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Vestibular-evoked myogenic potentials in central vestibular disorders

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Abstract

Vestibular-evoked myogenic potentials (VEMPs) are short latency manifestations of vestibulo-ocular and vestibulocollic reflexes that originate from the utricle and saccule. Although cervical and ocular VEMPs have mostly been applied to peripheral vestibular disorders, the characteristics and the diagnostic values of VEMPs have been expanded to assess the function of the central otolithic pathways. In the central nervous system, the cervical VEMPs (cVEMPs) are mediated by the vestibular nuclei and uncrossed medial vestibulospinal tract descending in the lower brainstem and spinal cord. In contrast, the ocular VEMPs (oVEMPs) reflect the function of the vestibular nuclei and the crossed vestibulo-ocular reflex (VOR) pathways, mostly contained in the medial longitudinal fasciculus (MLF). Therefore, lesions involving the vestibular nuclei can present abnormalities of both cVEMPs and oVEMPs. The medullary lesions involving the descending MLF or the spinal accessory nucleus impair cVEMPs. In contrast, the lesions involving the MLF, the crossed ventral tegmental tract, oculomotor nuclei and the interstitial nucleus of Cajal can impair oVEMPs. Patients with unilateral cerebellar infarctions may show abnormal VEMPs especially when they have the ocular tilt reaction. Delayed responses of VEMPs are characteristic of multiple sclerosis (MS). Reduced VEMP responses can be observed in patients with vestibular migraine. VEMPs are useful in evaluating central as well as peripheral otolithic function that are not readily defined by conventional vestibular function tests, and can aid in detecting and localizing central lesions, especially silent brainstem lesions such as tiny infarctions or MS plaques.

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References

  1. Colebatch JG, Halmagyi GM (1992) Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation. Neurology 42(8):1635–1636

    Article  CAS  PubMed  Google Scholar 

  2. Colebatch JG, Halmagyi GM, Skuse NF (1994) Myogenic potentials generated by a click-evoked vestibulocollic reflex. J Neurol Neurosurg Psychiatry 57(2):190–197

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Curthoys IS (2010) A critical review of the neurophysiological evidence underlying clinical vestibular testing using sound, vibration and galvanic stimuli. Clin Neurophysiol 121(2):132–144

    Article  PubMed  Google Scholar 

  4. Todd NP et al (2007) Ocular vestibular evoked myogenic potentials (OVEMPs) produced by air- and bone-conducted sound. Clin Neurophysiol 118(2):381–390

    Article  PubMed  Google Scholar 

  5. Oh SY et al (2013) Ocular vestibular evoked myogenic potentials induced by air-conducted sound in patients with acute brainstem lesions. Clin Neurophysiol 124(4):770–778

    Article  PubMed  Google Scholar 

  6. Oh SY et al (2013) Cervical and ocular vestibular-evoked myogenic potentials in vestibular neuritis: comparison between air- and bone-conducted stimulation. J Neurol 260(8):2102–2109

    Article  PubMed  Google Scholar 

  7. Iwasaki S et al (2007) Head taps evoke a crossed vestibulo-ocular reflex. Neurology 68(15):1227–1229

    Article  CAS  PubMed  Google Scholar 

  8. Buttner-Ennever JA (1992) Patterns of connectivity in the vestibular nuclei. Ann NY Acad Sci 656:363–378

    Article  CAS  PubMed  Google Scholar 

  9. Rosengren SM et al (2007) Delayed vestibular evoked responses to the eyes and neck in a patient with an isolated brainstem lesion. Clin Neurophysiol 118(9):2112–2116

    Article  PubMed  Google Scholar 

  10. Kim HJ et al (2014) Isolated vestibular nuclear infarction: report of two cases and review of the literature. J Neurol 261(1):121–129

    Article  PubMed  Google Scholar 

  11. Heide G et al (2010) Brainstem representation of vestibular evoked myogenic potentials. Clin Neurophysiol 121(7):1102–1108

