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

Labanca, Ludimila; Caporali, Júlia Fonseca de Morais; Carvalho, Sirley Alves da Silva; Lambertucci, José Roberto; Proietti, Anna Bárbara de Freitas Carneiro; Romanelli, Luiz Cláudio Ferreira; Avan, Paul; Giraudet, Fabrice; Souza, Bárbara Oliveira; Florentino, Kyonis Rodrigues; Gonçalves, Denise Utsch

doi:10.1371/journal.pone.0200536

Cited by 8 publications

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“…VEMP can detect subclinical neurological changes in HTLV-1 infection [13,16,29]. We showed that many of those labeled as asymptomatic carriers, presented altered cervical VEMP and normal ocular VEMP, indicating alteration in cervical spine but not in the upper CNS.…”

Section: Discussionmentioning

confidence: 82%

“…The subclinical spinal cord injury related to HAM has been already shown through VEMP of cervical and of lower limbs muscles, exams that are used to test the vestibulo-collic reflex [8,9,13,16,17]. The present study proposes the use of VEMP of the oculomotor system (ocular VEMP) to test the brainstem pathways associated with body balance to verify the extension of the HTLV-1-neurological damage.…”

Section: Introductionmentioning

confidence: 99%

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Ocular vestibular evoked myogenic potential (VEMP) reveals mesencephalic HTLV-1-associated neurological disease

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PurposeVestibular Myogenic Evoked Potential (VEMP) evaluates vestibulo-ocular and vestibulo-collic reflexes involved in the function of the otolithic organs and their afferent pathways. We compared the results of cervical and ocular VEMP in HTLV-1 associated myelopathy (HAM) and HTLV-1-asymptomatic infection.Participants and methodsThis cross-sectional study included 52 HTLV-1-infected individuals (26 HAM and 26 asymptomatic carriers) and 26 seronegative controls. The groups were similar regarding age and gender. Participants underwent simultaneous ocular and cervical VEMP. The stimulus to generate VEMP was a low-frequency tone burst sound tone burst, with an intensity of 120 decibels normalized hearing level, bandpass filter from 10 to 1,500 Hertz (Hz), with 100 stimuli at 500 Hz and 50 milliseconds recording time. The latencies of the electrophysiological waves P13 and N23 for cervical VEMP and N10 and P15 waves for ocular VEMP were compared among the groups. The absence or delay of the electrophysiological waves were considered abnormal results.ResultsOcular VEMP was similar among the groups for N10 (p = 0.375) and different for P15 (p≤0.001). Cervical VEMP was different for P13 (p = 0.001) and N23 (p = 0.003). About ocular VEMP, in the HTLV-1-asymptomatic group, normal waves were found in 23(88.5%) individuals; in HAM group, normal waves were found in 7(26.9%). About cervical VEMP, 18(69.2%) asymptomatic carriers presented normal waves and only 3(11.5%) patients with HAM presented normal waves. Abnormalities in both VEMPs were found in 1(3.8%) asymptomatic carrier and in 16(61.5%) patients with HAM.ConclusionNeurological impairment in HAM was not restricted to the spinal cord. The mesencephalic connections, tested by ocular VEMP, have been also altered. Damage of the oculomotor system, responsible for eye stabilization during head and body movements, may explain why dizziness is such a frequent complaint in HAM.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Ocular vestibular evoked myogenic potential (VEMP) reveals mesencephalic HTLV-1-associated neurological disease

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“…Recent evidences have showed that HTLV-1 is related to a complex of neurological manifestations that are not limited to the clinical spectrum of HAM/TSP, affecting all the segments of the central nervous system to a greater or lesser extent [3,[8][9][10][11][12][13][14][15][16][17][18]. In this context, cognitive impairment has been reported as one of the manifestations of the HTLV-1 infection [11,13,[19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

“…However, the prevalence of neurological disorders that do not meet the criteria for de nite HAM/TSP, such as urinary disorders, sexual dysfunction and skin lesions, can occur in around 30% of those individuals classi ed as HTLV-1-asymptomatic carriers [4][5][6]. In fact, non-medullary symptoms have been neglected in the HTLV-1 infection [7].Recent evidences have showed that HTLV-1 is related to a complex of neurological manifestations that are not limited to the clinical spectrum of HAM/TSP, affecting all the segments of the central nervous system to a greater or lesser extent [3,[8][9][10][11][12][13][14][15][16][17][18]. In this context, cognitive impairment has been reported as one of the manifestations of the HTLV-1 infection [11,13,[19][20][21][22][23][24].…”

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Cognitive screening in HTLV-1–infected people using a self-perceived memory score and auditory P300

