Böttcher N, Bremova T, Feil K, Heinze C, Schniepp R, Strupp M
German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University, Munich, Germany; Dept. of Neurology, University Hospital Munich, Munich, Germany.
German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University, Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians University, Munich, Germany.
Clin Neurophysiol. 2016 May;127(5):2294-301. doi: 10.1016/j.clinph.2016.01.027. Epub 2016 Feb 28.
To investigate whether there is a change in ocular (oVEMP) and cervical (cVEMP) vestibular evoked myogenic potentials in patients with normal pressure hydrocephalus (NPH) before and after spinal tap test (STT).
In 25 patients (6 females, age 62-83years) c/oVEMP were measured before and after STT. Patients with an increase of >20% of walking velocity were classified as responders (n=10). VEMP were also measured in a control group of 13 non-NPH patients.
All patients had reproducible oVEMP; 68% had cVEMP. There was a significant increase of the peak-to-peak (pp) oVEMP amplitude after STT in responders (8.5±2.7 to 18.9±7.5μV (p=0.010)). No significant changes were found in non-responders (13.4±7.6 to 15.3±8.6μV) or controls (12.4±7.6 to 12.5±6.8μV). There were no significant differences in cVEMP before and after spinal tap test (STT).
One third of patients with suspected NPH had impaired otolith function. Responders to STT only had a significant increase of oVEMP and thereby utricular input, probably due to a decrease of pressure.
Both findings indicate that otolith dysfunction may contribute to imbalance in NPH and that increased utricular function after STT may be relevant for gait improvement.
研究正常压力脑积水（NPH）患者在腰椎穿刺试验（STT）前后眼震前庭诱发肌源性电位（oVEMP）和颈震前庭诱发肌源性电位（cVEMP）是否发生变化。
对25例患者（6例女性，年龄62 - 83岁）在STT前后测量c/oVEMP。步行速度增加>20%的患者被归类为反应者（n = 10）。还在13例非NPH患者的对照组中测量了VEMP。
所有患者的oVEMP均可重复；68%的患者有cVEMP。反应者在STT后oVEMP的峰峰值（pp）幅度显著增加（从8.5±2.7μV增至18.9±7.5μV，p = 0.010）。非反应者（从13.4±7.6μV至15.3±8.6μV）或对照组（从12.4±7.6μV至12.5±6.8μV）未发现显著变化。腰椎穿刺试验（STT）前后cVEMP无显著差异。
三分之一疑似NPH的患者存在耳石功能受损。STT的反应者仅oVEMP显著增加，从而椭圆囊输入增加，可能是由于压力降低。
这两个发现均表明耳石功能障碍可能导致NPH患者失衡，且STT后椭圆囊功能增加可能与步态改善有关。