    Article  PubMed  Google Scholar 

  12. Newlands SD et al (2003) Central projections of the saccular and utricular nerves in macaques. J Comp Neurol 466(1):31–47

    Article  PubMed  Google Scholar 

  13. Nyberg-Hansen R (1964) Origin and termination of fibers from the vestibular nuclei descending in the medial longitudinal fasciculus. An experimental study with silver impregnation methods in the cat. J Comp Neurol 122:355–367

    Article  CAS  PubMed  Google Scholar 

  14. Uchino Y et al (1994) Monosynaptic and disynaptic connections in the utriculo-ocular reflex arc of the cat. J Neurophysiol 71(3):950–958

    Article  CAS  PubMed  Google Scholar 

  15. Uchino Y et al (1996) Utriculoocular reflex arc of the cat. J Neurophysiol 76(3):1896–1903

    Article  CAS  PubMed  Google Scholar 

  16. Uchino Y, Kushiro K (2011) Differences between otolith- and semicircular canal-activated neural circuitry in the vestibular system. Neurosci Res 71(4):315–327

    Article  PubMed  Google Scholar 

  17. Kushiro K et al (1999) Saccular and utricular inputs to sternocleidomastoid motoneurons of decerebrate cats. Exp Brain Res 126(3):410–416

    Article  CAS  PubMed  Google Scholar 

  18. Isu N et al (2000) Sacculo-ocular reflex connectivity in cats. Exp Brain Res 131(3):262–268

    Article  CAS  PubMed  Google Scholar 

  19. Goto F et al (2004) Eye movements evoked by selective saccular nerve stimulation in cats. Auris Nasus Larynx 31(3):220–225

    Article  PubMed  Google Scholar 

  20. Uchino Y et al (1997) Sacculocollic reflex arcs in cats. J Neurophysiol 77(6):3003–3012

    Article  CAS  PubMed  Google Scholar 

  21. Kim HJ, Lee JH, Kim JS (2014) Ocular vestibular evoked myogenic potentials to head tap and cervical vestibular evoked myogenic potentials to air-conducted sounds in isolated internuclear ophthalmoplegia. Clin Neurophysiol 125(5):1042–1047

    Article  PubMed  Google Scholar 

  22. Itoh A et al (2001) Clinical study of vestibular-evoked myogenic potentials and auditory brainstem responses in patients with brainstem lesions. Acta Otolaryngol Suppl 545:116–119

    CAS  PubMed  Google Scholar 

  23. Kim S, Kim HJ, Kim JS (2011) Impaired sacculocollic reflex in lateral medullary infarction. Front Neurol 2:8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Tseng CL, Young YH (2010) Topographical correlations of lateral medullary infarction with caloric- and vestibular-evoked myogenic potential results. Eur Arch Otorhinolaryngol 267(2):191–195

    Article  PubMed  Google Scholar 

  25. Kim S, Lee HS, Kim JS (2010) Medial vestibulospinal tract lesions impair sacculo-collic reflexes. J Neurol 257(5):825–832

    Article  PubMed  Google Scholar 

  26. Rosengren SM, Colebatch JG (2011) Ocular vestibular evoked myogenic potentials are abnormal in internuclear ophthalmoplegia. Clin Neurophysiol 122(6):1264–1267

    Article  CAS  PubMed  Google Scholar 

  27. Highstein SM, Holstein GR (2006) The anatomy of the vestibular nuclei. Prog Brain Res 151:157–203

    Article  CAS  PubMed  Google Scholar 

  28. Newlands SD et al (2002) Central projections of the utricular nerve in the gerbil. J Comp Neurol 452(1):11–23

    Article  PubMed  Google Scholar 

  29. Ito M (1982) Cerebellar control of the vestibulo-ocular reflex–around the flocculus hypothesis. Annu Rev Neurosci 5:275–296

    Article  CAS  PubMed  Google Scholar 

  30. Angelaki DE, Hess BJ (1995) Lesion of the nodulus and ventral uvula abolish steady-state off-vertical axis otolith response. J Neurophysiol 73(4):1716–1720

