality rates running from audiometry (86%), cervical vestibular-evoked myogenic potential (cVEMP) test (55%) to the ocular (oVEMP) test (53%). However, such decreasing trend was not identified in Groups B and C. In Groups C and A combined, 4 (6%) of 62 EH patients had concomitant VS. Conversely, 4 (18%) of 22 VS patients in Groups C and B combined had concurrent EH. ConclusionA very low (6%) rate of VS in EH patients indicates that VS in EH patients may be coincidental. In contrast, EH was identified in 18% prevalence of VS patients, mirroring the 22% prevalence of cochlear EH demonstrated in VS donors through histopathological studies.

Cervical and ocular vestibular-evoked myogenic potentials test results and its relation to vestibular signs and symptoms in individuals with vestibular migraine

ObjectiveThe objective of the present study was to characterize the response rate, latency, and amplitude parameters of the cervical and ocular vestibular evoked myogenic potentials in individuals with vestibular migraine. The objective was also to describe the signs and symptoms exhibited by individuals with vestibular migraine and find out an association with VEMP results.MethodThirty individuals with a diagnosis of vestibular migraine and thirty healthy individuals participated in the study. The diagnosis of the vestibular migraine was made based on the diagnosis criteria given by the Barany Society and the International Headache Society. Cervical and ocular vestibular evoked myogenic potentials were recorded using 500 Hz tone burst stimulus for all the participants in both groups.ResultsThe latency was prolonged, and the amplitude was reduced for both the cervical and ocular vestibular evoked myogenic potentials in individuals with vestibular migraine compared with healthy individuals. There was no association between signs and symptoms exhibited by vestibular migraine individuals and VEMP results.ConclusionsBoth the sacullocollic and otolith ocular pathways are affected in vestibular migraine. Hence, there is a necessity for vestibular evaluation in all patients with vestibular migraine to understand the spectrum of the pathology.

Ocular vestibular evoked myogenic potentials in different types of amblyopia

ABSTRACT Clinical relevance The visual system plays an important role in the development of the vestibular-ocular reflex (VOR). In clinical practice, the ocular vestibular evoked myogenic potential (oVEMP) test is used to assess contralateral VOR. Background This study sought to compare the oVEMP in patients with anisometropic, strabismic, and mixed amblyopia using unilateral and bilateral (simultaneous binaural) stimulation. Methods Forty-two amblyopic patients (20 males and 22 females) with a mean age of 10.48 ± 4.00 years (range: 5 – 20 years) were examined. The Titmus stereopsis test, alternate cover test, and best-corrected visual acuity were evaluated. Patients were divided into three groups: anisometropic, strabismic, and mixed amblyopia. The oVEMP responses including the amplitude of electrical activity (n1-p1 complex) and the latencies (n1 and p1) of the VOR responses were recorded under unilateral and bilateral stimulations. Results In the anisometropic and strabismic group, n1 latency was significantly faster in the non-amblyopic eyes compared to amblyopic eyes (Z = −2.04, p = 0.042, andZ = −2.54, p = 0.024 respectively). Mean p1 latency was significantly faster in the non-amblyopic eyes compared to the amblyopic eyes of the strabismic group (Z = −2.31, p = 0.011)In all groups, the p1 latency was faster in the non-amblyopic eye compared to bilateral stimulation (all, p < 0.05). In all groups, the n1-p1 amplitude was not significantly different between the two eyes, and between each eye and bilateral stimulation (all, p > 0.05). No significant correlation was found between the depth of amblyopia and n1 and p1 responses (all, p > 0.05). In all groups there was no significant difference in the latency of n1 and p1 between the amblyopic eye and bilateral stimulation (all, p > 0.05). Conclusion Regardless of its type, amblyopia affects vestibular-ocular reflex responses. Further research is warranted to clarify the effect of the disease and its treatment on the ocular-vestibular system.

Cervical and Ocular Vestibular Evoked Myogenic Potentials in Fibromyalgia Syndrome Patients.

