背景:前庭功能障碍与伴随步态冻结(FOG)的帕金森病(PD)的病理生理密切相关;然而,缺乏支持这种临床关联的证据.前庭诱发的肌源性电位(VEMPs)已被广泛认为是临床评估前庭功能的关键电生理参数。
目的:本研究调查了诊断为PD的患者中FOG发生与VEMP观察结果的可能相关性。
方法:总之,本横断面研究招募了95例特发性PD患者。所有患者均使用系列量表进行运动和非运动评估。此外,进行前庭电生理评估,其中包括宫颈VEMP(cVEMP)和眼部VEMP(oVEMP)评估。此外,双侧c/oVEMP缺失与临床表型的相关性,尤其是FOG,对PD患者进行了分析。
结果:在95例PD患者中,44例(46.3%)有双侧oVEMP缺失,23例(24.2%)有双侧cVEMP缺失,分别。双侧oVEMP缺失的患者比例(77.8%vs30.9%,p=0.004)和双侧cVEMP缺失(44.4%vs19.5%,p=0.035)在显示FOG的患者组中高于无FOG的组。在调整混杂变量之后,双侧OVEMP缺失(OR=8.544,p=0.007),而不是双侧cVEMP缺失,被证明可以独立预测PD患者的FOG发生。
结论:PD患者双侧oVEMP缺失与FOG密切相关,为PD患者中央前庭/上脑干功能障碍在FOG发展中的可能作用提供了新的思路。
BACKGROUND: Vestibular dysfunction is closely associated with the pathophysiology of Parkinson\'s disease (PD) accompanied by freezing of gait (FOG); however, evidence supporting this clinical association is lacking. Vestibular-evoked myogenic potentials (VEMPs) have been widely acknowledged as a crucial electrophysiological parameter in the clinical evaluation of vestibular function.
OBJECTIVE: The present study investigated the possible correlation of FOG occurrence with VEMP observations in patients diagnosed with PD.
METHODS: Altogether, 95 idiopathic PD patients were recruited into the present cross-sectional study. All patients underwent motor and non-motor assessments using serial scales. In addition, the electrophysiological vestibular evaluation was conducted, which included cervical (cVEMP) and ocular VEMP (oVEMP) assessments. Furthermore, the correlations of bilateral c/oVEMP absence with clinical phenotypes, especially FOG, among the PD patients were analyzed.
RESULTS: Among the 95 patients with PD, 44 (46.3%) had bilateral oVEMP absence and 23 (24.2%) had bilateral cVEMP absence, respectively. The proportions of patients with bilateral oVEMP absence (77.8% vs 30.9%, p = 0.004) and bilateral cVEMP absence (44.4% vs 19.5%, p = 0.035) were higher in the patient group exhibiting FOG than in the group without FOG. Following the adjustment of confounding variables, bilateral oVEMP absence (OR = 8.544, p = 0.007), rather than bilateral cVEMP absence, was shown to independently predict FOG occurrence in patients with PD.
CONCLUSIONS: The close correlation between bilateral oVEMP absence and FOG in PD patients sheds new light on the possible role of central vestibular/upper brainstem dysfunction in FOG development in patients with PD.