Guidelines for Cervical, Ocular Vestibular Evoked Myogenic Potential Testing: AAN

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According to an updated clinical practice guideline, ocular vestibular evoked myogenic potential amplitude may be useful in distinguishing superior canal dehiscence syndrome from normal controls.
According to an updated clinical practice guideline, ocular vestibular evoked myogenic potential amplitude may be useful in distinguishing superior canal dehiscence syndrome from normal controls.

Cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potentials (oVEMPs) may provide some clinical utility for identifying superior canal dehiscence syndrome (SCDS), according to a new clinical practice guideline from the American Academy of Neurology published in Neurology.

In this systematic review, investigators, sought to establish recommendations on the diagnostic use of cVEMPs and oVEMPs. Specifically, the researchers reviewed published clinical trials to determine whether cVEMPs and oVEMPs can accurately diagnose SCDS and other vestibular disorders.

According to 2 class III studies included in this review, physicians may confidently use cVEMP stimulus threshold values (sensitivity, 86%-91%; specificity, 90%-96%) and corrected cVEMP amplitude (sensitivity, 100%; specificity, 93%) to identify SCDS. 

In addition, 3 class III studies indicated that oVEMP amplitude (sensitivity, 77%-100%; specificity, 98%-100%) and oVEMP threshold values (sensitivity, 70%-100%; specificity, 77%-100%) can be considered useful tools for determining SCDS when compared with healthy controls.

Evidence included in this review indicate that neither cVEMPs nor oVEMPs can provide accurate identification of saccule- or utricle-related vestibular function. In addition, there are few data to show that cVEMPs and oVEMPs are able to diagnose Ménière disease or vestibular neuritis.

Other diseases, including benign paroxysmal positional vertigo and vestibular migraine, have yet to be identified with the cVEMPs and oVEMPs in current research.

If oVEMPs and cVEMPs are to be used in clinical practice, the researchers of this study suggest greater "standardization is needed of stimulation and recording methods, and of normal and pathologic ranges of the amplitudes and latencies, with specifications of the reporting measures."

Reference

Fife TD, Colebatch JG, Kerber KA, et al. 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(22):2288-2296.

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