VEMPによって新しいめまいの疾患概念が生み出されうるか?

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  • Can a new disease concept be developed using VEMP testing?

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Two decades have passed since the first publication of vestibular evoked myogenic potentials (VEMP). Now, cervical VEMP and ocular VEMP are accepted widely for the examination of the saccular organs and utricular organs, respectively. Can a new disease concept be developed using VEMP testing? In a previous study, it was reported that 6 out of 18 patients with undiagnosed dizziness showed abnormal cVEMP. Dizziness with a sensation of falling was related to the abnormal results. Another author study reported that 9 out of 10 subjects with lateral tilt sensation showed abnormal oVEMP. Thus, disequilibrium in the sagittal plane and horizontal plane is probably caused by otolith disorders and can be diagnosed only by VEMP testing. The lesion site of vestibular neuritis had been believed to be in the superior vestibular nerve. However, there are some reports about cases of acute-onset disequlibrium who showed inferior vestibular verve lesions. They showed abnormal cVEMP and normal results on caloric testing, thus the etiology was suggested to be inferior vestibular neuritis. The disease could be diagnosed only by VEMP testing. A positive result of diuretic-loading VEMP testing was observed in patients with Meniere's disease; a positive result was also obtained in some cases without the typical symptoms of Meniere's disease. They complained of recurrent tinnitus, aural fullness and severe disequilibrium or the sensation of falling downward or backward. The etiology was suggested to be saccular endolymphatic hydrops that could only be diagnosed by VEMP testing. As mentioned above, VEMP testing was useful to diagnose the etiology of disequilibrium caused by otolith dysfunction or superior vestibular nerve disorders. Therefore, the answer to the question, “Can new disease concept be developed using VEMP testing?” is “yes”.

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