Event-related auditory evoked potentials and multiple sclerosis

doi:10.1016/0168-5597(93)90003-8

Electroencephalography and Clinical Neurophysiology/Evoked Potentials Section

Volume 88, Issue 3, May–June 1993, Pages 182-187

https://doi.org/10.1016/0168-5597(93)90003-8 Get rights and content

Abstract

Long latency event-related auditory evoked potentials, particularly the P300 wave, constitute an objective electrophysiological index of cognitive function. For this reason, these potentials have been studied in a series of 101 patients with multiple sclerosis (MS), classified according to McAlpine's criteria into definite, probable and possible cases. The patients were also classified as depressed or non-depressed according to the DSM-III and Research Diagnostic Criteria. They were also subjected to a battery of psychometric tests.

In the patient population the N200 and P300 latencies were increased, as were the P200 latencies, when compared with a control population. This electrophysiological pattern had previously been observed in other conditions characterised by subcortical lesions. Partial correlations (at constant disease duration) between the disability score and the cognitive deficit were found to be significant. Patients with an increased P300 latency had a greater disability and the P300 latency was significantly correlated with the duration of the illness.

The N200 and P300 latencies were increased in depressed MS subjects, but this increase did not reach the level of significance. Depression was more frequent in the more severely handicapped patients. This suggests that the origin of the depression seen in multiple sclerosis is only partly organic, and that it is one of the factors contributing to the subcortical cognitive deficit in multiple sclerosis.

Progressive forms of the disease exhibited the most profound cognitive deficit, and the most marked increase in P300 latency.

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Neuropsychological studies indicate cognitive dysfunctions in 54–65% of these patients, who may have changes in their memory, attention, verbal fluency, task performance, and visual perception [40,41]. A study conducted by Gil et al. [42] used the P300 auditory potential in a group of MS patients submitted to a battery of psychometric tests, aiming to compare P300 data with cognitive impairment and the course of the disease. The authors verified that the P300 and N200 latencies grew longer as cognitive disability grew worse.
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To characterize BAEP and LLAEP in children and adolescents with MS and NMOSD and verify the diagnostic values of these potentials in each of the demyelinating diseases.
The 40 participants were divided into two study groups (SG1 – MS, SG2 – NMOSD) and two comparison groups (CG1 and CG2), matched for age (9 years–17 years and 11 months) and sex. Electrophysiological hearing assessment was performed with BAEP and LLAEP.
When SG1 and SG2 were compared with CG1 and CG2 regarding BAEP and LLAEP, both SG1 and SG2 presented a higher occurrence of changes. Also, individuals with MS had higher occurrences of BAEP changes, whereas individuals with NMOSD had a higher occurrence of LLAEP changes.
BAEP and LLAEP in children and adolescents with MS or NMOSD showed higher latencies and lower amplitudes of some components when these individuals were compared with their peers. These procedures were highly accurate to identify demyelinating diseases. BAEP results were more abnormal in individuals with MS, while LLAEP was so with NMOSD. These findings indicate that the auditory evoked potentials are important instruments for the differential diagnosis of MS and NMOSD, and valuable to monitor disease evolution.
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Auditory and visual oddball tasks have frequently been used to examine differences in the P3 ERP component in MS patients and controls. MS patients tested with oddball paradigms have often exhibited longer latency and lower amplitude P3 components compared to HCs (Aminoff and Goodin, 2001; Ellger et al., 2002; Gil et al., 1993; Polich et al., 1992). ERP alterations also have been observed in MS that are more specific to the P3a component (Jung et al., 2006; Whelan et al., 2010).
To examine event-related brain potentials (ERPs) in Multiple Sclerosis (MS) during a visual n-back working memory (WM) task, and test the hypothesis that compensatory brain function may be associated with variance in task performance in MS patients.
Midline ERPs for 25 MS patients and 18 HCs were obtained for a visual n-back task that placed increasing demands on WM. N-back behavioral measures and neuropsychological performance measures of WM were also obtained.
MS patients had slower reaction times (RTs) than HCs during the n-back task. Accuracy on the n-back and on neuropsychological tests did not differ between groups. P3 ERP amplitude decreased for both groups as WM demand increased. MS patients had lower overall P1 and P3 amplitudes compared to HCs. In MS, anteriorization of P3 amplitude was associated with better n-back performance. P1 and P3 amplitudes were also related to neuropsychological test performance in MS.
MS patients had reduced ERP amplitude compared to HCs during the n-back, and changes in ERP anterior–posterior midline amplitude distribution in MS were associated with cognitive performance.
ERPs, and in particular the P3 component obtained during a visual n-back task, are sensitive to subtle WM dysfunction in MS and may reflect compensatory reallocation of brain resources.
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Therefore, P300 latency is directly correlated with cognitive abilities in normal and abnormal conditions. ERPs have been widely used in the assessment of cognitive functions in patients suffering from MS (Newton et al., 1989; Gil et al., 1993; Giesser et al., 1992; Sundgren et al., 2015). According to the results of these studies, significant correlations exist between N200 and P300 wave and neuroradiological parameters such as lesion load in T2 sequence.
Cognitive event-related potentials (ERPs) have been previously correlated with T2 lesion load (Τ2LL) in patients with multiple sclerosis (MS). It is currently unknown, however, whether ERPs also correlate with brain atrophy or the presence of T1 hypointense lesions (“black holes”) which reflect tissue destruction and axonal loss. The primary aim of the current study is to explore the effect of neuroradiological parameters such as brain atrophy, T1 and T2 lesion load on auditory ERPs in MS patients. In addition, we correlated cognitive impairment with neurophysiological (ERP) and neuroradiological (MRI) variables and investigated whether a combination of ERP and MRI parameters is capable of distinguishing patients suffering from secondary progressive (SP), primary progressive (PP) and relapsing-remitting (RR) MS.
The study sample consisted of fifty nine MS patients (mean age±SD: 37.82±1.38 years; average disease duration: 6.76±5.3 years) and twenty six age-matched controls (mean age±SD: 41.42±15.39 years). The patients’ EDSS and NRS scores were 3.77±2.14 (range: 1–7.5) and 75.88±11.99 (range: 42–94) respectively. ERPs were recorded using the auditory “odd-ball” paradigm. T1 and T2 lesions were automatically segmented using an edge-finding tool and total lesion volumes were calculated. MRI measures of brain atrophy included third ventricle width (THIRDVW) and the ratio of mid-sagittal corpus callosum area to the mid-sagittal intracranial skull surface area (CC/MISS). Statistical analysis was performed using multiple regression, principal component (PCA) and discriminant analysis.
T1 lesion load emerged as the most significant predictor of P300 and N200 latency. The rest of the endogenous ERPs parameters (P300 amplitude, N200 amplitude) were not significantly correlated with the MRI variables. PCA of pooled neuroradiological and neurophysiological markers suggested that four components accounted for 64.6% of the total variability. Discriminant analysis based on ERP & MRI markers classified correctly 79.63% of patients in RR, PP and SP subgroups.
T1 lesion load is the most significant MRI correlate of auditory ERPs in MS patients. Importantly, ERPs in combination with MRI variables can be usefully employed for distinguishing patients with different subtypes of MS.
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Their latency and amplitude are respectively related to the speed of cognitive processing and to the amount of synchronized neurons participating in a given task. An increased latency of P300 has been reported in MS (Gil et al., 1993; Aminoff and Goodin, 2001; Piras et al., 2003; Magnano et al., 2006) with differential involvement according to disease course (Ellger et al., 2002; Gonzalez-Rosa et al., 2006), related to brain lesion load (Sailer et al., 2001; Piras et al., 2003), disability (Ellger et al., 2002), and to the degree of cognitive involvement (Magnano et al., 2006). ERPs have been used to monitor MS evolution and the effects of treatment.
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Main articleEvent-related auditory evoked potentials and multiple sclerosis

