Intrarater and interrater agreement and reliability of vestibular evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) for HTLV-1 associated myelopathy testing.

BACKGROUND:The vestibular evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) has been used to assess the function of the vestibulospinal motor tract and is a candidate biomarker to predict and monitor the human T-cell lymphotropic virus type 1 (HTLV-1) associated myelopathy (HAM). This study determined the agreement and reliability of this exam. METHODS:Galvanic-VEMP was performed in 96 participants, of which 24 patients presented HAM, 27 HTLV-1-asymptomatic carriers, and 45 HTLV-1-negative asymptomatic controls. Galvanic vestibular stimulation was achieved by passing a binaural and bipolar current at a 2 milliamperes (mA) intensity for 400 milliseconds (ms) between the mastoid processes. Galvanic-VEMP electromyographic wave responses of short latency (SL) and medium latency (ML) were recorded from the gastrocnemius muscle. Intrarater (test-retest) and interrater (two independent examiners) agreement and reliability were assessed by standard error of measurement (SEM), coefficient of repeatability (CR), intraclass correlation coefficient (ICC), and Kappa coefficient. RESULTS:In the total sample (n = 96), SL and ML medians were 56 ms (IQR 52-66) and 120 ms (IQR 107-130), respectively. The intrarater repeatability measures for SL and ML were, respectively: SEM of 6 and 8 ms; CR of 16 and 22 ms; ICC of 0.80 (p<0.001) and 0.91 (p<0.001); and a Kappa coefficient of 0.53 (p<0.001) and 0.82 (p<0.001). The interrater reproducibility measures for SL and ML were, respectively: SEM of 3 and 10 ms; CR of 8 and 27 ms; ICC of 0.95 (p<0.001) and 0.86 (p<0.001); and a Kappa coefficient of 0.77 (p<0.001) and 0.88 (p<0.001). CONCLUSION:Galvanic-VEMP is a reliable and reproducible method to define the integrity of the vestibulospinal tract. Longitudinal studies will clarify its validity in the clinical context, aimed at achieving an early diagnosis and the monitoring of HAM

Vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation may reveal subclinical alterations in human T-cell lymphotropic virus type 1-associated myelopathy.

BACKGROUND:Vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) evaluates the motor spinal cord and identifies subclinical myelopathies. We used galvanic-VEMP to compare spinal cord function in individuals infected with human T-cell lymphotropic virus type 1 (HTLV-1) from asymptomatic status to HTLV-1-associated myelopathy (HAM). METHODOLOGY/PRINCIPAL FINDINGS:This cross-sectional study with 122 individuals included 26 HTLV-1-asymptomatic carriers, 26 individuals with possible HAM, 25 individuals with HAM, and 45 HTLV-1-seronegative individuals (controls). The groups were similar regarding gender, age, and height. Galvanic stimuli (duration: 400 ms; intensity: 2 mA) were applied bilaterally to the mastoid processes and VEMP was recorded from the gastrocnemius muscle. The electromyographic parameters investigated were the latency and amplitude of the short-latency (SL) and medium-latency (ML) responses. While SL and ML amplitudes were similar between groups, SL and ML latencies were delayed in the HTLV-1 groups compared to the control group (p<0.001). Using neurological examination as the gold standard, ROC curve showed an area under the curve of 0.83 (p<0.001) for SL and 0.86 (p<0.001) for ML to detect spinal cord injury. Sensibility and specificity were, respectively, 76% and 86% for SL and 79% and 85% for ML. Galvanic-VEMP disclosed alterations that were progressive in HTLV-1-neurological disease, ranging from SL delayed latency in HTLV-1-asymptomatic carriers, SL and ML delayed latency in possible HAM group, to absence of VEMP response in HAM group. CONCLUSIONS/SIGNIFICANCE:The worse the galvanic-VEMP response, the more severe the myelopathy. Galvanic-VEMP alteration followed a pattern of alteration and may be a prognostic marker of progression from HTLV-1-asymptomatic carrier to HAM

General characteristics of human T-cell lymphotropic virus type 1 (HTLV-1)-infected and -uninfected groups (n = 122).

<p>General characteristics of human T-cell lymphotropic virus type 1 (HTLV-1)-infected and -uninfected groups (n = 122).</p

Vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) tracings.

<p>(A) Delayed short-latency (SL) and medium-latency (ML) waves in an individual with asymptomatic human T-cell lymphotropic virus type 1 (HTLV-1) infection. (B) Absent SL response with delayed ML response latency in an individual with possible HTLV-1-associated myelopathy (HAM). (C) Absent SL and ML responses in an individual with HAM. These recordings were obtained from subjects with their heads rotated to the left and electromyographic (EMG) responses recorded from the right gastrocnemius muscle. The black line indicates the trace recorded with the cathode and anode on the right and left side respectively, whereas the gray line indicates the opposite stimulation polarity. SL, short-latency response onset; ML, medium-latency response onset.</p

Comparative analysis of the latency and amplitude of short-latency (SL) and medium-latency (ML) responses between human T-cell lymphotropic virus type 1 (HTLV-1)-infected and -uninfected groups.

<p>Comparative analysis of the latency and amplitude of short-latency (SL) and medium-latency (ML) responses between human T-cell lymphotropic virus type 1 (HTLV-1)-infected and -uninfected groups.</p

Frequency comparisons between normal and altered vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) for each group.

<p>The type of response (normal, delayed latency, or absent) and its frequency (%) is shown for each group. G1, uninfected control group; G2, human T-cell lymphotropic virus type 1 (HTLV-1)-asymptomatic group; G3, possible HTLV-1-associated myelopathy (HAM) group; G4, HAM group; n, number of participants. ^aDelayed latency of short-latency (SL), medium-latency (ML), or both responses. ^bAbsent SL, ML, or both responses. *p<0.001, chi-square or Fisher’s exact test.</p