Brain-stem trigeminal and auditory evoked potentials in multiple sclerosis: physiological insights

doi:10.1016/0013-4694(95)00172-7

Electroencephalography and Clinical Neurophysiology/Evoked Potentials Section

Volume 100, Issue 2, March 1996, Pages 152-157

https://doi.org/10.1016/0013-4694(95)00172-7 Get rights and content

Abstract

Thirty-six patients with multiple sclerosis were evaluated by means of brain-stem trigeminal and auditory evoked potentials. The brain-stem auditory evoked potentials (BAEPs) were abnormal in 26 patients (72.2%). Brain-stem trigeminal evoked potentials (BTEPs) yielded similar results, showing distorted waveforms and/or prolonged latencies in 25 patients (69.4%). As expected, the MRI proved to be the most efficient single test, revealing plaques in 86.4% of the patients evaluated. However, the diagnostic accuracy of MRI was lower than that provided by the combination of the BTEP and the BAEP (88.9%). Moreover, in patients having signs of brain-stem involvement, the BTEP, alone and in combination with the BAEP, proved to be more sensitive than the MRI in revealing brain-stem lesions.

Correlation between clinical and BTEP findings could be found only in those patients who presented with signs of trigeminal involvement such as trigeminal neuralgia or dysesthesiae. The analysis of the BTEP waveforms showed two distinct types of abnormality — a peripheral type and a central type — suggesting plaques in distinct locations.

Both the BTEP and the BAEP demonstrated a correlation with the clinical course of the disease and the condition of the patient at the time of the evaluation. Relapse of the disease was associated with a marked prolongation of the central conduction time in the BTEP and in the BAEP, suggesting the application of such studies to the monitoring of unstable patients or the evaluation of new therapeutic protocols.

