- Email: [email protected]
P71-F Clinical use of vestibular evoked myogenic potential (VEMP) in unilateral Menière disease (MD)
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
might reflect brain arousal in patients with Alzheimer’s disease dementia (ADD) at the group and the individual level. Methods: Our dataset was an international archive of Clinical and rsEEG data of 42 ADD and 40 healthy elderly (Nold) subjects. The delta, theta, alpha 1, alpha 2, and alpha 3 frequency bands were determined by Individual alpha frequency peak (IAF). Fixed beta 1, beta 2, and gamma bands were also considered. rsEEG cortical sources were estimated by means of the exact low-resolution brain electromagnetic source tomography and were then classified across individuals, on the basis of the receiver operating characteristic (ROC) curves. Results: Compared to the Nold group, IAF showed slowing in the ADD group. Furthermore, The ADD group showed lower posterior alpha 2 source activities and higher occipital delta source activities. The ratio of occipital delta to alpha 2 allowed good classification accuracy (sensitivity: 88.1%, specificity: 85%, and accuracy: 86.6%) between the Nold and ADD individuals. Conclusion: In quiet wakefulness, delta and alpha sources unveiled different spatial and frequency features of the cortical neural synchronization underpinning brain arousal in ADD patients compared with Nold subjects. An ongoing study is testing the enrichment of markers derived from structural magnetic resonance imaging (MRI) in the classification accuracy between Nold and ADD patients for potential clinical applications. doi:10.1016/j.clinph.2019.04.517
P69-F A short computerized cognitive training may improve cortical neural synchronization mechanisms in Parkinson’s disease patients—Roberta Lizio a,*, Miss. Jessica Janson b, Claudio Del Percio b, Giuseppe Noce a, Susanna Lopez b, Lucia Fraioli c, Antonio Ivano Triggiani d, Fabrizio Stocchi e, Laura Vacca e, Maria Francesca De Pandis c, Claudio Babiloni b,c (a IRCCS SDN, Naples, Italy , b Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy, c Hospital San Raffaele of Cassino, Cassino, FR, Italy, d Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy, e IRCCS San Raffaele Pisana, Rome, Italy) ⇑
Corresponding author.
Background: Previous evidence showed abnormal posterior sources of resting-state electroencephalographic (rsEEG) delta (<4 Hz) and alpha (about 8–12 Hz) rhythms in patients with Parkinson’s disease (PD) as cortical neural synchronization markers in quiet wakefulness. We hypothesized that a relatively short computerized cognitive training in PD patients might affect these mechanisms. Methods: Clinical and rsEEG data were collected in PD patients with cognitive deficits (e.g., dementia or mild cognitive impairment), undergoing a standard levodopa therapy, and normal elderly (Nold) subjects. The rsEEG data in PD patients were recorded in three phases: before intervention (baseline), after two weeks of a computerized cognitive training (executive and episodic memory functions), and after two weeks of a computerized control procedure (watching favorite videos), in a cross-over design. Cortical rsEEG sources were estimated by exact low-resolution brain electromagnetic tomography (eLORETA). Results: During baseline recordings, the PD group showed reduced posterior alpha and increased widespread delta source activities compared to the Nold group. In PD patients, the widespread delta
e87
source activities significantly decreased after cognitive training but not after the control intervention. Conclusions: These results suggest that in PD patients with cognitive deficits a relatively short computerized cognitive training may have beneficial effects on cortical neural synchronization mechanisms generating abnormal cortical delta rhythms in quiet wakefulness. doi:10.1016/j.clinph.2019.04.518
P70-F Vestibular-evoked myogenic potentials for the diagnosis of superior canal dehiscence syndrome—Esmeralda Rocío Martín *, Rybel Wix, Salvador Delis Gómez, Marleny Macario, Jesús Pastor Gómez (Hospital Universitario La Princesa, Madrid, Spain) ⇑
Corresponding author.