Fibromyalgia syndrome (FMS) is a chronic pain condition that may be associated with dysfunction in the central nervous system. The aim of this study was to assess the vestibulo-spinal reflex (VSR) and vestibulo-ocular reflex (VOR) in FMS using the cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) tests, respectively, and to evaluate their relation to disease severity. This study included 30 female FMS patients and 30 well-matched healthy controls. They underwent full history taking and assessment of the severity of dizziness/vertigo using the Dizziness Handicap Inventory; assessment of the severity of FMS symptoms using the Revised Fibromyalgia Impact Questionnaire; bedside examination of the dizzy patient; videonystagmography, cVEMP, and oVEMP tests; basic audiologic evaluation; and uncomfortable loudness level (UCL) testing. Dizziness was reported in 46.6% and vertigo in 11.1% of patients. Abnormalities in cVEMP (50%) and oVEMP (63.3%) were mostly unilateral, irrespective of FMS severity. Disease duration affected only the oVEMP amplitude. Fibromyalgia syndrome patients had a statistically significant lower UCL and narrower dynamic range compared to controls. The VSR and VOR are commonly affected in FMS patients, and findings suggest central sensitization involving the brain stem. We recommend routine cVEMP and oVEMP testing to assess brainstem function in FMS patients.

Otolithic functions in patients with residual dizziness after successful repositioning manoeuvres for unilateral posterior canal BPPV.

To evaluate otolithic functions in patients with residual dizziness after successful canalith repositioning procedures (CRPs) for unilateral posterior canal benign paroxysmal positional vertigo (BPPV), and to investigate possible risk factors. This case-control observational study included healthy controls and patients with residual dizziness after improvement following CRP for BPPV. All participants were subjected to full history taking, otoscopy, audiological basic evaluation, Dix-Hallpike test to search for posterior canal BPPV, residual dizziness screening, and vestibular evoked myogenic potential (VEMP) testing. Between-group differences were assessed and possible factors associated with residual dizziness were identified by univariate analysis. A total of 50 patients with residual dizziness (mean age, 56.53 ± 7.46 years [29 female: 21 male]) and 50 healthy controls (mean age, 58.13 ± 7.57 years [20 female: 30 male]) were included. A significant difference in VEMP latencies was found between the patient and control group (delayed in the patient group), with no significant between-group difference in amplitude in both ears. Aging, female sex, long duration of BPPV, number of CRPs, cervical VEMP and ocular VEMP abnormalities, and winter onset, were significantly associated with the risk of residual dizziness. Residual dizziness is a frequent sequel of BPPV that may relate to otolithic dysfunction. VEMP changes were revealed in the form of delayed latencies.

China expert consensus on clinical practice of vestibular evoked myogenic potentials testing(2024)

China expert consensus on clinical practice of vestibular evoked myogenic potentials testing(2024)

Masseter Vestibular-Evoked Myogenic Potential Result of Possible Meniere's Patients.

The masseter vestibular-evoked myogenic potential (mVEMP) test evaluates the vestibulomasseteric reflex neural pathway between the sound-stimulated saccule hair cells and the motor neurons of the trigeminal nerve. This study aims to investigate the contribution of mVEMP to the conclusive diagnosis of recurrent vestibulopathy patients that were diagnosed with Possible Meniere's disease. The study includes 20 healthy individuals aged 18 to 40 years and 20 patients that were diagnosed with Possible Meniere's disease according to the American Academy of Otorhinolaryngology and Head and Neck Surgery (AAO-HNS, 1995) Guidelines for the Definition of Meniere's Disease. In addition to the AAO-HNS, 1995 criteria, the presence of aural signs on the affected side was questioned according to the Meniere's criteria updated in 2015. mVEMP records were obtained by using surface electrodes placed on masseter muscles. Latency and amplitude values and asymmetry ratios of mVEMP waves were used for statistical analysis. Asymmetry ratios were 15.9 ± 9.7% for the control group and 60.61 ± 45.52 for the experimental group; this difference was statistically significant (p < 0.05). The absolute latency and amplitude results were not statistically different between groups (p > 0.05). As Murofushi et al. (2001) stated in the literature, cervical vestibular-evoked myogenic potential (VEMP)/ocular VEMP latencies were not affected in peripheral pathologies, and in our study, no difference was observed between the groups in mVEMP latencies. The findings of our study showed that asymmetry ratio and absence of waves should be used in the clinical evaluation of Possible Meniere's disease. We conclude that mVEMP can be used to determine the lateralization of vestibular disorders and to support the presence of a vestibular pathology. mVEMP can contribute to the vestibular test battery.

Multi-frequency VEMPs improve detection of present otolith responses in bilateral vestibulopathy.

