使用前庭诱发肌源性电位和平衡评估来区分神经退行性帕金森综合征。

Differentiating neurodegenerative parkinsonian syndromes using vestibular evoked myogenic potentials and balance assessment.

机构信息

Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; Department of Neurology, Altenburger Land Hospital, Am Waldessaum 10, 04600 Altenburg, Germany.

Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany.

出版信息

Clin Neurophysiol. 2021 Nov;132(11):2808-2819. doi: 10.1016/j.clinph.2021.08.012. Epub 2021 Sep 14.

DOI:10.1016/j.clinph.2021.08.012

PMID:34628341

Abstract

OBJECTIVE

Vestibular evoked myogenic potentials (VEMP) were investigated to differentiate between parkinsonian syndromes. We correlated balance and VEMP parameters to investigate the VEMP brainstem circuits as possible origin for postural instability.

METHODS

We assessed clinical status, ocular and cervical VEMP (oVEMP, cVEMP) and conducted a balance assessment (posturography, Activities-specific Balance Confidence Scale, Berg Balance Scale, modified Barthel Index) in 76 subjects: 30 with Parkinson's disease (PD), 16 with atypical parkinsonism (AP) and 30 healthy controls. VEMP were elicited by using a mini-shaker on the forehead.

RESULTS

Patients with PD had a prolonged oVEMP n10 in comparison to controls and prolonged p15 compared to controls and AP. Patients with AP showed reduced oVEMP amplitudes compared to PD and controls. CVEMP did not differ between groups. Postural impairment was higher in AP compared to controls and PD, particularly in the rating scales. No correlations between VEMP and posturography were found. A support vector machine classifier was able to automatically classify controls and patient subgroups with moderate to good accuracy based on oVEMP latencies and balance questionnaires.

CONCLUSIONS

Both oVEMP and posturography, but not cVEMP, may be differentially affected in PD and AP. We did not find evidence that impairment of the cVEMP or oVEMP pathways is directly related to postural impairment.

SIGNIFICANCE

OVEMP and balance assessment could be implemented in the differential diagnostic work-up of parkinsonian syndromes.

摘要

目的

研究前庭诱发肌源性电位（VEMP）以区分帕金森综合征。我们将平衡和 VEMP 参数相关联，以研究 VEMP 脑干回路是否可能是姿势不稳定的起源。

方法

我们评估了 76 名受试者的临床状况、眼和颈 VEMP（oVEMP、cVEMP），并进行了平衡评估（平衡测试、活动特异性平衡信心量表、伯格平衡量表、改良巴氏量表）：30 名帕金森病（PD）患者、16 名非典型帕金森病（AP）患者和 30 名健康对照者。VEMP 通过在前额使用迷你振动器诱发。

结果

与对照组相比，PD 患者的 oVEMP n10 延长，与对照组和 AP 相比，p15 延长。与 PD 和对照组相比，AP 患者的 oVEMP 振幅降低。各组间 CVEMP 无差异。与对照组和 PD 相比，AP 患者的姿势障碍更高，特别是在评分量表中。VEMP 与平衡测试之间未发现相关性。基于 oVEMP 潜伏期和平衡问卷，支持向量机分类器能够自动对健康对照组和患者亚组进行中等至良好的分类。