Our investigation was designed to assess the saccular function of the vestibular system upon postural control dysfunction amongst children with spastic cerebral palsy (CP) using recording of cervical vestibular evoked myogenic potentials (cVEMPs), as well as to compare such findings with those in healthy subjects. Sixty two-children (aged 7-12 years) were enrolled and assigned to two groups. There were 31 cases of spastic CP with the functional levels of I or II according to the Gross Motor Function Classification System in the patient group and 31 aged-matched healthy children as controls. The examined parameters were the latencies of the P13 and N23 waves, P13–N23 peak-to-peak amplitude, amplitude asymmetry ratio (AAR), and the cVEMP threshold. The cVEMP responses were recorded in 93.5% of cases in the CP group and in all healthy subjects. Only 51.6% of the CP-group cases were within the normal AAR spectrum range. There were significant differences between the two groups with regard to the N23 wave latency (P < 0.001), P13–N23 wave amplitude (P < 0.001), and cVEMP threshold (P<0.05). The significant difference in the cVEMP measured values between the CP cases and healthy controls may be attributed to a motor development delay and deficits in the vestibulo-collic reflex pathway. Our findings suggest that cVEMP recording may be considered an auxiliary tool for the assessment of the vestibular system in children with spastic CP. Such a test is expected to help more adequate planning for interventions.
Similar content being viewed by others
References
P. Rosenbaum, N. Paneth, A. Leviton, et al., “A report: The definition and classification of cerebral palsy April 2006,” Dev. Med. Child Neurol. Suppl., 109, 8-14 (2007).
I. Kolker, “Hearing function and auditory evoked potentials in children with spastic forms of cerebral palsy”, Neurophysiology, 36, No. 4, 270–5(2004).
D. Christensen, K .Van Naarden Braun, N. S. Doernberg, et al., “Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning:Autism and Developmental Disabilities Monitoring Network, USA, 2008,” Dev. Med. Child Neurol., 56, 59–65 (2014).
S. Marret, C. Vanhulle, and A. Laquerriere.” Pathophysiology of cerebral palsy,” Handb. Clin. Neurol., 111, 169–176 (2012).
M. Ferdjallah, G. F. Harris, P. Smith, and J. J. Wertsch, “Analysis of postural control synergies during quiet standing in healthy children and children with cerebral palsy”, Clin. Biomech.,.17, No. 3, 203–210 (2002).
R. Rine, “Management of the pediatric patient with vestibular hypofunction,” in: Vestibular Rehabilitation, 3rd ed., FA Davis Co., Philadelphia, pp. 360–375 (2007).
S. L. Westcott and P. A. Burtner, “Postural control in children: Implications for pediatric practice”, Phys. Occup. Ther. Pediatr., 24, Nos. 1-2, 5–55 (2004).
R. M. Rine and S. Wiener-Vacher.” Evaluation and treatment of vestibular dysfunction in children”, NeuroRehabilitation, 32, No. 3, 507–518 (2013).
G. P. Jacobson, D. L. McCaslin, E. G. Piker, et al., “Patterns of abnormality in cVEMP, oVEMP, and caloric tests may provide topological information about vestibular impairment,” J. Am. Acad. Audiol., 22, No. 9, 601–611 (2011).
E. S. Papathanasiou, T. Murofushi, F. W. Akin, and J. G. Colebatch, “International guidelines for the clinical application of cervical vestibular evoked myogenic potentials: An expert consensus report,” Clin. Neurophysiol., 125, No. 4, 658–666 (2014).
G. P. Jacobson and D. L. McCaslin, “The vestibular evoked myogenic potential and other sonomotor evoked potentials,” in: Auditory Evoked Potentials: Basic Principles and Clinical Application (R. F. Burkard, J. J. Eggermont, and M. Don, eds). Lippincott Williams andWilkins, 572–598 (2007).
M. Valente, “Maturational effects of the vestibular system: a study of rotary chair, computerized dynamic posturography, and vestibular evoked myogenic potentials with children,” J. Am. Acad. Audiol., 18, No. 6, 461–481 (2007).
C. N. Chen, S. J. Wang, C. T. Wang, et al., “Vestibular evoked myogenic potentials in newborns”, Audiol. Neurootol., 12, No.1, 59–63 (2007).
P. M. Picciotti, A. Fiorita, W. Di Nardo, et al., “Vestibular evoked myogenic potentials in children”, Int. J. Pediatr. Otorhinolaryngol., 71, No.1, 29–33 (2007).
Y. H. Young, C. N. Chen, W. S. Hsieh, and S. J. Wang, “Development of vestibular evoked myogenic potentials in early life”, Eur. J. Paediatr. Neurol., 13, No.3, 235–239 (2009).
S. Erbek, S. S. Erbek, Z. Gokmen, et al., “Clinical application of vestibular evoked myogenic potentials in healthy newborns,” Int. J. Pediatr. Otorhinolaryngol., 71, No. 8, 1181-1185 (2007).
