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Fife TD, Colebatch JG, Kerber KA, Brantberg K, Strupp M, Lee H, Walker MF, Ashman E, Fletcher J, Callaghan B, Gloss DS. Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2017; 89:2288-2296. [PMID: 29093067 PMCID: PMC5705249 DOI: 10.1212/wnl.0000000000004690] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/22/2017] [Indexed: 12/26/2022] Open
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.
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Affiliation(s)
- Terry D Fife
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - James G Colebatch
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Kevin A Kerber
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Krister Brantberg
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Michael Strupp
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Hyung Lee
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Mark F Walker
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Eric Ashman
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Jeffrey Fletcher
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - Brian Callaghan
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
| | - David S Gloss
- From the Department of Neurology (T.D.F.), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Department of Neurology (J.G.C.), Prince of Wales Hospital, Clinical School, University of New South Wales and Neuroscience Research Australia, Randwick, Sydney; Departments of Neurology (K.A.K., B.C.) and Neurosurgery (J.F.), University of Michigan, Ann Arbor; Department of Audiology and Neurotology (K.B.), Karolinska University Hospital, Stockholm, Sweden; Department of Neurology and German Center for Dizziness and Balance Disorders (M.S.), University of Munich, Germany; Department of Neurology (H.L.), Keimyung University School of Medicine, Daegu, South Korea; Department of Neurology (M.F.W.), Case Western Reserve University, and Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Bronson Neuroscience Center (E.A.), Kalamazoo, MI; and Department of Neurology (D.S.G.), Charleston Area Medical Center, WV
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