Zaleski Ashley, Bogle Jamie, Starling Amaal, Zapala David A, Davis Laurie, Wester Matthew, Cevette Michael
*Mayo Clinic Arizona, Audiology Section, Scottsdale, Arizona; †Mayo Clinic Arizona, Neurology Section, Scottsdale, Arizona; and ‡Mayo Clinic Florida, Audiology Section, Jacksonville, Florida, U.S.A.
Otol Neurotol. 2015 Feb;36(2):295-302. doi: 10.1097/MAO.0000000000000665.
Literature investigating otolith reflexes in patients with vestibular migraine (VM) is variable and primarily describes the descending saccular pathway. This research aimed to study ocular vestibular evoked myogenic potential (oVEMP) and cervical vestibular evoked myogenic potential (cVEMP) prevalence and response characteristics in patients with suspected VM and in control patients. The purpose is to assess vulnerabilities within the ascending utricular and descending saccular pathways in the VM population.
Retrospective study
Tertiary academic referral center
39 adults with VM, 29 control patients
MAIN OUTCOME MEASURE(S): Air conducted oVEMPs and cVEMPs measured with 500 Hz tone burst stimuli
Age of headache onset was most often in childhood or adolescence, with dizziness onset occurring later. The rate of bilaterally absent oVEMPs was significantly higher (28%, p < 0.01) in the VM group compared with the control group (0%). oVEMP amplitude asymmetry ratios were significantly higher for the definite VM (p < 0.01) and probable VM (p = 0.023) groups than the control group. Eleven patients also had history of concussion; they were significantly more likely to demonstrate bilaterally absent oVEMPs (p < 0.01) in comparison to the control patients. When VM patients with a history of concussion were omitted from analysis, differences in oVEMP amplitude asymmetry (p < 0.01) and bilateral oVEMP absence remained significant (p = 0.015). There were no differences in the rate of bilateral cVEMP presence or response parameters between VM and control groups.
VEMP presentation differs for some patients diagnosed with VM. The higher rates of abnormal oVEMPs may suggest greater vulnerability within the ascending utricular-ocular pathway in patients with VM.
关于前庭性偏头痛（VM）患者耳石反射的文献研究结果不一，主要描述的是下行球囊通路。本研究旨在探讨疑似VM患者和对照患者的眼前庭诱发肌源性电位（oVEMP）和颈前庭诱发肌源性电位（cVEMP）的患病率及反应特征。目的是评估VM人群中上行椭圆囊通路和下行球囊通路的易损性。
回顾性研究
三级学术转诊中心
39例成年VM患者，29例对照患者
用500Hz短纯音刺激测量的气导oVEMP和cVEMP
头痛发作年龄多在儿童期或青春期，头晕发作较晚。VM组双侧oVEMP缺失率（28%，p<0.01）显著高于对照组（0%）。明确VM组（p<0.01）和可能VM组（p = 0.023）的oVEMP振幅不对称率显著高于对照组。11例患者有脑震荡史；与对照患者相比，他们双侧oVEMP缺失的可能性显著更高（p<0.01）。当分析中排除有脑震荡史的VM患者时，oVEMP振幅不对称差异（p<0.01）和双侧oVEMP缺失仍有显著性（p = 0.015）。VM组和对照组之间双侧cVEMP出现率或反应参数无差异。
一些诊断为VM的患者VEMP表现不同。oVEMP异常率较高可能提示VM患者上行椭圆囊 - 眼通路的易损性更大。
