Does the human immunodeficiency virus influence the vestibulocollic reflex pathways? A comparative study

Background:This study compared vestibulocollic reflex and vestibulo-ocular reflex functioning in subjects with and without human immunodeficiency virus. It also described test results throughout progression of the disease and compared the results of human immunodeficiency virus positive subjects who were receiving antiretroviral therapies with those not receiving this treatment.Methods:Subjects comprised 53 adults with human immunodeficiency virus (mean age 38.5 ± 4.4 years) and 38 without human immunodeficiency virus (mean age 36.9 ± 8.2 years). Clinical examinations included cervical vestibular-evoked myogenic potential and bithermal caloric testing.Results:Abnormal cervical vestibular-evoked myogenic potential and caloric results were significantly higher in the human immunodeficiency virus positive group (p = 0.001), with an odds ratio of 10.2. Vestibulocollic reflex and vestibulo-ocular reflex involvement increased with progression of the disease. There were more abnormal test results in subjects receiving antiretroviral therapies (66.7 per cent) than in those not receiving antiretroviral therapies (63.6 per cent), but this difference was insignificant.Conclusion:Human immunodeficiency virus seems to influence vestibulocollic reflex pathways. Combining cervical vestibular-evoked myogenic potential and caloric testing may be useful to detect early neurological involvement in human immunodeficiency virus positive subjects.

The Recordability of Two Sonomotor Responses in Young Normal Subjects

Background: It has been reported that up to 40% of patients over age 60 fail to generate a vestibular evoked myogenic potential (VEMP; Su et al, 2004). When this occurs it is difficult to determine whether the absent VEMP represents evidence of bilateral impairment of the vestibulocollic reflex pathway or a normal age-related variant (i.e., idiopathic absence). Purpose: The purpose of the present investigation was to determine whether both VEMPs and PAMs could be recorded reliably in a sample of neurologically and otologically intact young adults. If both could be obtained with high reliability in normal subjects, then the bilateral presence of PAM in the bilateral absence of VEMP, at least in younger patients, could be used to support the contention that the absent VEMP represented evidence of bilateral impairment. Research Design: A descriptive study. Study Sample: Attempts were made to record both the VEMP and a second sonomotor response, the postauricular muscle potential (PAM) from 20 young adults. Results: Results showed both the VEMP and the PAM were present in 90% of the ears. Both the VEMP and PAM responses were bilaterally absent for one subject. Also, the VEMP and PAM were unilaterally absent for two subjects. Subjects who generated VEMPs also generated a PAM in at least one ear. Conclusions: The present investigation represents an initial step in the determination of whether the presence of PAMs in the absence of VEMPs can be used as a method of validating the presence of an impairment affecting the vestibulocollic reflex pathway.

Effect of MLF transection on the vertical vestibulocollic reflex in decerebrate cats

1. In the cat, motoneurons supplying biventer cervicis, complexus and rectus capitis posterior receive disynaptic input from the posterior semicircular canals and from the contralateral anterior canal via the medial vestibulospinal tract (MVST). Disynaptic excitation from the ipsilateral anterior canal reaches these motoneurons via the lateral vestibulospinal tract. 2. We hypothesized that if the MVST has a unique role in the production of the vertical vestibulocollic reflex (VCR) in these muscles then interruption of this tract by transection of the medial longitudinal fasciculus (MLF) would change the VCR responses. Specifically, response vector orientations would shift toward the plane of the ipsilateral anterior canal, and response gains would drop at high frequencies. 3. We lesioned the MLF bilaterally and observed no substantial effect on neck-muscle responses. Response vector orientations did not shift systematically toward a single plane, nor was there a consistent decrease in response gains at high frequencies. 4. As in the horizontal VCR, there is no unique contribution from MVST neurons; parallel pathways must play an important role in the vertical VCR.