Background: Superior canal dehiscence syndrome (SCDS) is a clinical entity characterized by vertigo and oscillopsia in response to sound (Tullio phenomenon), pressure (Hennebert sign) and vestibular stimulation with Valsalva maneuvers, disequilibrium, autophony, bone-conductive hyperacusis and pulsatile tinnitus. Vestibularevoked myogenic potentials (VEMPs) is a technique used to determine the function of the otolithic organs. The aim of the study is to examine the VEMPs characteristics in patients with SCDS. Material and methods: 5 patients with SCDS between 2016 and 2018 were included. VEMPs were recorded from the ipsilateral sternocleidomastoid muscle (cVEMP) and periocular sites (oVEMP). 500 Hz tone burst at 105 dB nHL was used as stimuli at 5 Hz stimulation rate and averaged for 200 repetitions. Bandpass-filtered between 20 Hz and 2 kHz. Statistical analysis included paired sample MannWhitney U test in the SPSS program. We compared the latency and amplitude of the affected ear with the healthy ear. Data shown as mean ± SE. Results: The mean age of the test group was 61.4 ± 8.08 years with 3 males and 2 females. Comparing the affected ear and healthy ear: oVEMP amplitude (33.2 ± 5.9/8 ± 2.1 lV, p < 0.01); oVEMP-n10 (9.9 ± 0.2/11.6 ± 1.1 ms, p > 0.11); cVEMPamplitude (158.8 ± 41.2/125 ± 29.86 lV, p > 0.56); cVEMP-p13 (15.2 ± 0.4/15.1 ± 0.7 ms, p > 0.8); In 100% of patients with SCDS, oVEMP amplitudes were significantly higher than normal values (p > 0.01 Mann-Whitney U). No statistically significant differences were obtained in the remaining parameters. Conclusions: oVEMP amplitude in patients diagnosed as SCDS are significantly higher than normal values. These techniques have proven to be useful for diagnosis of superior canal dehiscence syndrome. doi:10.1016/j.clinph.2019.04.519
P71-F Clinical use of vestibular evoked myogenic potential (VEMP) in unilateral Menière disease (MD)—Marleny Macario *, Esmeralda Rocío Martín, Cecilia Luque, Salvador Delis Gómez, Rybel Wix (Hospital Universitario La Princesa, Madrid, Spain) ⇑
Corresponding author.
Background: VEMP test averages myogenic responses evoked by sound that stimulates otolithic organs in the inner ear. is an inner ear pathology characterised by episodic attacks of vertigo and fluctuating cochlear symptoThe aim of the study is to describe the VEMP values obtained in patients diagnosed with unilateral MD.
e88
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
Materials and methods: VEMP studies performed in patients diagnosed with unilateral younger than 60 years old and done between 2014 and 2017 were analysed. VEMPs were recorded from the ipsilateral sternocleidomastoid muscle (cVEMP) and periocular sites (oVEMP). 500 Hz tone burst at 105 dB nHL was used as stimuli at 5 Hz stimulation rate and averaged for 200 repetitions. Bandpassfiltered between 20 Hz and 2 kHz. Statistical analysis included paired sample test in the SPSS program. We compared latency and amplitude of the affected side (AS) with healthy side (HS). Results: We included 9 patients, mean age 48.7 ± 6.8 years old. Patients without bilateral response (1 in cVEMP, 2 in oVEMP), were not included in the statistical analysis of its category. In 87.5% of the cases, p13 latency was longer in AS (13.5–21.1 ms) vs HS (12.9–15.9 ms, p = .017 Wilcoxon test). No statistically significant differences were obtained in the remaining parameter. Conclusion: The p13 latency of cVEMP is longer on the affected side with compared to the contralateral healthy side. Since VEMP test clinically evaluates the otolithic function, it is not invasive and is well tolerated, its use should be extended. doi:10.1016/j.clinph.2019.04.520
P72-F Electromyography in the course of amyotrophic lateral sclerosis—Ilona Hübner a,*, Jacek Hübner a, n. med. Sławomir Kroczka b (a Laboratory of Neurophysiology, Neurology Unit, District Hospital in Radomsko, Radomsko, Poland, b Laboratory of Neurophysiology, Chair of Child and Youth Neurology Collegium Medicum, Jagiellonian University in Krakow, Krakow, Poland) ⇑
Corresponding author.
