直流电刺激诱发的前庭诱发肌源性电位儿童检测方法的建立

Establishment of a Method for Galvanic Vestibular Stimulation-vestibular Evoked Myogenic Potentials in Healthy Children

陈耔辰;胡娟;陈飞云;杨慧;陈彦飞;薛婷婷;杨方园;张玉忠;吴琼;金玉莲;任晓勇;张青

1:西安交通大学第二附属医院耳鼻咽喉头颈外科

2:上海交通大学医学院附属新华医院耳鼻咽喉头颈外科听力学与眩晕中心/上海交通大学医学院耳科学研究所/上海市耳鼻疾病转化医学重点实验室

摘要
目的 建立健康儿童直流电刺激诱发(galvanic vestibular stimulation, GVS)的颈肌前庭诱发肌源性电位(cervical vestibular evoked myogenic potential, cVEMP)和眼肌前庭诱发肌源性电位(ocular vestibular evoked myogenic potential, oVEMP)的检测方法,并确定正常范围。方法 对健康儿童20例(3~14岁)和健康成人24例(18~30岁)分别进行GVS-cVEMP和GVS-oVEMP检测,儿童组直流电刺激强度不超过3 mA,成人组最大刺激强度5 mA,记录两组GVS-cVEMP和GVS-oVEMP的引出率和特点,并进行不同刺激强度下的疼痛评分。结果 GVS-cVEMP和GVS-oVEMP在儿童组和成人组的引出率均为100.0%。儿童组GVS-cVEMP的p1潜伏期、n1潜伏期和p1-n1波间期分别为10.46±1.84 ms、16.98±2.12 ms和6.52±1.42 ms, n1潜伏期和p1-n1波间期较成人组明显缩短(P<0.05)。儿童组GVS-oVEMP的n1潜伏期、p1潜伏期和p1-n1波间期分别为8.87±1.40 ms、12.25±1.80 ms和3.39±1.07 ms,与成人组无明显差异。儿童组GVS-cVEMP和GVS-oVEMP的阈值均明显低于成人组(P<0.01),但振幅和振幅不对称比无明显差异。本文健康儿童检测结果可作为其正常范围。随着电流刺激强度的增加,受试者的疼痛评分增高,其对应的GVS-cVEMP和GVS-oVEMP的引出率也增加。结论 采取3 mA刺激强度和适宜的记录方法,可在3岁以上儿童及青少年人群中进行GVS-cVEMP和GVS-oVEMP检测并引出波形,并得到了其正常范围,儿童GVS-cVEMP潜伏期略短于成人,进行评估时,建议选取同年龄段健康儿童进行比较。
关键词
前庭诱发肌源性电位;直流电刺激;健康儿童
基金项目(Foundation):
国家自然科学基金项目(81970891,82171137);; 陕西省国际科技合作重点项目(2017KW-048);; 陕西省国际合作重点研发计划项目(2020KWZ-019)
作者
陈耔辰;胡娟;陈飞云;杨慧;陈彦飞;薛婷婷;杨方园;张玉忠;吴琼;金玉莲;任晓勇;张青
参考文献

1 Wang SJ,Hsieh WS,Young YH.Development of ocular vestibular-evoked myogenic potentials in small children[J].Laryngoscope,2013,123(2):512-517.

2 Young YH,Chen CN,Hsieh WS,et al.Development of vestibular evoked myogenic potentials in early life[J].Eur J Paediatr Neurol,2009,13(3):235-239.

3 Greenwalt NL,Patterson JN,Rodriguez AI,et al.Bone conduction vibration vestibular evoked myogenic potential (VEMP) testing:reliability in children,adolescents,and young adults[J].Ear Hear,2021,42(2):355-363.

4 Chou CH,Hsu WC,Young YH.Ocular vestibular-evoked myogenic potentials via bone-conducted vibration in children[J].Clin Neurophysiol,2012,123(9):1880-1885.

5 Rodriguez AI,Marler E,Fitzpatrick D,et al.Optimization of cervical and ocular vestibular evoked myogenic potential testing using an impulse hammer in adults,adolescents,and children[J].Otol Neurotol,2020,41(6):817-827.

6 张玉忠,张滟,魏馨雨,等.双侧大前庭水管综合征患儿的前庭诱发肌源性电位特征[J].听力学及言语疾病杂志,2019,27(3):233-237.

7 徐勇,陈耔辰,张玉忠,等.人工耳蜗植入对前庭诱发肌源性电位远期影响的初步研究[J].中华耳科学杂志,2017,15(4):441-446.

8 Xu XD,Zhang Q,Hu J,et al.The hidden loss of otolithic function in children with profound sensorineural hearing loss[J].Int J Pediatr Otorhinolaryngol,2015,79(6):852-857.

9 Singh S,Gupta RK,Kumar P.Vestibular evoked myogenic potentials in children with sensorineural hearing loss[J].Int J Pediatr Otorhinolaryngol,2012,76(9):1308-1311.

10 Akdogan O,Selcuk A,Ozcan I,et al.Vestibular nerve functions in children with auditory neuropathy[J].Int J Pediatr Otorhinolaryngol,2008,72(3):415-419.

11 Cheng PW,Chen CC,Wang SJ,et al.Acoustic,mechanical and galvanic stimulation modes elicit ocular vestibular-evoked myogenic potentials[J].Clin Neurophysiol,2009,120(10):1841-1844.

12 Rosengren SM,Jombik P,Halmagyi GM,et al.Galvanic ocular vestibular evoked myogenic potentials provide new insight into vestibulo-ocular reflexes and unilateral vestibular loss[J].Clin Neurophysiol,2009,120(3):569-580.

13 Sung PH,Chang CM,Young YH,et al.Optimal stimulation mode for obtaining galvanic ocular vestibular-evoked myogenic potentials:our experience[J].Clin Otolaryngol,2014,39(4):240-245.

14 陈耔辰,魏馨雨,张玉忠,等.直流电刺激诱发健康青年人前庭诱发肌源性电位的初步观察[J].中华耳鼻咽喉头颈外科杂志,2019,54(6):432-438.

15 Cheng PW,Yang CS,Huang TW,et al.Optimal stimulation mode for galvanic-evoked myogenic potentials[J].Ear Hear,2008,29(6):942-946.

16 Barkovich AJ.Magnetic resonance techniques in the assessment of myelin and myelination[J].J Inherit Metab Dis,2005,28(3):311-343.

17 Wang SJ,Yeh TH,Chang CH,et al.Consistent latencies of vestibular evoked myogenic potentials[J].Ear Hear,2008,29(6):923-929.

18 Adolph KE,Vereijken B,Shrout PE.What changes in infant walking and why[J].Child Dev,2003,74(2):475-497.

19 Chang CM,Young YH,Cheng PW.Feasibility of simultaneous recording of cervical and ocular vestibular-evoked myogenic potentials via galvanic vestibular stimulation[J].Acta Otolaryngol,2013,133(12):1278-1284.