Vestibular function for children with insulin dependent diabetes using cervical vestibular evoked myogenic potentials testing

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.

Keywords: Children; Type 1 diabetes; Otolith organ; Cervical vestibular evoked myogenic potential

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.