Are test results from Subjective Visual Vertical and Ocular Vestibular Evoked Potentials correlated in a Danish Cohort of Patients admitted to a tertiary Dizziness Clinic?

Larsen, Frederik

5. Term (Master thesis)

Medicine, Master

2018

2018-01-04

15

Formål: At undersøge om resultaterne fra to standardbalancetests – oVEMP og SVV – stemmer overens hos patienter, der for første gang oplever svimmelhed som eneste symptom. oVEMP og SVV bruges i vestibulær diagnostik; SVV vurderer personens sans for lodret, mens oVEMP afspejler balancereaktioner målt omkring øjnene. Metode: Et retrospektivt klinisk studie omfattede 103 patienter henvist til en tertiær svimmelhedsklinik med førstegangs monosymptomatisk svimmelhed. Alle fik både SVV og oVEMP. Testene blev sammenlignet ved stratificering og Receiver Operating Characteristics (ROC)-kurver, hvor arealet under kurven (AUC) blev beregnet. oVEMP blev brugt som reference for, hvad der blev betragtet som patologisk. Resultater: Hos patienter med symptomvarighed under én måned kunne SVV i rimelig grad skelne mellem normale og patologiske fund defineret af oVEMP (AUC 0,83). For hele populationen og for patienter med symptomer i mere end én måned var AUC < 0,5, hvilket indikerer ringere end tilfældig træfsikkerhed. For patienter med Ménières sygdom, vestibulær neuritis eller BPPV, grupperet efter hvilken side lægen vurderede som afficeret, var overensstemmelsen mellem lægens vurdering og henholdsvis oVEMP og SVV på 27,5 % og 24 %. For BPPV alene var overensstemmelsen 20 % for begge tests. Blandt patienter, hvor kun én oVEMP-respons kunne måles, var overensstemmelsen mellem SVV og oVEMP 34 %, og 59 % havde normal SVV men patologisk oVEMP. Konklusion: Hos patienter med førstegangs monosymptomatisk svimmelhed sås en sammenhæng mellem oVEMP- og SVV-resultater, når symptomerne havde varet under én måned. Uden for denne tidlige fase var sammenhængen begrænset. Selvom begge tests indgår i den udvidede vestibulære udredning, bør klinikere være opmærksomme på de potentielle fejl i udførelse og fortolkning, som diskuteres i studiet.

Objective: To examine whether two standard balance tests—oVEMP and SVV—produce matching results in patients admitted for a first episode of vertigo as their only symptom. These vestibular tests are commonly used in diagnostics; SVV assesses a person’s sense of vertical, while oVEMP reflects balance-related responses measured around the eyes. Methods: This retrospective clinical study included 103 patients referred to a tertiary dizziness clinic for first-time monosymptomatic vertigo. All underwent both SVV and oVEMP. The tests were compared using stratification and Receiver Operating Characteristics (ROC) curves, with area under the curve (AUC) calculated. oVEMP served as the reference for what counted as a pathological finding. Results: Among patients with symptoms lasting less than one month, SVV could reasonably distinguish between normal and abnormal findings as defined by oVEMP (AUC 0.83). For the full cohort and for those with symptoms longer than one month, AUC values were <0.5, indicating worse-than-chance accuracy. In patients with Ménière’s disease, vestibular neuritis, or BPPV, grouped by the clinician-identified affected side, agreement with oVEMP and with SVV was 27.5% and 24%, respectively. For BPPV alone, agreement was 20% for both tests. Among patients in whom only one oVEMP response was measurable, agreement between SVV and oVEMP was 34%, and 59% had normal SVV but abnormal oVEMP. Conclusion: In first-time monosymptomatic vertigo, oVEMP and SVV results correlate when symptoms are recent (less than one month). Beyond this early phase, concordance is limited. Although both tests are part of comprehensive vestibular assessment, clinicians should remain alert to potential testing and interpretation errors highlighted in the study.

[This abstract was generated with the help of AI]

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