To investigate whether multi-frequency Vestibular Evoked Myogenic Potential (VEMP) testing at 500, 750, 1,000, and 2,000 Hz, would improve the detection of present dynamic otolith responses in patients with bilateral vestibulopathy (BV). Prospective study in a tertiary referral center. BV patients underwent multi-frequency VEMP testing. Cervical VEMPs and ocular VEMPs were recorded with the Neuro-Audio system (v2010, Neurosoft, Ivanovo, Russia). The stimuli included air-conducted tone bursts of 500, 750, 1,000, and 2,000 Hz, at a stimulation rate of 13 Hz. Outcome measures included the percentage of present and absent VEMP responses, and VEMP thresholds. Outcomes were compared between frequencies and type of VEMPs (cVEMPs, oVEMPs). VEMP outcomes obtained with the 500 Hz stimulus, were also compared to normative values obtained in healthy subjects. Forty-nine BV patients completed VEMP testing: 47 patients completed cVEMP testing and 48 patients completed oVEMP testing. Six to 15 % more present VEMP responses were obtained with multifrequency testing, compared to only testing at 500 Hz. The 2,000 Hz stimulus elicited significantly fewer present cVEMP responses (right and left ears) and oVEMP responses (right ears) compared to the other frequencies (p ≤ 0.044). Using multi-frequency testing, 78% of BV patients demonstrated at least one present VEMP response in at least one ear. In 46% a present VEMP response was found bilaterally. BV patients demonstrated a significantly higher percentage of absent VEMP responses and significantly higher VEMP thresholds than healthy subjects, when corrected for age (p ≤ 0.002). Based on these results, a pragmatic VEMP testing paradigm is proposed, taking into account multi-frequency VEMP testing. Multi-frequency VEMP testing improves the detection rate of present otolith responses in BV patients. Therefore, multi-frequency VEMPs should be considered when evaluation of (residual) otolith function is indicated.

Effects of valproic acid and levetiracetam monotherapy on balance functions in patients with generalized epilepsy

BackgroundIt is reported that antiepileptic drugs have an effect on balance functions. The aim of the study was to evaluate and compare the effects of valproic acid and levetiracetam monotherapy on balance functions in patients with generalized epilepsy using objective test methods. MethodsThe study included 43 generalized epilepsy patients aged 18–60 years, including 20 patients receiving valproic acid monotherapy, 23 patients receiving levetiracetam monotherapy, and 25 healthy individuals as controls, in the Neurology Clinic of a university hospital in eastern Turkey. The demographic data form was filled out and the Video Head Impulse Test and Vestibular Evoked Myogenic Potentials test were performed. ResultsStatistically significant differences were obtained between the groups in lateral, posterior, and anterior semicircular canal gains and RALP and LARP asymmetry values in the V-HIT test (p < 0.05). Statistically significant differences were obtained between the groups in P1, N1 latency and asymmetry values in the C-VEMP test and in N1, P1 latency, amplitude, and asymmetry values in the o-VEMP test (p < 0.05). ConclusionValproic acid and levetiracetam may affect the vestibulocular and vestibulocolic reflex pathways negatively. In this cohort, valproic acid had more pronounced adverse effects on balance functions as compared to levetiracetam.

The Caloric Test Is More Consistent With the Presence of Endolymphatic Hydrops Than the Vestibular-Evoked Myogenic Potential Test in Meniere's Disease.

