Elsevier

Ophthalmology

Volume 113, Issue 2, February 2006, Pages 315-323.e2
Ophthalmology

Original Article
Multifocal Visual Evoked Potential Analysis of Inflammatory or Demyelinating Optic Neuritis

Presented at: American Academy of Ophthalmology Annual Meeting, September, 2005; Chicago, Illinois.
https://doi.org/10.1016/j.ophtha.2005.10.017Get rights and content

Objective

To determine the sensitivity of multifocal visual evoked potentials (mVEP) in optic neuritis of an inflammatory or demyelinating nature.

Design

Cross-sectional study.

Participants

Sixty-four patients participated who had a confirmed diagnosis of optic neuritis (ON) (past and acute). Based on the McDonald multiple sclerosis (MS) criteria, 25 patients (27 eyes with ON) were deemed to have isolated optic neuritis and thus not have MS (i.e., the not-MS group), and 19 patients (24 eyes with ON) had a diagnosis of MS (i.e., the MS group). The remaining 20 patients (25 eyes with ON) were at a high risk of MS, but diagnostic evaluation was equivocal, and thus were classified as the possible MS group. A control group of 20 normal patients was enrolled.

Testing

The mVEP test was performed using the Accumap. All ON patients had recent magnetic resonance imaging scans of the brain and spinal cord.

Main Outcome Measures

Multifocal visual evoked potentials amplitude and latency values were analyzed within each group and were compared with the normal controls.

Results

No abnormality was recorded on mVEP in the control group. Of all the ON eyes, 74 (97.3%) were abnormal on mVEP testing. Amplitude values were abnormal in 92.6% of not-MS eyes, 92.0% of possible MS eyes, and 100% of those with MS, and latency was abnormal in 33.3%, 76.0%, and 100%, respectively. There was a significant difference in the mVEP latency z-scores among all ON groups (P<0.01; Kruskal-Wallis test). Although distribution graphs of latency z-scores in the not-MS and MS groups had single peaks and were clearly separate from each other, the latency z-score distribution within the possible MS group in postacute patients was bimodal, with each peak corresponding to the distribution of the not-MS and MS group, respectively. The mVEP latency z-scores had a sensitivity and specificity of 100% in detecting patients with ON due to MS when compared with normal patients.

Conclusions

The mVEP test is a sensitive and specific tool for detecting optic neuritis. There was a significant difference in latency analysis findings between patient groups as classified according to the McDonald MS criteria. Latency results suggest a role in identifying a patient’s risk for future MS.

Section snippets

Subjects and Methods

Sixty-four subjects (mean age, 34.8 ±11.1 years) with inflammatory or demyelinating ON were recruited from the Sydney Eye Hospital and St. Vincent’s Hospital. Each patient had a diagnosis of either acute or previous optic neuritis (with unilateral visual loss, afferent papillary defect, and pain on eye movement) confirmed by a consultant neuro-ophthalmologist. The time from onset of optic neuritis was recorded (mean, 16.6 months; range, 15 days–5 years). Several patients had a history of past

Amplitude

Table 1 shows the number of ON eyes with an amplitude abnormality on mVEP.

As can be seen from the table, the percentage of eyes with an amplitude deviation scotoma is increased in the MS groups compared with the other groups. There were no amplitude abnormalities seen in the control group. Within the not-MS and possible MS groups, only approximately 70% of the eyes showed an amplitude deviation with respect to the normal population; however nearly 90% had intereye amplitude asymmetry, which

Discussion

This is the first study that has examined the sensitivity of the multifocal VEP technique in a large number of patients with ON classified according to the McDonald criteria. The separation of ON patients into groups with MS, possible MS, and not-MS provided a basis from which to analyze amplitude and latency results that have not been used with full-field conventional VEP studies to our knowledge.

Previous VEP studies on inflammatory ON and MS have often reported conflicting results, which to

References (62)

  • J. Froehlich et al.

    Use of pattern electroretinography to differentiate acute optic neuritis from acute anterior ischemic optic neuropathy

    Electroencephalogr Clin Neurophysiol

    (1994)
  • D. Papakostopoulos et al.

    The electroretinogram in multiple sclerosis and demyelinating optic neuritis

    Electroencephalogr Clin Neurophysiol

    (1989)
  • D.A. Jacobs et al.

    Multiple sclerosis and the visual system

    Ophthalmol Clin North Am

    (2004)
  • M. Soderstrom

    Optic neuritis and multiple sclerosis

    Acta Ophthalmol Scand

    (2001)
  • S.J. Hickman et al.

    Visual recovery following acute optic neuritis—a clinical, electrophysiological and magnetic resonance imaging study

    J Neurol

    (2004)
  • A. Ghezzi et al.

    Long-term follow-up of isolated optic neuritisthe risk of developing multiple sclerosis, its outcome, and the prognostic role of paraclinical tests

    J Neurol

    (1999)
  • A.M. Halliday et al.

    Visual evoked response in the diagnosis of multiple sclerosis

    Br Med J

    (1973)
  • I.H. Heinrichs et al.

    Evolution of visual evoked potentials in optic neuritis

    Can J Neurol Sci

    (1988)
  • R. Garrick et al.

    Electrophysiological tests and immunological studies in optic neuritis

    Clin Exp Neurol

    (1977)
  • P. Asselman et al.

    Visual evoked responses in the diagnosis and management of patients suspected of multiple sclerosis

    Brain

    (1975)
  • J.L. Frederiksen et al.

    Serial MRI, VEP, SEP and biotesiometry in acute optic neuritisvalue of baseline results to predict the development of new lesions at one year follow up

    Acta Neurol Scand

    (1996)
  • P. Fuhr et al.

    Visual and motor evoked potentials in the course of multiple sclerosis

    Brain

    (2001)
  • W.B. Matthews et al.

    Prolonged follow-up of abnormal visual evoked potentials in multiple sclerosisevidence for delayed recovery

    J Neurol Neurosurg Psychiatry

    (1983)
  • Evoked potentials in the diagnosis of multiple sclerosis

    Electroencephalogr Clin Neurophysiol Suppl

    (1987)
  • J.J. Kanski

    Clinical Ophthalmology. A Systematic Approach.

    (2000)
  • Objective perimetry in glaucomarecent advances with multifocal stimuli

    Surv Ophthalmol

    (1999)
  • D.C. Hood et al.

    Quantifying the benefits of additional channels of multifocal VEP recording

    Doc Ophthalmol

    (2002)
  • D.C. Hood et al.

    An interocular comparison of the multifocal VEPa possible technique for detecting local damage to the optic nerve

    Invest Ophthalmol Vis Sci

    (2000)
  • D.C. Hood et al.

    Multifocal ERG and VEP responses and visual fieldscomparing disease-related changes

    Doc Ophthalmol

    (2000)
  • Electrode position and the multi-focal visual-evoked potentialrole in objective visual field assessment

    Aust N Z J Ophthalmol

    (1998)
  • A.I. Klistorner et al.

    Multifocal topographic visual evoked potentialimproving objective detection of local visual field defects

    Invest Ophthalmol Vis Sci

    (1998)
  • Cited by (0)

    Manuscript no. 2005-436.

    Supported by University of Sydney, Sydney, Australia (University Postgraduate Scholarship).

    1

    Drs Klistorner and Graham have a financial interest in the Accumap, being coinventors of the machine and acting as consultants to ObjectiVision, Sydney, Australia. They are both involved in the ongoing research and development of the product.

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