Hamed SA, Metwalley KA, Farghaly HS, Oseily AM. Vestibular function for children with insulin dependent diabetes using cervical vestibular evoked myogenic potentials testing . World J Clin Pediatr 2022; 11(1): 61-70 [PMID: 35096547 DOI: 10.5409/wjcp.v11.i1.61]
Corresponding Author of This Article
Sherifa Ahmed Hamed, MD, Professor, Department of Neurology and Psychiatry, Assiut University Hospital, Floor # 7, Room # 4, P.O.Box, Assiut 71516, Egypt. hamedsherifa@aun.edu.eg
Research Domain of This Article
Pediatrics
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Pediatr. Jan 9, 2022; 11(1): 61-70 Published online Jan 9, 2022. doi: 10.5409/wjcp.v11.i1.61
Vestibular function for children with insulin dependent diabetes using cervical vestibular evoked myogenic potentials testing
Sherifa Ahmed Hamed, Kotb Abbas Metwalley, Hekma Saad Farghaly, Amira Mohamed Oseily
Sherifa Ahmed Hamed, Department of Neurology and Psychiatry, Assiut University Hospitals, Assiut 71516, Egypt
Kotb Abbas Metwalley, Hekma Saad Farghaly, Department of Pediatrics, Assiut University Hospitals, Assiut 71516, Egypt
Amira Mohamed Oseily, Department of ENT (Auditory Unit), Assiut University Hospitals, Assiut 71516, Egypt
Author contributions: Hamed SA, Metwalley KA and Farghaly HS carried out the clinical evaluation of participants, design of the study, statistical analyses and manuscript drafting; Oseily AM carried out the audiology and vestibular evaluations and participated in study design, statistical analyses and drafting the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study protocol was approved by the local research ethics committee of Faculty of medicine, Assiut University, Assiut, Egypt, No. AUFM_PED_232/2019.
Informed consent statement: Parents/guardians provided their written informed consent for participation of their children in the study.
Conflict-of-interest statement: The authors declared no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sherifa Ahmed Hamed, MD, Professor, Department of Neurology and Psychiatry, Assiut University Hospital, Floor # 7, Room # 4, P.O.Box, Assiut 71516, Egypt. hamedsherifa@aun.edu.eg
Received: January 6, 2021 Peer-review started: January 6, 2021 First decision: June 5, 2021 Revised: July 17, 2021 Accepted: November 15, 2021 Article in press: November 15, 2021 Published online: January 9, 2022 Processing time: 365 Days and 8.6 Hours
Abstract
BACKGROUND
Healthy vestibular system adjusts balance during static and dynamic conditions. This is important for normal development (standing up and walking). Vestipulopathies (central and peripheral) are common complications of diabetes in adult population. Related studies are scare in children with type 1 diabetes (T1D).
AIM
To assess saccular function of otolith organ in children with T1D and predictors for its dysfunction.
METHODS
Cervical vestibular evoked myogenic potential (cVEMP) was used for objective evaluation.
RESULTS
The study included 40 patients (boys = 15; girls = 25). Patients had mean age of 13.63 ± 1.50 years, duration of diabetes of 5.62 ± 2.80 years, frequent attacks of diabetic ketoacidosis (55%) and hypoglycemia (30%), hyperlipidemia (20%), hypertension (12.5%) and peripheral neuropathy (40%). Dizziness was found in 10%. Compared to healthy children (n = 25), patients had prolonged cVEMP P1 and N1 latencies and reduced P1-N1 amplitude. Bilateral cVEMP abnormalities were found in 60% (vs 25% for unilateral abnormalities). Higher frequencies and severe vestibulopathies were found with chronic diabetes of > 5 years, hemoglobin A1c values > 7%, frequent diabetic ketoacidosis and hypoglycemic attacks and presence of dizziness. Regression analyses showed that predictors for prolonged P1 latencies and reduced P1-N1 amplitudes were only chronic diabetes (> 5 years) {odds ratio (OR) = 2.80 [95% confidence interval (CI): 1.80–5.33], P = 0.01; OR = 3.42 (95%CI: 2.82–6.81)} and its severity (hemoglobin A1c > 7%) [OR = 3.05 (95%CI: 2.55–6.82), P = 0.01; OR = 4.20 (95%CI: 3.55–8.50), P = 0.001].
CONCLUSION
Dysfunction or injury of the saccular macula and its pathways is prevalent in children with T1D. Optimum glycemic control is important to prevent diabetes related vestipulopathies.
Core Tip: Vestipulopathies are common complications of diabetes. The vestibular system is crucial for early normal motor and mental developments. Vestibular evoked myogenic potential testing is objective, noninvasive, inexpensive, rapid and reliable. It is used to assess the function of otolith organs (saccule and utricle) of the inner ear. The otolith organs register forces related to linear acceleration and static tilt to the gravitational axis. Cervical vestibular evoked myogenic potential is vestibulo-collic reflex record from neck muscles in response to acoustic stimulation. It provides information about type 1 hair cells in saccular macula, inferior vestibular nerve, vestibular nuclei, lateral and medial vestibulospinal tracts and accessory nerve nuclei. This study aimed to evaluate saccular function in children with type 1 diabetes and predictors of its abnormalities.
