Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing. (28th November 2017)

• Record Type: Journal Article
• Authors: 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.
• Is Part Of: Neurology. Volume 89:Number 22(2017)
• Publication Date: 2017-11-28
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000004690
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: 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? Methods: The guideline panel identified and classified relevant published studies (January 1980–December 2016) according to the 2004 American Academy of Neurology process. Results and Recommendations: 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.