Background: Amyotrophic lateral sclerosis is a progressive, incurable neurodegenerative disease resulting in neurogenic muscle damage. Material and methods: The study covered 20 patients – 5 women and 15 men aged 43–85; 65.5 on average. The group included patients with clinically proven or probable ALS diagnosis established based on the modified El Escorial criteria. The study was performed three times with three-month long intervals. Muscles from three layers of the central nervous system were subject to analysis: bulbs (muscle of the tongue), cervical (left biceps brachii – BB and left first dorsal interosseous – FDI), sacrolumbar (right vastus lateralis – VL and right tibialis anterior – TA). Resting activity and MUP parameters (amplitude, area, duration, size index – SI) were evaluated. Results: Incorrect results most frequently concerned the amplitude, area, SI MUP – BB (100%), FDI (100% – SI; 95% – the MUP amplitude; 90% – the MUP area), VL (90% – the MUP amplitude and area; 80% – SI), TA (95% – SI; 85% – the MUP amplitude and area) and duration – BB (85%), FDI (90%). Moreover, at rest, the majority of patients had, in all the muscles subject to the study, their active denervation potentials recorded, i.e. fibrillation or positive slow waves. Significant differences were observed within the course of a sixmonth period as regards the measurements concerning the duration of MUP of the muscles subject to the study (prolonged duration of MUP). Conclusion: Neurogenic lesions are already present at the time of ALS diagnosis.Relationship was observed between motor neurons loss and the gradually increasing duration of MUP of particular muscles in the course of ALS. doi:10.1016/j.clinph.2019.04.521
P73-F Electroneurographic parameters in ALS patients—Jacek Hübner a,*, Ilona Hübner a, Sławomir Kroczka b (a Laboratory of Neurophysiology, Neurology Unit, District Hospital in Radomsko, Radomsko, Poland , b Laboratory of Neurophysiology, Chair of Child and Youth Neurology Collegium Medicum, Jagiellonian University in Krakow, Krakow, Poland) ⇑
Corresponding author.
Background: Amyotrophic lateral sclerosis is an incurable neurodegenerative disease characterised by intensifying motor conduction disorders. Material and methods: The study covered 20 people (5 women, 15 men; aged 65.5 ± 20) with clinically proven or probable ALS diagnosis established based on El Escorial criteria. The patients were subject to examination three times over a six-month period. Motor conduction was assessed in both the median nerves and ulnar nerves. In each case, the speed of conduction, terminal latency, compound muscle action potential (CMAP) amplitude, and minimal F wave latency were assessed. Results: Incorrect values were most often observed in the CMAP amplitude: left median nerve in 70%, right median nerve in 70%; left ulnar nerve in 40%; right ulnar nerve in 35%. In subsequent measurements, the CMAP amplitude of the left median nerve and both ulnar nerves was lower than during the preliminary measurement. Conclusion: Motor conduction disorders are already present at the time of diagnosis. There is a marked dependence of motor cell loss of the anterior horns of the spinal cord on intensified motor conduction changes. doi:10.1016/j.clinph.2019.04.522
P74-F Vestibular evoked myogenic potentials and their clinical utility in patients with amyotrophic lateral sclerosis—Xiaoxuan Liu, Dongsheng Fan (Peking University Third Hospital, Beijing, China)
Background: To evaluate the diagnostic value of vestibular evoked myogenic potentials (VEMPs) in the assessment of brainstem function integrity in patients with amyotrophic lateral sclerosis (ALS). Materials and methods: This was a prospective case-control study including 30 definite or probable ALS patients divided into two groups (with or without brainstem involvement) and 30 healthy controls. Cervical (c-), masseter (m-) and ocular VEMP (o-VEMP) measurements were obtained for all the participants. Results: The c-VEMP mean p13 and n23 were significantly prolonged in the ALS patients. The interside peak differences in p13 and n23 of c-VEMP and in n10 and p15 of o-VEMP were significantly prolonged. The rates of alteration in c-VEMP, m-VEMP and o-VEMP in the ALS patients were 67%, 40%, and 45%, respectively. The ALS patients with brainstem involvement had a significantly higher percentage of VEMP abnormalities than did those without brainstem involvement (p = 0.027). Conclusions: c-VEMP is a sensitive tool to detect lower levels of brainstem involvement. Impairments in o-VEMP and m-VEMP indicate involvement of the upper brainstem. The use of combined VEMPs may provide useful insights into the pathophysiological mechanism of ALS. VEMPs may be useful in the evaluation of brainstem dysfunction in ALS patients. doi:10.1016/j.clinph.2019.04.523
