Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-27T14:34:32.867Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of Brainstem Involvement in Multiple Sclerosis

Published online by Cambridge University Press:  23 September 2014

Magdalena Krbot Skorić ,
Ivan Adamec ,
Vesna Nesek Mađarić  and
Mario Habek
Magdalena Krbot Skorić
Affiliation:
University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System
Ivan Adamec
Affiliation:
University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System
Vesna Nesek Mađarić
Affiliation:
University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System
Mario Habek*
Affiliation:
School of Medicine, University of Zagreb, Zagreb, Croatia
*
*University Department of Neurology, Zagreb School of Medicine and University Hospital Center, Kišpatićeva 12, HR-10000 Zagreb, Croatia. Email: mhabek@mef.hr
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background/Aims:

The aim of the present study was to determine the optimum method to detect brainstem lesions in patients with Multiple Sclerosis (MS).

Methods:

72 patients with the diagnosis of relapsing-remitting MS were prospectively included. Brainstem functional system score (BSFS) (part of the expanded disability status scale (EDSS) evaluating brainstem symptomatology) was calculated. Magnetic resonance imaging (MRI) was performed on 1.5T and T1, T2, PD and fluid-attenuated inversion recovery (FLAIR) sequences were analyzed for presence of brainstem lesions. Auditory evoked potentials (AEP) and ocular and cervical vestibular evoked myogenic potentials (oVEMP and cVEMP) were performed according to the standardized protocol.

Results:

From 72 patients, 18 (25%) had clinical involvement of the brainstem. MRI showed brainstem involvement in 29 (40%) patients. Of the neurophysiological tests, AEP showed pathological result in 16 (22%) patients, oVEMP in 36 (50%) patients, cVEMP in 18 (25%) patients, and VEMP (combination of oVEMP and cVEMP) in 45 (63%) patients. VEMP detected brainstem lesions in higher percentage than clinical examination, MRI and AEP, which was statistically significant (< 0.0001, 0.012 and < 0.0001, respectively).

Conclusions:

Results of the present study have shown that VEMPs are the optimal method to detect brainstem lesions in multiple sclerosis and that they detect them significantly better than clinical examination, AEP or MRI.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 3 , May 2014 , pp. 346 - 349
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1.Renoux, C. Natural history of multiple sclerosis: long-term prognostic factors. Neurol Clin. 2011 29(2)293308.CrossRefGoogle ScholarPubMed
2.Tintore, M, Rovira, A, Arrambide, G. Brainstem lesions in clinically isolated syndromes. Neurology. 2010 75(21)19338.Google Scholar
3.Minneboo, A, Barkhof, F, Polman, CH, Uitdehaag, BM, Knol, DL, Castelijns, JA. Infratentorial lesions predict long-term disability in patients with initial findings suggestive of multiple sclerosis. Arch Neurol. 2004 61(2)21721.Google Scholar
4.Sastre-Garriga, J, Tintore, M, Rovira, A. Conversion to multiple sclerosis after a clinically isolated syndrome of the brainstem: cranial magnetic resonance imaging, cerebrospinal fluid and neurophysiological findings. Mult Scler. 2003 9(1)3943.CrossRefGoogle ScholarPubMed
5.Gass, A, Filippi, M, Grossman, RI. The contribution of MRI in the differential diagnosis of posterior fossa damage. J Neurol Sci. 2000 172 Suppl 1S439.Google Scholar
6.Zadro, I, Barun, B, Habek, M, Brinar, VV. Isolated cranial nerve palsies in multiple sclerosis. Clin Neurol Neurosurg. 2008 110(9)8868.CrossRefGoogle ScholarPubMed
7.Nguyen, KD, Welgampola, MS, Carey, JP. Test-retest reliability and age-related characteristics of the ocular and cervical vestibular evoked myogenic potential tests. Otol Neurotol. 2010 31(5)793802.CrossRefGoogle ScholarPubMed
8.Eleftheriadou, A, Deftereos, SN, Zarikas, V. The diagnostic value of earlier and later components of Vestibular Evoked Myogenic Potentials (VEMP) in multiple sclerosis. J Vestib Res. 2009 19 1–25966.Google Scholar
9.Gabelic, T, Krbot, M, Sefer, AB, Isgum, V, Adamec, I, Habek, M. Ocular and cervical vestibular evoked myogenic potentials in patients with multiple sclerosis. J Clin Neurophysiol. 2013 30(1)8691.Google Scholar
10.Polman, CH, Reingold, SC, Banwell, B. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011 69(2)292302.Google Scholar
11.Ivankovic, A, Nesek Madaric, V, Starcevic, K. Auditory evoked potentials and vestibular evoked myogenic potentials in evaluation of brainstem lesions in multiple sclerosis. J Neurol Sci. 2013 328 1–2247.Google Scholar
12.Gazioglu, S, Boz, C. Ocular and cervical vestibular evoked myogenic potentials in multiple sclerosis patients. Clin Neurophysiol. 2012 123(9)18729.Google Scholar
13.Japaridze, G, Shakarishvili, R, Kevanishvili, Z. Auditory brainstem, middle-latency, and slow cortical responses in multiple sclerosis. Acta Neurol Scand. 2002 106(1)4753.CrossRefGoogle ScholarPubMed
14.Sailer, M, O'Riordan, JI, Thompson, AJ. Quantitative MRI in patients with clinically isolated syndromes suggestive of demyelination. Neurology. 1999 52(3)599606.CrossRefGoogle ScholarPubMed
15.Invernizzi, P, Bertolasi, L, Bianchi, MR, Turatti, M, Gajofatto, A, Benedetti, MD. Prognostic value of multimodal evoked potentials in multiple sclerosis: the EP score. J Neurol. 2011 258(11)19339.CrossRefGoogle ScholarPubMed
16.Wattjes, MP, Lutterbey, GG, Gieseke, J. Double inversion recovery brain imaging at 3T: diagnostic value in the detection of multiple sclerosis lesions. AJNR Am J Neuroradiol. 2007 28(1)549.Google ScholarPubMed