Abstract

Biol. Psychol.

Electroenceph. clin. Neurophysiol.

Biol. Psychiat.

Electroenceph. clin. Neurophysiol.

DSM III-R. Manuel Diagnostique et Statistique des Troubles Mentaux

Anterograde and retrograde amnesia in patients with chronic progressive multiple sclerosis

Arch. Neurol.

Cognitive disturbance in patients with relapsing remitting multiple sclerosis

Arch. Neurol.

Changes in auditory P3 event-related potential in schizophrenia and depression

Br. J. Psychiat.

The theory of fluid and crystallized intelligence: a critical experiment

J. Educ. Psychol.

Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients

Brain

Attention impairment and psychomotor retardation in depressed patients: and event-related potential study

Electroenceph. clin. Neurophysiol.

A comparison of dementia in Alzheimer's disease and multiple sclerosis

Arch. Neurol.

Cognitive loss in multiple sclerosis. Case reports and review of the literature

Arch. Neurol.

Etude psychométrique d'une population de parkinsoniens

Rev. Neurol.

Une méthode d'évaluation rapide des fonctions cognitive (ERFC). Son application à la démence sénile de type Alzheimer

Sem. Hôp. (Paris)

Maladie de Parkinson et potentiels évoqués cognitifs

Rev. Neurol.

Electrophysiological differences between subtypes of dementia

Brain

Cognition in Parkinson disease: an event-related potential perspective

Ann. Neurol.

Composantes tardives des potentiels évoqués auditifs (onde P300) et sclérose en plaques. A propos de 40 cas

Rev. ONO

Potentiels évoqués auditifs tardifs dans les détériorations cognitives sous-corticales

Rev. Neurol.

Neuropsychological findings in relapsing-remitting and chronic progressive multiple sclerosis

J. Cons. Clin. Psychol.

Cognitive deficits and emotional dysfunction in multiple sclerosis

Arch. Neurol.

Magnetic resonance imaging correlates of dementia in multiple sclerosis

Arch. Neurol.

Main article
Event-related auditory evoked potentials and multiple sclerosis