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Evolution of tongue somatosensory evoked potentials in people with multiple sclerosis
2020, Multiple Sclerosis and Related Disorders
Citation Excerpt :
Furthermore, the authors also analyzed part of the SSEP response of the median nerve (mSSEP) related to the brainstem and found that the combination of mSSEP and TSSEP was pathologically altered in 44 of 53 (83%) participants, whereas the combination of mSSEP, TSSEP, and AEP found brainstem damage in just one additional patient, suggesting the relative insensitivity of AEP (Cosi et al., 1989). On the other hand, Soustiel et al. showed that the combination of AEP and TSSEP was more sensitive than MR in detecting brainstem damage (Soustiel et al., 1996). However, this study also points to the insensitivity of AEP in patients with MS and the clinical signs of brainstem damage, since AEP was pathologically altered in only 53% of these patients, unlike TSSEP which was pathologically altered in 14 of 15 of these patients.
The aim of the present study was to investigate the long-term evolution of tongue somatosensory evoked potentials (tSSEP) in people with multiple sclerosis (pwMS).
Out of initial 121 participants, after two-year follow-up, the data were available for 74 and after four-year follow-up for 58 pwMS. In all pwMS complete neurological examination, brain MRI, cervical spinal cord MRI (if available) and tSSEP were performed at baseline visit (M0). Complete neurological examination and tSSEP were performed 2 and 4 years later (M24 and M48). tSSEP results were interpreted in the form of ordinal tSSEP score and quantitative tSSEP zscore calculated from the sum of z-transformed tSSEP latencies.
Differences in tSSEP scores and tSSEP zscores in three different timepoints showed significant worsening of both scores over time. For the tSSEP score the difference was significant for M0-M24 and M0-M48 visits, but not for M24-M48 visits. For the tSSEP zscore the difference was significant for M0-M48 and M24-M48 visits, but not for M0-M24 visits. The only significant negative predictor found for the tSSEP score improvement was presence of cervical spinal cord lesions on the MRI. A moderate to high correlation was observed between both forms of tSSEP score at all three timepoints.
This study demonstrates a significant deterioration of trigeminal sensory pathway in MS over time, giving further insight into trigeminal system damage in pwMS.
Acute vestibular syndrome and hearing loss mimicking labyrinthitis as initial presentation of multiple sclerosis
2020, International Journal of Pediatric Otorhinolaryngology
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Also, it appears to exist a correlation between the lesion level and the affected BAEPs’ waves [74]. Nevertheless, BAEPs may be normal in 30–50% of MS patients with symptoms or signs of brainstem involvement [75,76], reflecting an inferior sensitivity when compared to MRI. Thus, in patients presenting with a clinical syndrome suggestive of MS, MRI has been regarded as a key method of evaluation to support this diagnosis, enabling the in vivo assessment of the entire CNS.
Acute vestibular syndrome is most often caused by vestibular neuritis or stroke, although demyelinating diseases may be responsible for 4% of all AVS episodes. The authors present the case of a previously healthy 17-year-old female patient complaining of spontaneous vertigo and right-sided hearing loss. Otoneurological examination suggested a peripheral vestibular cause and video head impulse test revealed a reduced vestibulo-ocular reflex gain. The presence of sensorineural hearing loss raised the suspicion of a central cause and prompted imaging evaluation. A brain MRI evidenced demyelinating lesions in the right middle cerebellar peduncle and the patient was ultimately diagnosed with Multiple Sclerosis.
Exploring brainstem function in multiple sclerosis by combining brainstem reflexes, evoked potentials, clinical and MRI investigations
2014, Clinical Neurophysiology
Citation Excerpt :
Indeed, several brainstem reflexes (BSRs) have been investigated in MS and their distinctive alterations have been shown to reflect areas of brainstem damage. In particular, trigeminal reflexes such as jaw, blink, corneal reflexes (Sanders et al., 1985; Nazliel et al., 2002; Klissurski et al., 2009) and trigeminal somatosensory evoked potentials (Soustiel et al., 1996; de Pablos and Agirre, 2006; Gabelić et al., 2013b) were reported to provide valuable additional information. Yet despite this, they have not achieved widespread acceptance.
To investigate vestibulo-masseteric (VMR), acoustic-masseteric (AMR), vestibulo-collic (VCR) and trigemino-collic (TCR) reflexes in patients with multiple sclerosis (MS); to relate abnormalities of brainstem reflexes (BSRs) to multimodal evoked potentials (EPs), clinical and Magnetic Resonance Imaging (MRI) findings.
Click-evoked VMR, AMR and VCR were recorded from active masseter and sternocleidomastoid muscles, respectively; TCR was recorded from active sternocleidomastoid muscles, following electrical stimulation of the infraorbital nerve. EPs and MRI were performed with standard techniques.
Frequencies of abnormal BSRs were: VMR 62.1%, AMR 55.1%, VCR 25.9%, TCR 58.6%. Brainstem dysfunction was identified by these tests, combined into a four-reflex battery, in 86.9% of cases, by EPs in 82.7%, MRI in 71.7% and clinical examination in 37.7% of cases. The sensitivity of paired BSRs/EPs (93.3%) was significantly higher than combined MRI/clinical testing (70%) in patients with disease duration ⩽6.4 years. BSR alterations significantly correlated with clinical, EP and MRI findings.
The four-BSR battery effectively increases the performance of standard EPs in early detection of brainstem impairment, otherwise undetected by clinical examination and neuroimaging.