    Article  CAS  PubMed  Google Scholar 

  31. Welgampola MS, Colebatch JG (2005) Characteristics and clinical applications of vestibular-evoked myogenic potentials. Neurology 64(10):1682–1688

    Article  PubMed  Google Scholar 

  32. Pollak L, Kushnir M, Stryjer R (2006) Diagnostic value of vestibular evoked myogenic potentials in cerebellar and lower-brainstem strokes. Neurophysiol Clin 36(4):227–233

    Article  CAS  PubMed  Google Scholar 

  33. Ahn BH et al (2011) Abnormal cervical vestibular-evoked myogenic potential in anterior inferior cerebellar artery territory infarction: frequency, pattern, and a determinant. J Neurol Sci 307(1–2):114–119

    Article  PubMed  Google Scholar 

  34. Choi SY et al (2014) Impaired modulation of the otolithic function in acute unilateral cerebellar infarction. Cerebellum 13(3):362–371

    Article  PubMed  Google Scholar 

  35. Kirchner H et al (2011) Clinical, electrophysiological, and MRI findings in patients with cerebellar ataxia and a bilaterally pathological head-impulse test. Ann NY Acad Sci 1233:127–138

    Article  PubMed  Google Scholar 

  36. Takegoshi H, Murofushi T (2000) Vestibular evoked myogenic potentials in patients with spinocerebellar degeneration. Acta Otolaryngol 120(7):821–824

    Article  CAS  PubMed  Google Scholar 

  37. Marti S et al (2008) Dissociation between canal- and otolithfunction in cerebellar atrophy. J Neurol 255(5):769–771

    Article  PubMed  Google Scholar 

  38. Rabinovitch HE, Sharpe JA, Sylvester TO (1977) The ocular tilt reaction. A paroxysmal dyskinesia associated with elliptical nystagmus. Arch Ophthalmol 95(8):1395–1398

    Article  CAS  PubMed  Google Scholar 

  39. Su CH, Young YH (2011) Differentiating cerebellar and brainstem lesions with ocular vestibular-evoked myogenic potential test. Eur Arch Otorhinolaryngol 268(6):923–930

    Article  PubMed  Google Scholar 

  40. Williams NP, Roland PS, Yellin W (1997) Vestibular evaluation in patients with early multiple sclerosis. Am J Otol 18(1):93–100

    CAS  PubMed  Google Scholar 

  41. Shimizu K et al (2000) Vestibular evoked myogenic potentials in multiple sclerosis. J Neurol Neurosurg Psychiatry 69(2):276–277

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Alpini D et al (2004) Vestibular evoked myogenic potentials in multiple sclerosis: clinical and imaging correlations. Mult Scler 10(3):316–321

    Article  CAS  PubMed  Google Scholar 

  43. Versino M et al (2002) Vestibular evoked myogenic potentials in multiple sclerosis patients. Clin Neurophysiol 113(9):1464–1469

    Article  PubMed  Google Scholar 

  44. Bandini F et al (2004) The diagnostic value of vestibular evoked myogenic potentials in multiple sclerosis. J Neurol 251(5):617–621

    Article  CAS  PubMed  Google Scholar 

  45. Eleftheriadou A et al (2009) The diagnostic value of earlier and later components of vestibular evoked myogenic potentials (VEMP) in multiple sclerosis. J Vestib Res 19(1–2):59–66

    CAS  PubMed  Google Scholar 

  46. Colebatch JG (2012) Vestibular evoked myogenic potentials in multiple sclerosis. Clin Neurophysiol 123(9):1693–1694

    Article  PubMed  Google Scholar 

  47. Gabelic T et al (2013) Ocular and cervical vestibular evoked myogenic potentials in patients with multiple sclerosis. J Clin Neurophysiol 30(1):86–91

    Article  PubMed  Google Scholar 

  48. Gazioglu S, Boz C (2012) Ocular and cervical vestibular evoked myogenic potentials in multiple sclerosis patients. Clin Neurophysiol 123(9):1872–1879

