Vestibular evoked myogenic potentials and MRI in early multiple sclerosis: Validation of the VEMP score

Background: To validate the VEMP score as a measure of brainstem dysfunction in patients with the first symptom of multiple sclerosis (MS) (clinically isolated syndrome (CIS)) and to investigate the correlation between VEMP and brainstem MRI results. Methods: 121 consecutive CIS patients were enrolled and brainstem functional system score (BSFS) was determined. Ocular VEMP (oVEMP) and cervical VEMP (cVEMP) were analyzed for latencies, conduction block and amplitude asymmetry ratio and the VEMP score was calculated. MRI was analyzed for the presence of brainstem lesions as a whole and separately for the presence of pontine, midbrain and medulla oblongata lesions. Results: Patients with signs of brainstem involvement during the neurological examination (with BSFS >= 1) had a higher oVEMP score compared to patients with no signs of brainstem involvement. A binary logistic regression model showed that patients with brainstem lesion on the MRI are 6.780 times more likely to have BSFS >= 1 (p = 0.001); and also, a higher VEMP score is associated with BSFS >= 1 (p = 0.042). Furthermore, significant correlations were found between clinical brainstem involvement and brainstem and pontine MRI lesions, and prolonged latencies and/or absent VEMP responses. Conclusions: The VEMP score is a valuable tool in evaluation of brainstem involvement in patients with early MS. (C) 2016 Elsevier B.V. All rights reserved.