Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China.
J Neurol. 2024 Jun;271(6):3486-3495. doi: 10.1007/s00415-024-12324-1. Epub 2024 Mar 25.
Orthostatic hypotension (OH) is one of the most common symptoms in patients with multiple system atrophy (MSA). Vestibular system plays an important role in blood pressure regulation during orthostatic challenges through vestibular-sympathetic reflex. The current study aimed to investigate the relationship between vestibular function and OH in patients with MSA.
Participants with MSA, including 20 with OH (mean age, 57.55 ± 8.44 years; 7 females) and 15 without OH (mean age, 59.00 ± 8.12 years; 2 females) and 18 healthy controls (mean age, 59.03 ± 6.44 years; 8 females) were enrolled. Cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) tests were conducted to evaluate vestibular function.
Patients with MSA presented with significantly higher rate of absent cVEMPs (57.1% vs 11.1%, p = 0.001) and oVEMPs (25.7% vs 0, p = 0.021) than controls. MSA patients with OH showed more absent cVEMPs (75.0% vs 11.1%, Bonferroni corrected p < 0.001) and oVEMPs (40.0% vs 0, Bonferroni corrected p = 0.003) than controls. Patients with OH also showed higher rate of absent cVEMPs than those without OH (33.3%, Bonferroni corrected p = 0.014).
Our results demonstrated that impairment of vestibular function was associated with MSA, particularly in those with OH. Absent VEMPs may be a potential marker for MSA severity. Our findings suggest that impaired vestibular function is involved in OH development and may serve as an intervention target.
直立性低血压（OH）是多系统萎缩（MSA）患者最常见的症状之一。前庭系统通过前庭-交感反射在直立性挑战期间的血压调节中发挥重要作用。本研究旨在探讨 MSA 患者的前庭功能与 OH 之间的关系。
纳入 MSA 患者 20 例（OH 组，平均年龄 57.55±8.44 岁，女性 7 例）、15 例（无 OH 组，平均年龄 59.00±8.12 岁，女性 2 例）和 18 例健康对照者（对照组，平均年龄 59.03±6.44 岁，女性 8 例）。进行颈性前庭诱发肌源性电位（cVEMPs）和眼性前庭诱发肌源性电位（oVEMPs）检查以评估前庭功能。
MSA 患者的 cVEMPs 缺失率（57.1%比 11.1%，p=0.001）和 oVEMPs 缺失率（25.7%比 0，p=0.021）明显高于对照组。OH 组 MSA 患者的 cVEMPs 缺失率（75.0%比 11.1%，Bonferroni 校正后 p<0.001）和 oVEMPs 缺失率（40.0%比 0，Bonferroni 校正后 p=0.003）明显高于对照组。OH 组患者的 cVEMPs 缺失率也明显高于无 OH 组（33.3%，Bonferroni 校正后 p=0.014）。
本研究结果表明，前庭功能障碍与 MSA 有关，特别是在伴有 OH 的患者中。VEMPs 缺失可能是 MSA 严重程度的潜在标志物。我们的研究结果表明，前庭功能障碍参与了 OH 的发生发展，可能是一个干预靶点。
