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Vestibular evoked myogenic potentials in multiple sclerosis: clinical and imaging correlations

Scientific Institute S. Maria Nascente, ‘don Carlo Gnocchi’ Foundation, 20148 Milan, Italy, National Neurological Institute ‘Carlo Besta’, via Celoria 11, 20133 Milan, Italy, dalpini{at}dongnocchi.it

L Pugnetti

Scientific Institute S. Maria Nascente, ‘don Carlo Gnocchi’ Foundation, 20148 Milan, Italy

D Caputo

Scientific Institute S. Maria Nascente, ‘don Carlo Gnocchi’ Foundation, 20148 Milan, Italy

F Cornelio

National Neurological Institute ‘Carlo Besta’, via Celoria 11, 20133 Milan, Italy

S Capobianco

ENT Institute, University of Sassari, 07100 Sassari, Italy

A Cesarani

ENT Institute, University of Milan, 20100 Milan, Italy

Patients with multiple sclerosis (MS) frequently report symptoms related to vestibular disorders in the course of their disease. At present, the fundamental tests assessing vestibulospinal involvement are posturography and vestibular evoked myogenic potentials (VEMPs). While posturography cannot be performed in every subject requiring minimal stance control, VEMPs do not require any specific skill on the part of the subjects and they may be investigated in all patients able to sit. VEMPs were recorded for 40 patients (17 men, 23 women; mean age 38 years, range 17-71 years) fulfilling diagnostic criteria of clinically defined MS, by means of rarefaction clicks, recording modulation of sterno-cleido-mastoideus tonic contraction saccule-mediated modulation. VEMPs were found to be abnormal in 28 of 40 patients. In 18 of the cases the VEMPs were asymmetric, i.e., had a prolonged latency on one side. In six cases latency was increased on both sides (mean delay 4.1 ms). In four subjects VEMPs were absent on one side. C oncordance with clinical findings of presence/absence of brainstem involvement was found in 55% and with MRI findings in 65% of the cases. A bnormal VEMPs indicated brainstem dysfunction in four patients (10%) with normal MRI and no specific clinical signs.

Key Words: multiple sclerosis • vertigo • vestibular evoked myogenic potentials • vestibulocollic reflex

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