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Original Article Ocular vestibular-evoked myogenic potential assists in differentiation of multiple system atrophy from Parkinson’s disease
Keun-Tae Kim1, Kyoungwon Baik2, Sun-Uk Lee1,2corresp_icon, Euyhyun Park1,3, Chan-Nyoung Lee2, Donghoon Woo1, Yukang Kim1, Seoui Kwag1, Hyunsoh Park1, Ji-Soo Kim4,5

DOI: [Accepted]
Published online: July 9, 2024
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1Neurotology and Neuro-ophthalmology Laboratory, Korea University Medical Center, Seoul, South Korea
2Department of Neurology, Korea University Medical Center, Seoul, South Korea
3Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
4Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
5Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
Corresponding author:  Sun-Uk Lee, Tel: +82-2-2199-3808, 
Received: 19 May 2024   • Revised: 21 June 2024   • Accepted: 8 July 2024

Vestibular-evoked myogenic potentials (VEMPs) can help assess otolithic neural pathway in the brainstem that may also participate in cardiovascular autonomic function. Parkinson’s disease (PD) is associated with altered VEMP responses; however, the association between VEMP abnormalities and multiple system atrophy (MSA) remains unknown. Therefore, we compared the extent of otolith dysfunction using ocular (oVEMP) and cervical VEMP (cVEMP) between MSA and PD. We analyzed the clinical features and VEMP and head-up tilt table test (HUT) findings using the Finometer in 24 patients with MSA and 52 with de-novo PD, who had undergone neurotologic evaluation in a referral-based university hospital in South Korea from January 2021 to March 2023. MSA was associated with bilateral oVEMP abnormality (odds ratio [95% confidence interval] = 9.19 [1.77–47.76], p=0.008). n1–p1 amplitude was negatively correlated with Unified Multiple System Atrophy Rating Scale I-II scores in patients with MSA (r=-0.571, p=0.033), whereas it did not correlate with Movement Disorder Society-Unified Parkinson’s Disease Rating Scale-III scores in patients with PD (r=-0.051, p=0.687). n1 latency was negatively correlated with maximum changes in systolic blood pressure within 15 s during HUT in patients with PD (r=-0.335, p=0.040) but not in those with MSA (r=0.277, p=0.299). In conclusion, bilaterally abnormal oVEMP responses may indicate the extent of brainstem dysfunction in MSA. oVEMP reflects the integrity of otolith-autonomic interplay, reliably assists in differentiating between MSA and PD, and helps infer clinical decline.

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