臨床検査52巻12号

2008年11月発行

今月の主題 平衡機能検査 平衡機能の検査

2．耳石機能検査―1) 前庭性頸筋電位

著者： 竹腰英樹¹ Catherine　de²

所属機関： ¹国立病院機構東京医療センター耳鼻咽喉科 ²Laboratoire de Neurobiologie des Réseaux Sensorimoteurs

ページ範囲：P.1419 - P.1424

　平衡機能検査の中で最近注目されている前庭性頸筋電位(vestibular evoked myogenic potential；VEMP)は，ヘッドフォンからクリック音刺激を与え短潜時に胸鎖乳突筋より得られる筋電位であり，耳石器に由来する反応と考えられている．動物実験などから，球形囊由来の反応とされ，球形囊や下前庭神経の障害を診断するのに有用である．刺激はクリック音刺激のほか，ショートトーンバースト刺激，骨導刺激，電気刺激などが行われるようになり，様々な疾患の検査に応用されている．反応を振幅ばかりでなく，潜時も検討することにより前庭脊髄路の障害も診断可能である．本稿では，VEMPの検査法や注意点を記し，代表的な疾患における反応について述べた．

参考文献

1) Lowenstein O, Roberts TD：The localization and analysis of the responses to vibration from the isolated elasmobranch labyrinth；a contribution to the problem of the evolution of hearing in vertebrates. J Physiol　114：471-489, 1951

2) Békésy G von：Über akustische Reizung des Vestibularapparates. Pflugers Arch　236：59-76, 1935

3) Bickford RG, Jacobson JL, Cody DT：Nature of average evoked potentials to sound and other stimuli. Ann NY Acad Sci　112：204-223, 1964

4) Townsend GL, Cody DT：The averaged inion response evoked by acoustic stimulation：its relation to the saccule. Ann Otol Rhinol Laryngol　80：121-131, 1971

5) Colebatch JG, Halmagyi GM：Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation. Neurology　42：1635-1636, 1992

6) McCue MP, Guinan JJ：Acoustically responsive fibers in the vestibular nerve of the cat. J Neurosci　14：6058-6070, 1994

7) Murofushi T, Curthoys IS, Topple AN, et al：Responses of guinea pig primary vestibular neurons to clicks. Exp Brain Res　103：174-178, 1995

8) Murofushi T, Curthoys IS：Physiological and anatomical study of clicksensitive primary vestibular afferents in the guinea pig. Acta Otolaryngol(Stockh)　117：66-72, 1997

9) Murofushi T, Curthoys IS, Gilchrist DP：Response of guinea pig vestibular nucleus neurons to clicks. Exp Brain Res　111：149-152, 1996

10) Uchino Y, Sato H, Sasaki M, et al：Sacculocollic reflex arcs in cats. J Neurophysiol　77：3003-3012, 1997

11) Kushiro K, Zakir M, Ogawa Y, et al：Saccular and utricular inputs to sternocleidomastoid motoneurons of decerebrate cats. Exp Brain Res　126：410-416, 1999

12) 室伏利久：VEMP(前庭誘発筋電位)活用ガイドブック，金原出版，pp28-32, 2007

13) Murofushi T, Matsuzaki M, Wu CH：Short tone burst-evoked myogenic potentials on the sternocleidomastoid muscle：are these potentials also of vestibular origin? Arch Otolaryngol Head Neck Surg　125：660-664, 1999

14) Welgampola MS, Colebatch JG：Characteristics of tone burst-evoked myogenic potentials in the sternocleidomastoid muscles. Otol Neurootol　22：796-802, 2001

15) Welgampola MS, Rosengren SM, Halmagyi GM, et al：Vestibular activation by bone conducted sound. J Neurol Neurosurg Psychiatry　74：771-778, 2003

16) Sheykholeslami K, Habiby Kermany M, Kaga K：Frequency sensitivity range of the saccule to bone-conducted stimuli measured by vestibular evoked myogenic potentials. Hear Res　160：58-62, 2001

17) Watson SR, Colebatch JG：Vestibulocollic reflexes evoked by shortduration galvanic stimulation in man. J Physiol　513：587-597, 1998

18) Murofushi T, Matsuzaki M, Mizuno M：Vestibular evoked myogenic potentials in patients with acoustic neuromas. Arch Otolaryngol Head Neck Surg　124：509-512, 1998

19) Welgampola MS, Colebatch JG：Vestibulocollic reflexes：normal values and the effect of age. Clin Neurophysiol　112：1971-1979, 2001

20) Bath AP, Harris N, McEwan J：Effect of conductive hearing loss on the vestibulocollic reflex. Clin Otolaryngol　24：181-183, 1999

21) Brantberg K, Tribukait A：Vestibular evoked myogenic potentials in response to laterally directed skull taps. J Vestib Res　12：35-45, 2002

22) Welgampola MS, Rosengren SM, Halmagyi GM, et al：Vestibular activation by bone conducted sound. J Neurol Neurosurg Psychiatry　74：771-778, 2003

23) Murofushi T, Takegoshi H, Ohki M, et al：Galvanic-evoked myogenic responses in patients with an absence of click-evoked vestibulocollic reflexes. Clin Neurophysiol　113：305-309, 2002