    Article  PubMed  Google Scholar 

  49. Murofushi T et al (2001) Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg 127(9):1069–1072

    Article  CAS  PubMed  Google Scholar 

  50. von Brevern M et al (2005) Acute migrainous vertigo: clinical and oculographic findings. Brain 128(Pt 2):365–374

    Google Scholar 

  51. Baier B, Stieber N, Dieterich M (2009) Vestibular-evoked myogenic potentials in vestibular migraine. J Neurol 256(9):1447–1454

    Article  PubMed  Google Scholar 

  52. Baier B, Dieterich M (2009) Vestibular-evoked myogenic potentials in “vestibular migraine” and Meniere’s disease: a sign of an electrophysiological link? Ann NY Acad Sci 1164:324–327

    Article  PubMed  Google Scholar 

  53. Boldingh MI et al (2011) Vestibular sensitivity in vestibular migraine: VEMPs and motion sickness susceptibility. Cephalalgia 31(11):1211–1219

    Article  PubMed  Google Scholar 

  54. Zuniga MG et al (2012) Can vestibular-evoked myogenic potentials help differentiate Meniere disease from vestibular migraine? Otolaryngol Head Neck Surg 146(5):788–796

    Article  PubMed  PubMed Central  Google Scholar 

  55. Taylor RL et al (2012) Vestibular evoked myogenic potentials to sound and vibration: characteristics in vestibular migraine that enable separation from Meniere’s disease. Cephalalgia 32(3):213–225

    Article  PubMed  Google Scholar 

  56. Stephan T et al (2005) Functional MRI of galvanic vestibular stimulation with alternating currents at different frequencies. Neuroimage 26(3):721–732

    Article  PubMed  Google Scholar 

  57. Fasold O et al (2002) Human vestibular cortex as identified with caloric stimulation in functional magnetic resonance imaging. Neuroimage 17(3):1384–1393

    Article  PubMed  Google Scholar 

  58. Schlindwein P et al (2008) Cortical representation of saccular vestibular stimulation: VEMPs in fMRI. Neuroimage 39(1):19–31

    Article  CAS  PubMed  Google Scholar 

  59. Bremmer F et al (2001) Polymodal motion processing in posterior parietal and premotor cortex: a human fMRI study strongly implies equivalencies between humans and monkeys. Neuron 29(1):287–296

    Article  CAS  PubMed  Google Scholar 

  60. Bense S et al (2001) Multisensory cortical signal increases and decreases during vestibular galvanic stimulation (fMRI). J Neurophysiol 85(2):886–899

    Article  CAS  PubMed  Google Scholar 

  61. Cheng PW et al (2009) Acoustic, mechanical and galvanic stimulation modes elicit ocular vestibular-evoked myogenic potentials. Clin Neurophysiol 120(10):1841–1844

    Article  PubMed  Google Scholar 

  62. Papathanasiou ES et al (2014) International guidelines for the clinical application of cervical vestibular evoked myogenic potentials: an expert consensus report. Clin Neurophysiol 125(4):658–666

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by research funds of Chonbuk National University in 2015 and by Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital.

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Authors and Affiliations

  1. Department of Neurology, Chonbuk National University School of Medicine, Jeonju-Si, Korea

    Sun-Young Oh

  2. Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-Si, Korea

    Sun-Young Oh

  3. Department of Biomedical Laboratory Science, Kyungdong University, Goseong, Korea

    Hyo-Jeong Kim

  4. Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 463-707, Korea

    Ji-Soo Kim

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Correspondence to Ji-Soo Kim.

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Oh is supported by research funds of Chonbuk National University in 2014 and by Research Institute of Clinical Medicine of Chonbuk National University- Chonbuk National University Hospital. HJ Kim reports no disclosures. JS Kim serves as an Associate Editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, and Journal of Neurology.

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Oh, SY., Kim, HJ. & Kim, JS. Vestibular-evoked myogenic potentials in central vestibular disorders. J Neurol 263, 210–220 (2016). https://doi.org/10.1007/s00415-015-7860-y

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