might reflect brain arousal in patients with Alzheimer’s disease dementia (ADD) at the group and the individual level. Methods: Our dataset was an international archive of Clinical and rsEEG data of 42 ADD and 40 healthy elderly (Nold) subjects. The delta, theta, alpha 1, alpha 2, and alpha 3 frequency bands were determined by Individual alpha frequency peak (IAF). Fixed beta 1, beta 2, and gamma bands were also considered. rsEEG cortical sources were estimated by means of the exact low-resolution brain electromagnetic source tomography and were then classified across individuals, on the basis of the receiver operating characteristic (ROC) curves. Results: Compared to the Nold group, IAF showed slowing in the ADD group. Furthermore, The ADD group showed lower posterior alpha 2 source activities and higher occipital delta source activities. The ratio of occipital delta to alpha 2 allowed good classification accuracy (sensitivity: 88.1%, specificity: 85%, and accuracy: 86.6%) between the Nold and ADD individuals. Conclusion: In quiet wakefulness, delta and alpha sources unveiled different spatial and frequency features of the cortical neural synchronization underpinning brain arousal in ADD patients compared with Nold subjects. An ongoing study is testing the enrichment of markers derived from structural magnetic resonance imaging (MRI) in the classification accuracy between Nold and ADD patients for potential clinical applications. doi:10.1016/j.clinph.2019.04.517
P69-F A short computerized cognitive training may improve cortical neural synchronization mechanisms in Parkinson’s disease patients—Roberta Lizio a,*, Miss. Jessica Janson b, Claudio Del Percio b, Giuseppe Noce a, Susanna Lopez b, Lucia Fraioli c, Antonio Ivano Triggiani d, Fabrizio Stocchi e, Laura Vacca e, Maria Francesca De Pandis c, Claudio Babiloni b,c (a IRCCS SDN, Naples, Italy , b Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy, c Hospital San Raffaele of Cassino, Cassino, FR, Italy, d Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy, e IRCCS San Raffaele Pisana, Rome, Italy) ⇑
Corresponding author.
Background: Previous evidence showed abnormal posterior sources of resting-state electroencephalographic (rsEEG) delta (<4 Hz) and alpha (about 8–12 Hz) rhythms in patients with Parkinson’s disease (PD) as cortical neural synchronization markers in quiet wakefulness. We hypothesized that a relatively short computerized cognitive training in PD patients might affect these mechanisms. Methods: Clinical and rsEEG data were collected in PD patients with cognitive deficits (e.g., dementia or mild cognitive impairment), undergoing a standard levodopa therapy, and normal elderly (Nold) subjects. The rsEEG data in PD patients were recorded in three phases: before intervention (baseline), after two weeks of a computerized cognitive training (executive and episodic memory functions), and after two weeks of a computerized control procedure (watching favorite videos), in a cross-over design. Cortical rsEEG sources were estimated by exact low-resolution brain electromagnetic tomography (eLORETA). Results: During baseline recordings, the PD group showed reduced posterior alpha and increased widespread delta source activities compared to the Nold group. In PD patients, the widespread delta
e87
source activities significantly decreased after cognitive training but not after the control intervention. Conclusions: These results suggest that in PD patients with cognitive deficits a relatively short computerized cognitive training may have beneficial effects on cortical neural synchronization mechanisms generating abnormal cortical delta rhythms in quiet wakefulness. doi:10.1016/j.clinph.2019.04.518
P70-F Vestibular-evoked myogenic potentials for the diagnosis of superior canal dehiscence syndrome—Esmeralda Rocío Martín *, Rybel Wix, Salvador Delis Gómez, Marleny Macario, Jesús Pastor Gómez (Hospital Universitario La Princesa, Madrid, Spain) ⇑
Corresponding author.
