Evaluation of brainstem involvement in multiple sclerosis

Abstract

Evidence suggests that brainstem involvement in multiple sclerosis (MS) is one of the major predictive factors for future disability. Recent work demonstrates that brainstem pathology is more frequent than can be depicted either clinically or with the use of MRI. Evoked potentials have been shown to reliably predict disability in MS patients. This review will consider the main clinical and neuroradiological aspects together with the role of different neurophysiological tests, as ancillary tools to conventional studies, in evaluation of brainstem pathology in MS patients. Specifically, the role of vestibular evoked myogenic potentials, trigeminal somatosensory evoked potentials, autonomic nervous system testing and sleep testing in MS, as correlates of brainstem damage, will be explored.

Paired neurophysiological and clinical study of the brainstem at different stages of Parkinson’s Disease

“…VEMPs have been largely used for the study of a number of neurological conditions affecting the brainstem for which they, singularly or in combination, have shown a potential for detection of otherwise clinically and radiologically silent lesions (Pollak et al, 2006;Boldingh et al, 2011;Habek, 2013;Magnano et al, 2014). In PD, the cVEMP has only been tested in patients with the full-blown disease, where a general pattern of absence and of amplitude reduction has been reported (Pollak et al, 2009;Potter-Nerger et al, 2012).…”

Tongue somatosensory evoked potentials reflect midbrain involvement in patients with clinically isolated syndrome

“…The affection of the brainstem in MS bears significant clinical importance. Patients with demyelinating lesions in the brainstem have a greater chance of having disability at follow-up than patients with no infratentorial lesions (2). Furthermore, they tend to have worse long term prognosis, and identification of these patients can influence important management decisions (3).…”

Correlation of the VEMP score, ambulation and upper extremity function in clinically isolated syndrome

“…(12,13,14) Furthermore, several MRI studies tried to correlate MRI burden of the disease with walking impairment. (15,16) However, as the information provided by evoked potentials is more related to function unlike the information provided by MRI, which is more related to anatomy, evoked potentials may prove to be more useful in monitoring disease evolution in MS (17). For some neurophysiological methods, like the blink reflex, it has even been shown a good correlation between the pathological response and brainstem disease burden.…”