Prince of Wales Clinical School and Medical Research Institute, University of New South Wales, Randwick, Sydney, NSW 2031, Australia.
Clin Neurophysiol. 2010 May;121(5):636-51. doi: 10.1016/j.clinph.2009.10.016. Epub 2010 Jan 18.
Since the first description of sound-evoked short-latency myogenic reflexes recorded from neck muscles, vestibular evoked myogenic potentials (VEMPs) have become an important part of the neuro-otological test battery. VEMPs provide a means of assessing otolith function: stimulation of the vestibular system with air-conducted sound activates predominantly saccular afferents, while bone-conducted vibration activates a combination of saccular and utricular afferents. The conventional method for recording the VEMP involves measuring electromyographic (EMG) activity from surface electrodes placed over the tonically-activated sternocleidomastoid (SCM) muscles. The "cervical VEMP" (cVEMP) is thus a manifestation of the vestibulo-collic reflex. However, recent research has shown that VEMPs can also be recorded from the extraocular muscles using surface electrodes placed near the eyes. These "ocular VEMPs" (oVEMPs) are a manifestation of the vestibulo-ocular reflex. Here we describe the historical development and neurophysiological properties of the cVEMP and oVEMP and provide recommendations for recording both reflexes. While the cVEMP has documented diagnostic utility in many disorders affecting vestibular function, relatively little is known as yet about the clinical value of the oVEMP. We therefore outline the known cVEMP and oVEMP characteristics in common central and peripheral disorders encountered in neuro-otology clinics.
自从首次描述从颈部肌肉记录到的声音诱发的短潜伏期肌源性反射以来，前庭诱发肌源性电位（VEMP）已成为神经耳科学测试组合的重要组成部分。VEMP 提供了评估耳石功能的一种手段：用空气传导声音刺激前庭系统主要激活球囊传入纤维，而骨传导振动则激活球囊和椭圆囊传入纤维的组合。记录 VEMP 的传统方法涉及测量放置在持续激活的胸锁乳突肌（SCM）表面电极上的肌电图（EMG）活动。因此，“颈 VEMP”（cVEMP）是前庭-橄榄反射的表现。然而，最近的研究表明，也可以使用放置在眼睛附近的表面电极从眼外肌记录 VEMP。这些“眼 VEMP”（oVEMP）是前庭眼反射的表现。在这里，我们描述了 cVEMP 和 oVEMP 的历史发展和神经生理学特性，并为记录这两种反射提供了建议。虽然 cVEMP 在许多影响前庭功能的疾病中具有明确的诊断效用，但迄今为止，oVEMP 的临床价值相对知之甚少。因此，我们概述了在神经耳科学诊所中遇到的常见中枢和外周疾病中已知的 cVEMP 和 oVEMP 特征。