Background: Superior canal dehiscence syndrome (SCDS) is a clinical entity characterized by vertigo and oscillopsia in response to sound (Tullio phenomenon), pressure (Hennebert sign) and vestibular stimulation with Valsalva maneuvers, disequilibrium, autophony, bone-conductive hyperacusis and pulsatile tinnitus. Vestibularevoked myogenic potentials (VEMPs) is a technique used to determine the function of the otolithic organs. The aim of the study is to examine the VEMPs characteristics in patients with SCDS. Material and methods: 5 patients with SCDS between 2016 and 2018 were included. VEMPs were recorded from the ipsilateral sternocleidomastoid muscle (cVEMP) and periocular sites (oVEMP). 500 Hz tone burst at 105 dB nHL was used as stimuli at 5 Hz stimulation rate and averaged for 200 repetitions. Bandpass-filtered between 20 Hz and 2 kHz. Statistical analysis included paired sample MannWhitney U test in the SPSS program. We compared the latency and amplitude of the affected ear with the healthy ear. Data shown as mean ± SE. Results: The mean age of the test group was 61.4 ± 8.08 years with 3 males and 2 females. Comparing the affected ear and healthy ear: oVEMP amplitude (33.2 ± 5.9/8 ± 2.1 lV, p < 0.01); oVEMP-n10 (9.9 ± 0.2/11.6 ± 1.1 ms, p > 0.11); cVEMPamplitude (158.8 ± 41.2/125 ± 29.86 lV, p > 0.56); cVEMP-p13 (15.2 ± 0.4/15.1 ± 0.7 ms, p > 0.8); In 100% of patients with SCDS, oVEMP amplitudes were significantly higher than normal values (p > 0.01 Mann-Whitney U). No statistically significant differences were obtained in the remaining parameters. Conclusions: oVEMP amplitude in patients diagnosed as SCDS are significantly higher than normal values. These techniques have proven to be useful for diagnosis of superior canal dehiscence syndrome. doi:10.1016/j.clinph.2019.04.519
P71-F Clinical use of vestibular evoked myogenic potential (VEMP) in unilateral Menière disease (MD)—Marleny Macario *, Esmeralda Rocío Martín, Cecilia Luque, Salvador Delis Gómez, Rybel Wix (Hospital Universitario La Princesa, Madrid, Spain) ⇑
Corresponding author.
Background: VEMP test averages myogenic responses evoked by sound that stimulates otolithic organs in the inner ear. is an inner ear pathology characterised by episodic attacks of vertigo and fluctuating cochlear symptoThe aim of the study is to describe the VEMP values obtained in patients diagnosed with unilateral MD.
e88
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
Materials and methods: VEMP studies performed in patients diagnosed with unilateral younger than 60 years old and done between 2014 and 2017 were analysed. VEMPs were recorded from the ipsilateral sternocleidomastoid muscle (cVEMP) and periocular sites (oVEMP). 500 Hz tone burst at 105 dB nHL was used as stimuli at 5 Hz stimulation rate and averaged for 200 repetitions. Bandpassfiltered between 20 Hz and 2 kHz. Statistical analysis included paired sample test in the SPSS program. We compared latency and amplitude of the affected side (AS) with healthy side (HS). Results: We included 9 patients, mean age 48.7 ± 6.8 years old. Patients without bilateral response (1 in cVEMP, 2 in oVEMP), were not included in the statistical analysis of its category. In 87.5% of the cases, p13 latency was longer in AS (13.5–21.1 ms) vs HS (12.9–15.9 ms, p = .017 Wilcoxon test). No statistically significant differences were obtained in the remaining parameter. Conclusion: The p13 latency of cVEMP is longer on the affected side with compared to the contralateral healthy side. Since VEMP test clinically evaluates the otolithic function, it is not invasive and is well tolerated, its use should be extended. doi:10.1016/j.clinph.2019.04.520
P72-F Electromyography in the course of amyotrophic lateral sclerosis—Ilona Hübner a,*, Jacek Hübner a, n. med. Sławomir Kroczka b (a Laboratory of Neurophysiology, Neurology Unit, District Hospital in Radomsko, Radomsko, Poland, b Laboratory of Neurophysiology, Chair of Child and Youth Neurology Collegium Medicum, Jagiellonian University in Krakow, Krakow, Poland) ⇑
Corresponding author.
