Fife Terry D, Colebatch James G, Kerber Kevin A, Brantberg Krister, Strupp Michael, Lee Hyung, Walker Mark F, Ashman Eric, Fletcher Jeffrey, Callaghan Brian, Gloss David S
From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV.
Neurology. 2017 Nov 28;89(22):2288-2296. doi: 10.1212/WNL.0000000000004690. Epub 2017 Nov 1.
To systematically review the evidence and make recommendations with regard to diagnostic utility of cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP, respectively). Four questions were asked: Does cVEMP accurately identify superior canal dehiscence syndrome (SCDS)? Does oVEMP accurately identify SCDS? For suspected vestibular symptoms, does cVEMP/oVEMP accurately identify vestibular dysfunction related to the saccule/utricle? For vestibular symptoms, does cVEMP/oVEMP accurately and substantively aid diagnosis of any specific vestibular disorder besides SCDS?
The guideline panel identified and classified relevant published studies (January 1980-December 2016) according to the 2004 American Academy of Neurology process.
Level C positive: Clinicians may use cVEMP stimulus threshold values to distinguish SCDS from controls (2 Class III studies) (sensitivity 86%-91%, specificity 90%-96%). Corrected cVEMP amplitude may be used to distinguish SCDS from controls (2 Class III studies) (sensitivity 100%, specificity 93%). Clinicians may use oVEMP amplitude to distinguish SCDS from normal controls (3 Class III studies) (sensitivity 77%-100%, specificity 98%-100%). oVEMP threshold may be used to aid in distinguishing SCDS from controls (3 Class III studies) (sensitivity 70%-100%, specificity 77%-100%). Level U: Evidence is insufficient to determine whether cVEMP and oVEMP can accurately identify vestibular function specifically related to the saccule/utricle, or whether cVEMP or oVEMP is useful in diagnosing vestibular neuritis or Ménière disease. Level C negative: It has not been demonstrated that cVEMP substantively aids in diagnosing benign paroxysmal positional vertigo, or that cVEMP or oVEMP aids in diagnosing/managing vestibular migraine.
系统评价关于颈肌和眼肌前庭诱发肌源性电位（分别为cVEMP和oVEMP）诊断效用的证据并提出建议。提出了四个问题：cVEMP能否准确识别半规管裂综合征（SCDS）？oVEMP能否准确识别SCDS？对于疑似前庭症状，cVEMP/oVEMP能否准确识别与球囊/椭圆囊相关的前庭功能障碍？对于前庭症状，cVEMP/oVEMP除了SCDS之外能否准确且实质性地辅助诊断任何特定的前庭疾病？
指南小组根据2004年美国神经病学学会的流程对相关已发表研究（1980年1月至2016年12月）进行识别和分类。
C级阳性：临床医生可使用cVEMP刺激阈值将SCDS与对照组区分开来（2项III类研究）（敏感性86%-91%，特异性90%-96%）。校正后的cVEMP振幅可用于将SCDS与对照组区分开来（2项III类研究）（敏感性100%，特异性93%）。临床医生可使用oVEMP振幅将SCDS与正常对照组区分开来（3项III类研究）（敏感性77%-100%，特异性98%-100%）。oVEMP阈值可用于辅助将SCDS与对照组区分开来（3项III类研究）（敏感性70%-100%，特异性77%-100%）。U级：证据不足，无法确定cVEMP和oVEMP是否能准确识别与球囊/椭圆囊特异性相关的前庭功能，或者cVEMP或oVEMP是否有助于诊断前庭神经炎或梅尼埃病。C级阴性：尚未证明cVEMP能实质性地辅助诊断良性阵发性位置性眩晕，或者cVEMP或oVEMP能辅助诊断/管理前庭性偏头痛。
