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.

中文翻译：

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使用前庭诱发肌源电位和平衡评估区分神经退行性帕金森综合征

客观的

研究了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 脑干回路作为姿势不稳定的可能来源。

方法

我们评估了 76 名受试者的临床状态、眼部和颈部 VEMP（oVEMP、cVEMP）并进行了平衡评估（姿势图、活动特定平衡信心量表、Berg 平衡量表、改良的 Barthel 指数）：30 名患有帕金森病 (PD)，16 名非典型帕金森综合征 (AP) 和 30 名健康对照。VEMP 是通过在前额上使用迷你摇床来引起的。

结果

与对照组相比，PD 患者的 oVEMP n10 延长，p15 与对照组和 AP 相比延长。与 PD 和对照组相比，AP 患者的 oVEMP 幅度降低。CVEMP 组间没有差异。与对照组和 PD 相比，AP 的姿势障碍更高，尤其是在评分量表中。未发现 VEMP 与姿势描记之间的相关性。支持向量机分类器能够根据 oVEMP 延迟和平衡问卷自动对对照组和患者亚组进行中等至良好的分类。

结论

oVEMP 和姿势描记术（但不是 cVEMP）在 PD 和 AP 中可能受到不同的影响。我们没有发现 cVEMP 或 oVEMP 通路的损害与姿势损害直接相关的证据。

意义

OVEMP 和平衡评估可用于帕金森综合征的鉴别诊断工作。