Evaluation of Brainstem Involvement in Multiple Sclerosis

Abstract

Multiple sclerosis (MS) is a chronic neurological disease, which affects young adults at a time when they have to make most of their personal and professional choices. predicting the long-term disability of MS is therefore very important for patients as well as neurologists. it has become even more crucial nowadays with more and more treatment options becoming available.Several prognostic factors of long-term irreversible disability have been described in MS: 1) at onset: ethnicity, sex, age, type of symptoms, and initial course and 2) later on, they include recovery from the initial symptoms, delay to the second neurologic episode, number of relapses in the first few years, and clinical characteristics in the early phase of the disease.1 recent studies have also suggested that brainstem involvement is an important predictor of future disability.2,3 these studies have shown that the presence of at least one brainstem lesion increases both the risk of conversion and disability, 2 and that two ABSTRACT: 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.RÉSUMÉ: Évaluation de l'atteinte du tronc cérébral dans la sclérose en plaques. Contexte/Objectifs : le but de cette étude était de déterminer quel est le meilleur moyen de détection des lésions du tronc cérébral chez les patients atteints de sclérose en plaques (Sp). Méthode : Soixante-douze patients, chez qui un diagnostic de Sp récurrente rémittante avait été posé, ont été inclus dans l'étude de façon prospective. le score à l'exploration fonctionnelle du tronc cérébral (bSfS), la partie de l'edSS qui évalue la symptomatologie du tronc cérébral, a été calculé. l'ir...

The vestibular evoked myogenic potentials (VEMP) score: a promising tool for evaluation of brainstem involvement in multiple sclerosis

“…This finding suggests that BAEP is insufficient in neurophysiological evaluation of the brainstem in MS. Knowing that brainstem lesions are good predictors of future disability, the EP score is lacking a good measure of brainstem dysfunction. Our previous two studies have shown that BAEP detects brainstem involvement at a significantly lower percentage than VEMP [21,23]. Therefore, based on this the VEMP score was developed as a potential valid measure of brainstem involvement ( Table 1).…”

The Value of Blink Reflex in Early Diagnosis of Multiple Sclerosis

“…Although the sensitivity of BR in MS has been confirmed in several previous studies, as well as other neurophysiological methods, MRI has proved to be superior in the confirmation of dissemination in time and space 14,15 . In our study, MRI results showed brainstem lesions in 60% of MS patients and 40% of CIS patients, with no statistical difference between the two groups.…”

Cervical and Ocular Vestibular-Evoked Myogenic Potentials in Patients With Intracochlear Schwannomas

“…Many factors can cause reduced or absent VEMP responses. Particularly in central pathology, the VEMPs are absent, reduced and/or prolonged which can be an early indicator of pathology (53)(54)(55)(56). Many studies reported reduced or absent VEMPs in patients with cochleovestibular schwannoma (i.e., vestibular schwannoma, see introduction) and reported a strong relationship with tumor size (57).…”