Objective This study aimed to investigate the correlation between enhanced inner ear magnetic resonance imaging (MRI) findings and vestibular and cochlear function test results in patients with definite Meniere's disease and confirmed endolymphatic hydrops. Methods Among 70 consecutive patients diagnosed with definite Meniere's disease, 49 underwent contrast-enhanced 3-T inner ear MRI. The patients also underwent pure-tone audiometry, glycerol, caloric, and vestibular-evoked myogenic potential (VEMP) tests. Correlations between the pure-tone audiometry, glycerol test, caloric test, VEMP test, and MRI findings were evaluated using the chi-square test or Fisher's exact test, Student's t-test, one-way ANOVA, and Bonferroni's post-hoc test. Results Contrast-enhanced inner ear MRI revealed that 33 of 49 patients (67.3%) had endolymphatic hydrops. Among them, 19 patients had bilateral endolymphatic hydrops, and 14 had unilateral hydrops. The mean hearing threshold was higher in patients with endolymphatic hydrops than those without (p< 0.001). The proportion of patients with positive glycerol test results was higher among those with endolymphatic hydrops than in those without (p= 0.01). The rate of abnormal caloric response in patients with and without endolymphatic hydrops was not significantly different (p= 0.09). Furthermore, the rate of abnormal VEMP response in patients with and without endolymphatic hydrops was not significantly different (p= 0.70). On the affected side, in the caloric test, the ratio of the presence of vestibular and cochlear hydrops was similar (p= 1.00). On the affected side, in the VEMP test, the ratio of the presence of vestibular and cochlear hydrops was also similar (p= 0.80). The consistency of the caloric test in detecting cochlear hydrops was higher than that of the VEMP test (p= 0.04). The consistency of the caloric test in detecting vestibular hydrops tended to be higher (but not significantly) than that of the VEMP test (p= 0.11). Conclusion The cochlea and vestibule on the clinically affected side were more likely to have endolymphatic hydropsrevealed by contrast-enhanced 3-T inner ear MRI than on the unaffected side. The sum of the three low frequencies (125, 250, and 500 Hz) of the pure-tone audiometry was higher in patients with endolymphatic hydrops than in those without endolymphatic hydrops. The caloric test was more consistent in detecting endolymphatic hydrops, especially cochlear hydrops, than the VEMP test in patients with definite Meniere's disease. The results of this study may contribute to the future diagnosis of Meniere's disease and improve the understanding of endolymphatic hydrops.

Improvement of cognitive skills in elderly undergoing vestibular rehabilitation

AbstractBackgroundstudies that used vestibular rehabilitation (VR) found improvement in cognitive abilities of spatial memory, visuospatial function, executive functions, attention and a decrease in psychological distress. However, these studies only used cognitive screening tests or did not include comprehensive neuropsychological assessment.Methodlongitudinal, observational, analytical and quasi‐experimental study. The sample consisted of 50 elderly people of both sexes, aged between 60 and 86 years. Elderly people with vestibular dysfunction confirmed by the Vestibular Evoked Myogenic Potential (VEMP) and Video Head Impulse Test (v‐HIT) tests were included. The Geriatric Depression Scale ‐ short version (GDS‐15) was used to assess psychological distress and cognition was assessed using the Brief Neuropsychological Battery (Neupsilin). Psychological distress and cognition were assessed before and after eight sessions of vestibular rehabilitation according to the Cawthorne and Cooksey method (customized). Pre and post VR variables were detected using the Wilcoxon test. A significance level of 5% was adopted (p&lt; 0.05).Resultafter vestibular rehabilitation, there was improvement in general cognition ‐ Neupsilin (142/145) and its subscales orientation (8/8), attention (12/20), memory (24/26), arithmetic skills (5/7), oral language (20/21), written language (28/29), praxis (12/14.5), executive functions (5/6) and decrease in psychological distress ‐ GDS‐15 (5/3).Conclusionafter vestibular rehabilitation, the elderly showed improvement in general cognition, orientation skills, memory, arithmetic skills, oral and written language, praxis and executive functions. Also note the decrease in psychic suffering.

Clinical Manifestations.

the vestibular system has neural connections from the vestibular nucleus to limbic and cortical areas, involved in both cognition and spatial orientation. The superior vestibular cortex consists of a network that interacts with other sensory systems, such as visual, sensorimotor, motor and cognition. Studies have found structural changes in the brain of patients with persistent perceptual postural dizziness (PPPD) when compared to controls, particularly in visual, vestibular and limbic areas, including a decrease in gray matter volume and turnover, a decrease in blood flow to the cortex region. cross-sectional, observational and analytical study. The sample consisted of 50 elderly people, of both sexes, aged between 60 and 86 years. Elderly individuals with vestibular dysfunction confirmed by Vestibular Evoked Myogenic Potential (VEMP) and Video Head Impulse Test (v-HIT) tests were included. Balance and the impact of dizziness on quality of life were evaluated through tests and vestibular scales. Cognition, functioning and depression were assessed in a quiet room using tests and scales. Univariate analysis was performed using the Spearman test. Variables that presented correlation ≤ 0.2 were selected for multivariate analysis by linear regression. A significance level of 5% was adopted (p< 0.05). there was a correlation between vestibular dysfunction and imbalance with the results of neuropsychological assessment (p = 0.000), depressive symptoms (p = 0.001) and functionality (p = 0.002). in this present study, a correlation was found between vestibular dysfunction and imbalance with the worst clinical and functional indices, worse functionality, depressive symptoms and in visuospatial function skills, executive functions and praxis.