Background: Amyotrophic lateral sclerosis is a progressive, incurable neurodegenerative disease resulting in neurogenic muscle damage. Material and methods: The study covered 20 patients – 5 women and 15 men aged 43–85; 65.5 on average. The group included patients with clinically proven or probable ALS diagnosis established based on the modified El Escorial criteria. The study was performed three times with three-month long intervals. Muscles from three layers of the central nervous system were subject to analysis: bulbs (muscle of the tongue), cervical (left biceps brachii – BB and left first dorsal interosseous – FDI), sacrolumbar (right vastus lateralis – VL and right tibialis anterior – TA). Resting activity and MUP parameters (amplitude, area, duration, size index – SI) were evaluated. Results: Incorrect results most frequently concerned the amplitude, area, SI MUP – BB (100%), FDI (100% – SI; 95% – the MUP amplitude; 90% – the MUP area), VL (90% – the MUP amplitude and area; 80% – SI), TA (95% – SI; 85% – the MUP amplitude and area) and duration – BB (85%), FDI (90%). Moreover, at rest, the majority of patients had, in all the muscles subject to the study, their active denervation potentials recorded, i.e. fibrillation or positive slow waves. Significant differences were observed within the course of a sixmonth period as regards the measurements concerning the duration of MUP of the muscles subject to the study (prolonged duration of MUP). Conclusion: Neurogenic lesions are already present at the time of ALS diagnosis.Relationship was observed between motor neurons loss and the gradually increasing duration of MUP of particular muscles in the course of ALS. doi:10.1016/j.clinph.2019.04.521
P73-F Electroneurographic parameters in ALS patients—Jacek Hübner a,*, Ilona Hübner a, Sławomir Kroczka b (a Laboratory of Neurophysiology, Neurology Unit, District Hospital in Radomsko, Radomsko, Poland , b Laboratory of Neurophysiology, Chair of Child and Youth Neurology Collegium Medicum, Jagiellonian University in Krakow, Krakow, Poland) ⇑
Corresponding author.
Background: Amyotrophic lateral sclerosis is an incurable neurodegenerative disease characterised by intensifying motor conduction disorders. Material and methods: The study covered 20 people (5 women, 15 men; aged 65.5 ± 20) with clinically proven or probable ALS diagnosis established based on El Escorial criteria. The patients were subject to examination three times over a six-month period. Motor conduction was assessed in both the median nerves and ulnar nerves. In each case, the speed of conduction, terminal latency, compound muscle action potential (CMAP) amplitude, and minimal F wave latency were assessed. Results: Incorrect values were most often observed in the CMAP amplitude: left median nerve in 70%, right median nerve in 70%; left ulnar nerve in 40%; right ulnar nerve in 35%. In subsequent measurements, the CMAP amplitude of the left median nerve and both ulnar nerves was lower than during the preliminary measurement. Conclusion: Motor conduction disorders are already present at the time of diagnosis. There is a marked dependence of motor cell loss of the anterior horns of the spinal cord on intensified motor conduction changes. doi:10.1016/j.clinph.2019.04.522
P74-F Vestibular evoked myogenic potentials and their clinical utility in patients with amyotrophic lateral sclerosis—Xiaoxuan Liu, Dongsheng Fan (Peking University Third Hospital, Beijing, China)
Background: To evaluate the diagnostic value of vestibular evoked myogenic potentials (VEMPs) in the assessment of brainstem function integrity in patients with amyotrophic lateral sclerosis (ALS). Materials and methods: This was a prospective case-control study including 30 definite or probable ALS patients divided into two groups (with or without brainstem involvement) and 30 healthy controls. Cervical (c-), masseter (m-) and ocular VEMP (o-VEMP) measurements were obtained for all the participants. Results: The c-VEMP mean p13 and n23 were significantly prolonged in the ALS patients. The interside peak differences in p13 and n23 of c-VEMP and in n10 and p15 of o-VEMP were significantly prolonged. The rates of alteration in c-VEMP, m-VEMP and o-VEMP in the ALS patients were 67%, 40%, and 45%, respectively. The ALS patients with brainstem involvement had a significantly higher percentage of VEMP abnormalities than did those without brainstem involvement (p = 0.027). Conclusions: c-VEMP is a sensitive tool to detect lower levels of brainstem involvement. Impairments in o-VEMP and m-VEMP indicate involvement of the upper brainstem. The use of combined VEMPs may provide useful insights into the pathophysiological mechanism of ALS. VEMPs may be useful in the evaluation of brainstem dysfunction in ALS patients. doi:10.1016/j.clinph.2019.04.523