24) De Waele C, Tran Ba Huy P, Diard JP, et al：Saccular dysfunction in Meniere's patients. A vestibular-evoked myogenic potential study. Ann NY Acad Sci　871：392-397, 1999

25) Murofushi T, Matsuzaki M, Takegoshi H：Glycerol affects vestibular evoked myogenic potentials in Meniere's disease. Auris Nasus Larynx　28：205-208, 2001

26) Young YH, Huang TW, Cheng PW：Assessing the stage of Meniere's disease using vestibular evoked myogenic potentials. Arch Otolaryngol Head Neck Surg　129：815-818, 2003

27) Seo T, Yoshida K, Shibano A, et al：A possible case of saccular endolymphatic hydrops. ORL　61：215-218, 1999

28) Magliulo G, Cuiuli G, Gagliardi M, et al：Vestibular evoked myogenic potentials and glycerol testing. Laryngoscope　114：338-343, 2004

29) Murofushi T, Halmagyi GM, Yavor RA, et al：Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis. An indicator of inferior vestibular nerve involvement? Arch Otolaryngol Head Neck Surg　122：845-849, 1996

30) Chen CW, Young YH, Wu CH：Vestibular neuritis：three-dimensional videonystagmography and vestibular evoked myogenic potential results. Acta Otolaryngol　120：845-848, 2000

31) Ochi K, Ohashi T, Watanabe S：Vestibular-evoked myogenic potential in patients with unilateral vestibular neuritis：abnormal VEMP and its recovery. J Laryngol Otol　117：104-108, 2003

32) Takeichi N, Sakamoto T, Fukuda S, et al：Vestibular evoked myogenic potential (VEMP) in patients with acoustic neuromas. Auris Nasus Larynx　28(suppl)：39-41, 2001

33) Ushio M, Matsuzaki M, Takegoshi H, et al：Click-and short tone burst evoked myogenic potentials in cerebellopontine angle tumors. Acta Otolaryngol(Suppl)　545：133-135, 2001

34) Patko T, Vidal PP, Vibert N, et al：Vestibular evoked myogenic potentials in patients suffering from an unilateral acoustic neuroma：a study of 170 patients. Clin Neurophysiol　114：1344-1350, 2003

35) Matsuzaki M, Murofushi T, Mizuno M：Vestibular evoked myogenic potentials in acoustic tumor patients with normal auditory brainstem responses. Eur Arch Otorhinolaryngol　256：1-4, 1999

36) Tsutsumi T, Tsunoda A, Noguchi Y, et al：Prediction of the nerves of origin of vestibular schwannomas with vestibular evoked myogenic potentials. Am J Otol　21：712-715, 2000

37) Chen CW, Young YH, Tseng HM：Preoperative versus postoperative role of vestibular-evoked myogenic potentials in cerebellopontine angle tumor. Laryngoscope　112：267-271, 2002

38) Tsutsumi T, Komatsuzaki A, Noguchi Y, et al：Postoperative vestibular-evoked myogenic potentials in cases with vestibular schwannomas. Acta Otolaryngol　121：490-493, 2001

39) Minor LB, Solomon D, Zinreich JS, et al：Sound-and/or pressureinduced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg　124：249-258, 1998

40) Watson SR, Halmagyi GM, Colebatch JG：Vestibular hypersensitivity to sound (Tullio phenomenon)：structural and functional assessment. Neurology　54：722-728, 2000

41) Minor LB, Cremer PD, Carey JP, et al：Symptoms and signs in superior canal dehiscence syndrome. Ann NY Acad Sci　942：259-273, 2001

42) Streubel SO, Cremer PD, Carey JP, et al：Vestibularevoked myogenic potentials in the diagnosis of superior canal dehiscence syndrome. Acta Otolaryngol(Suppl)　545：41-49, 2001

43) Minor LB, Carey JP, Cremer PD, et al：Dehiscence of bone overlying the superior canal as a cause of apparent conductive hearing loss. Otol Neurootol　24：270-278, 2003

44) Murofushi T, Shimizu K, Takegoshi H, et al：Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg　127：1069-1072, 2001

45) Sartucci F, Logi F：Vestibular-evoked myogenic potentials：a method to assess vestibulo-spinal conduction in multiple sclerosis patients. Brain Res Bull　59：59-63, 2002

46) Versino M, Colnaghi S, Callieco R, et al：Vestibular evoked myogenic potentials in multiple sclerosis patients. Clin Neurophysiol　113：1464-1469, 2002

47) Bandini F, Beronio A, Ghiglione E, et al：The diagnostic value of vestibular evoked myogenic potentials in multiple sclerosis. J Neurol　251：617-621, 2004

48) Dillmann U, Heide G, Wollenberg I, et al：Der Klick-evozierte vestibulokolläre reflex bei topologisch definierten hirnstammläsionen. Z Elektroencephalogr Elektromyogr　28：146-150, 1997

49) Chen CH, Young YH：Vestibular evoked myogenic potentials in brainstem stroke. Laryngoscope　113：990-993, 2003

50) Takegoshi H, Murofushi T：Vestibular evoked myogenic potentials in patients with spinocerebellar degeneration. Acta Otolaryngol　120：821-824, 2000