et al. 2022

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Background: The HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most common neurological manifestation associated with Human T-cell Lymphotropic Virus type-1 (HTLV-1) infection. Although cognitive impairment has been highlighted in the spectrum of HTLV-1 neurological manifestations, it may go unnoticed in those who do not spontaneously report it. We aimed at evaluating the applicability of a self-perceived memory score (SMS) and the cognitive event-related potential (P300) for the early detection of cognitive impairment in HTLV-1-infected people.Methods: The SMS was measured by a 0-10 visual analog scale combined with a sad-happy faces rating scale. The higher the number, the better was the SMS. The P300 was obtained through an oddball paradigm with a mental counting task. The participants were 15(21,4%) individuals with HAM/TSP, 20(28,6%) HTLV-1-asymptomatic carriers, and 35(50%) seronegative controls.Results: SMS (p<0.001) and P300 latency (p<0.001) got progressively worse from asymptomatic to HAM/TSP. A SMS <7.2 points and a P300 latency >369.0 milliseconds were considered as altered result and indicated cognitive impairment. The HAM/TSP group showed the highest prevalence of altered P300 (80%) and SMS (87%). Interestingly, the asymptomatic group also presented signi cant higher prevalence of altered SMS (60%) and P300 (35%) when compared to controls (<10%). The frequency of cognitive impairment was 16 times higher in the asymptomatic group and 69 times higher in the HAM/TSP group when compared to controls. Conclusion:The use of SMS in the medical consultation was a useful and easy-to-apply method to screen HTLV-1 infected subjects for everyday memory complaints. BackgroundThe rst descriptions of the neurological disease associated with HTLV-1 infections were based on the motor function assessed by mobility and strength disability [1, 2]. The HTLV-1 associated myelopathy / tropical spastic paraparesis (HAM/TSP) is a chronic, slow-progressing neurological in ammatory disease that affects approximately 4% of the infected individuals [3, 4]. However, the prevalence of neurological disorders that do not meet the criteria for de nite HAM/TSP, such as urinary disorders, sexual dysfunction and skin lesions, can occur in around 30% of those individuals classi ed as HTLV-1-asymptomatic carriers [4][5][6]. In fact, non-medullary symptoms have been neglected in the HTLV-1 infection [7].Recent evidences have showed that HTLV-1 is related to a complex of neurological manifestations that are not limited to the clinical spectrum of HAM/TSP, affecting all the segments of the central nervous system to a greater or lesser extent [3,[8][9][10][11][12][13][14][15][16][17][18]. In this context, cognitive impairment has been reported as one of the manifestations of the HTLV-1 infection [11,13,[19][20][21][22][23][24]. On the other hand, HAM/TSP remains as the most important neurological disease associated with 26]. Therefore, cognitive impairment can be underdiagnosed and may go unnoticed in those indivi...

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“…The subclinical spinal cord injury related to HAM has been already shown 27 through VEMP of cervical and of lower limbs muscles, exams that are used to test 28 the vestibulospinal reflex [11,12,16,19,20]. The present study proposes the use of 29 VEMP of the oculomotor system (ocular VEMP) to test the subcortical pathways 30 associated with body balance to verify the extension of the HTLV-1-neurological 31 damage.…”

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Ocular vestibular evoked myogenic potential (VEMP) reveals subcortical HTLV-1-associated neurological disease

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Introduction: Vestibular Myogenic Evoked Potential (VEMP) evaluates vestibuloocular and vestibulospinal reflexes associated with posture. Purpose: To compare cervical and ocular VEMP in individuals with HTLV-1 associated myelopathy (HAM) and with HTLV-1-asymptomatic infection. Materials and Methods: This cross-sectional study included 52 HTLV-1-infected individuals (26 HAM and 26asymptomatic carriers) and 26 negative controls. The groups were similar regarding age and gender. Participants underwent ocular and cervical VEMP that were performed simultaneously. The stimulus used to generate VEMP was a sound, lowfrequency toneburst, intensity of 120 decibels normalized hearing level (dB nHL), bandpass filter from 10 to 1,500 Hz, with 100 stimuli at 500 Hertz (Hz) and 50 milliseconds (ms) recording time. An alteration in the electrophysiological waves 3 P13 and N23 for cervical VEMP and N10 and P15 waves for ocular VEMP was compared between groups. Results: Cervical VEMP was different among the groups for P13 (p=0.001) and N23 (p=0.003). Ocular VEMP was similar for N10 (p=0.375) and different for P15 (p=0.000). In the HTLV-1-asymptomatic group, 1(3.8%) individual presented changes in both ocular and cervical VEMP, while in HAM group, 16(61.5%) presented changes in both tests. Conclusion: Neurological impairment in HAM was not restricted to the spinal cord. The mesencephalic and thalamic connections, tested by ocular VEMP, were also altered. Damage of the oculomotor system, responsible for eye stabilization during head and body movements, may explain why dizziness is such a frequent complaint in HAM. Authors' summaryHuman T-cell lymphotropic virus type 1 (HTLV-1) infection is endemic in Brazil and can cause HTLV-1-associated myelopathy (HAM). This neurological disease progresses slowly and, within ten years after its onset, can confine the patient to a wheelchair. Changes in HAM inflammatory characteristics can subsequently occur in the cortex, subcortical white matter, cerebellum, and brainstem. In the present study, we used the electrophysiological test Vestibular Myogenic Evoked Potential (VEMP) to evaluate the thalamic, brainstem, and spinal neural connections. This test evaluates the peripheral and the central vestibular pathway and has been used to test the postural reflexes involved in the control of one's balance. The VEMP from 4 the oculomotor muscles demonstrated that a subcortical impairment occurs in HAM and can also occur in the asymptomatic phase of HTLV-1 infection. 1 Introduction 2 The Human T-cell lymphotropic virus type 1 (HTLV-1) infection affects 3 approximately 5-10 million people worldwide [1]. The majority of the infected 4 individuals remain asymptomatic throughout their lives [2]. The host genetic and 5 immunological factors seem to be related to the development of HTLV-1-associated 6 diseases [1,2].7The range of neurological manifestations of HTLV-1-associated myelopathy 8 (HAM) includes not only the spine, with the classical motor limitations affecting 9 the lower limbs, but also the autonomi...

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

Cited by 8 publications

References 50 publications

Ocular vestibular evoked myogenic potential (VEMP) reveals mesencephalic HTLV-1-associated neurological disease

Ocular vestibular evoked myogenic potential (VEMP) reveals mesencephalic HTLV-1-associated neurological disease

Cognitive screening in HTLV-1–infected people using a self-perceived memory score and auditory P300

Ocular vestibular evoked myogenic potential (VEMP) reveals subcortical HTLV-1-associated neurological disease

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