Multiple BSR assessment usefully supplements conventional testing and monitoring of brainstem function in MS, especially in newly diagnosed patients.
Clinical neurophysiology of multiple sclerosis
2014, Handbook of Clinical Neurology
Citation Excerpt :
Even though the EPs provide information confined to eloquent pathways, and thus are of limited value in the diagnosis of MS, this feature is an advantage when assessing the functional involvement of MS patients (Leocani et al., 2000). In fact, EPs are strictly related to function, as reflected by the correlation between their abnormalities and symptoms and signs in the corresponding somatosensory (Leocani et al., 2003), pyramidal (van der Kamp et al., 1991), visual (Frederiksen and Petrera, 1999), and brainstem (Soustiel et al., 1996) systems. In the visual modality, EP amplitude has been reported to correlate also with lesion length (Youl et al., 1991), with MRI measures of optic nerve area (Trip et al., 2006), and with RNFL thickness on OCT (Trip et al., 2005).
The availability of new treatments able to modify the natural course of multiple sclerosis (MS) has generated interest in paraclinical measures to monitor disease evolution. Among these, neurophysiologic measures, mainly evoked potentials (EPs), are used in the functional assessment of central sensorimotor and cognitive networks affected by MS. EP abnormalities may reveal subclinical lesions, objectivate the involvement of sensory and motor pathways in the presence of vague disturbances, and provide indications of the demyelinating nature of the disease process. However, their diagnostic value is much lower than that of magnetic resonance imaging, and is more sensitive to brain and cervical spinal cord lesions. The application of EPs in assessing disease severity and monitoring the evolution of nervous damage is more promising, thanks to their good correlation with disability in cross-sectional and longitudinal studies, and potential use as paraclinical endpoints in clinical trials. Recent evidence indicates that EPs performed early in the disease may help to predict a worse future progression in the long term. If confirmed, these data suggest the possible usefulness of EPs in the early identification of patients who are more likely to develop future disability, thus requiring more frequent monitoring or being potential candidates for more aggressive disease-modifying treatments.
Electromyography and Evoked Potentials
2013, Practical Management of Pain: Fifth Edition
Auditory evoked potentials and vestibular evoked myogenic potentials in evaluation of brainstem lesions in multiple sclerosis
2013, Journal of the Neurological Sciences
Citation Excerpt :
The combined application of AEP, the auditory middle latency response, and slow cortical potentials promotes better detection of silent MS loci than either of these EP alone [13]. Although AEP may be normal in 30–50% of MS patients with symptoms or signs of brainstem involvement [9,14], one study on a relatively small number of patients showed that AEP was able to localize lesions along the auditory pathways at a rate that was almost similar to that of MR imaging [15]. Our study showed relatively small percentage of pathological AEP in MS patients compared to MRI and VEMP.
The aim of this study was to determine the roles of magnetic resonance imaging (MRI), auditory evoked potentials (AEP) and vestibular evoked myogenic potentials (VEMP) in the evaluation of brainstem involvement in multiple sclerosis (MS).
Altogether 32 patients with the diagnosis of MS participated in the study. The following data was collected from all patients: age, gender, Expanded Disability Status Scale (EDSS) score, brainstem functional system score (BSFS) (part of the EDSS evaluating brainstem symptomatology), and involvement of the brainstem on the brain MRI. AEP and ocular VEMP (oVEMP) and cervical VEMP (cVEMP) were studied in all patients.
BSFS, MRI, AEP, oVEMP and cVEMP involvement of the brainstem was evident in 9 (28.1%), 14 (43.8%), 7 (21.9%), 12 (37.5%) and 10 (31.0%) patients, respectively. None of the tests used showed statistically significant advantage in the detection of brainstem lesions. When combining oVEMP and cVEMP 18 (56.3%) patients showed brainstem involvement. This combination showed brainstem involvement in greater percentage than BSFS or AEP, with statistical significance (p = 0.035 and p = 0.007, respectively).
VEMP is a reliable method in detection of brainstem involvement in MS. It is comparable with MRI, but superior to clinical examination or AEP.

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Main articleBrain-stem trigeminal and auditory evoked potentials in multiple sclerosis: physiological insights

Abstract

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Hear. Res.

Percutaneous retrogasserian glycerol rhyzotomy for treatment of trigeminal neuralgia

J. Neurosurg.

Trigeminal neuralgia and multiple sclerosis

Arch. Neurol.

Brain stem auditory evoked potentials: interpretation

Studio del trunco encefalico e del midollo cervicale in pazienti con sclerosi multipla mediante i potenziali evocati e la risonanza magnetica nucleare

Brainstem impairment in multiple sclerosis: an assessment by multimodal evoked potentials

Ital. J. Neurol. Sci.

Evaluation of patients with multiple sclerosis by evoked potentials and magnetic resonance imaging: a comparative study

Ann. Neurol.

Five-and-a-half year's experience with percutaneous retrogasserian glycerol rhyzotomy in treatment of trigeminal neuralgia

Appl. Neurophysiol.

Magnetic resonance imaging and CT scanning in multiple sclerosis

Ann. NY Acad. Sci.

Occult fifth nerve dysfunction in multiple sclerosis

Can. J. Neurol. Sci.

Main article
Brain-stem trigeminal and auditory evoked potentials in multiple sclerosis: physiological insights