T. A. Kelsch, L. A. Schaefer, and C. R. Esquivel, “Vestibular evoked myogenic potentials in young children: Test parameters and normative data,” Laryngoscope, 116, No. 6, 895-900 (2006).
S. Erbek, Z. Gokmen, S. Ozkiraz, et al., “Vestibular evoked myogenic potentials in preterm infants,” Audiol. Neurootol., 14, No. 1, 1-6 (2009).
Z. Jafari and S. Asad Malayeri, “The effect of saccular function on static balance ability of profound hearingimpaired children,” Int. J. Pediatr. Otorhinolaryngol., 75, No. 7, 919-924 (2012).
P. M. Picciotti, A .Fiorita, L. Calò, et al., “Vestibular evoked myogenic potentials in children affected by myelomeningocele,” Child’s Nerv. Syst., 28, No. 10, 1761–1765 (2012).
S. J. Wang, C. N. Chen, W. S. Hsieh, and Y. H. Young, “Development of vestibular evoked myogenic potentials in preterm neonates,” Audiol. Neurootol., 13, No. 3, 145-152 (2007).
G. Zhou, M. A. Kenna, K. Stevens, and G. Licameli, “Assessment of saccular function in children with sensorineural hearing loss,” Arch. Otolaryngol. Head Neck Surg., 135, No. 1, 40-44 (2009).
K. Kaga, F. Tamai, M. Kodama, and K. Kodama, “Three young adult patients with Pelizaeus-Merzbacher disease who showed only waves I and II in auditory brainstem responses but had good auditory perception,” Acta Otolaryngol., 125, No. 9, 1018-1023 (2005).
T. Murofushi and K. Kaga. “Neurological application of VEMP recording during infancy and childhood,” in: Vestibular Evoked Myogenic Potential: Its Basics and Clinical Applications, Springer, 99-110 (2009).
ANSI S3.6-2004, Specification for Audiometers, American National Standards Institute.(2004).
J. Shanks and J. Shohet, “Tympanometry in clinical practice,” in Handbook of Clinical Audiology (6th ed.), J. Katz et al., eds., Lippincott, Williams and Wilkins, Baltimore, pp. 157-188 (2009).
R. Palisano, P. Rosenbaum, S. Walter, et al., “Development and reliability of a system to classify gross motor function in children with cerebral palsy,” Dev. Med. Child Neurol., 39, No. 4, 214-223 (1997).
E. Wood and P. Rosenbaum, “The gross motor function classification system for cerebral palsy: A study of reliability and stability over time,” Dev. Med. Child Neurol., 42, No. 5, 292-296 (2000).
C. H. Su, C. M. Chen, and Y. H. Young, “Differentiating cerebellopontine angle meningioma from schwannoma using caloric testing and vestibular-evoked myogenic potentials”, J. Neurol. Sci., 335, Nos. 1-2, 155–159 (2013).
J .C. Colebatch and G. M. Halrnagyi, “Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation,” Neurology, 42, No. 8, 1635–1636 (1992).
H. C. Su, T. W. Huang, Y. H. Young, and P. W. Cheng, “Aging effect on vestibular evoked myogenic potential,” Otol. Neurootol., 25, No. 6, 977-980 (2004).
I. Krägeloh-Mann and V .Horber, “The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review,” Dev. Med. Child Neurol., 49, No. 2, 144–151 (2007).
S. M. Scheck, R. N. Boyd, and S. E. Rose, “New insights into the pathology of white matter tracts in cerebral palsy from diffusion magnetic resonance imaging: a systematic review,” Dev. Med. Child Neurol., 54, No. 8, 684-696 (2012).
S. J .Wang, T. H. Yeh, C. H. Chang, and Y. H .Young, “Consistent latencies of vestibular evoked myogenic potentials,” Ear Hear., 29, No. 6, 923–929 (2008).
M. S. Shall,“The importance of saccular function to motor development in children with hearing impairments,” Int. J. Otolaryngol., 2009, 1-5 (2009).
R. O’Reilly, C. Grindle, E. F. Zwicky, and T. Morlet, “Development of the vestibular system and balance function: Differential diagnosis in the pediatric population,” Otolaryngol. Clin. North Am., 44, No. 2, 251-271 (2011).
Y. R. Burns and M. I. Bullock, “Comparison of abilities of preterm and maturely born children at 5 years of age,” Aust. Paediatr. J., 21, No. 1, 31-38 (1985).
J. G. Colebatch and J. C. Rothwell, “Motor unit excitability changes mediating vestibulo-collic reflexes in the sternocleidomastoid muscle,” Clin. Neurophysiol., 115, No. 11, 2567-2573 (2004).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Akbarfahimi, N., .Hosseini, S.A., Rassafiani, M. et al. Assessment of the Saccular Function in Children with Spastic Cerebral Palsy. Neurophysiology 48, 141–149 (2016). https://doi.org/10.1007/s11062-016-9580-z
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11062-016-9580-z