Differentiating neurodegenerative parkinsonian syndromes using vestibular evoked myogenic potentials and balance assessment. Issue 11 (November 2021)

• Record Type: Journal Article
• Authors: Klunk, Dietrich; Woost, Timo B.; Fricke, Christopher; Classen, Joseph; Weise, David
• Is Part Of: Clinical neurophysiology. Volume 132:Issue 11(2021)
• Page Start: 2808
• Page End: 2819
• Publication Date: 2021-11
• Subjects: Vestibular evoked myogenic potentials -- Parkinson's disease -- Atypical parkinsonism -- Posturography -- Balance assessment; ABC-16 Activities-specific Balance Confidence Scale (German Version) -- AP atypical parkinsonism -- C control group -- CBD corticobasal degeneration -- COP center of pressure -- cVEMP cervical VEMP -- EEG electroencephalography -- EMG electromyography -- MDS Movement Disorder Society -- MDS-UPDRS-III Movement Disorder Society – Unified Parkinson's Disease Rating Scale Part III -- MSA multiple system atrophy -- MSA-C MSA cerebellar subtype -- MSA-P MSA parkinsonian subtype -- oVEMP ocular VEMP -- PD Parkinson's disease -- PSP progressive supranuclear palsy -- ROC receiver operating characteristic -- SVM support vector machine(s) -- VEMP vestibular evoked myogenic potential(s); Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2021.08.012
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Ocular Vestibular Evoked Myogenic Potentials (oVEMP) and posturography may help to distinguish between different entities of parkinsonism. Cervical VEMP are not significantly altered in patients with parkinsonian syndromes. No correlation was found between VEMP and posturographic parameters. 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.