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Measuring evoked responses in multiple sclerosis

Department of Clinical Neurophysiology, MS Centre, University of Milan, Scientific Institute H San Raffaele, Milan, Italy

Letizia Leocani

Department of Clinical Neurophysiology, MS Centre, University of Milan, Scientific Institute H San Raffaele, Milan, Italy

Stefania Medaglini

Department of Clinical Neurophysiology, MS Centre, University of Milan, Scientific Institute H San Raffaele, Milan, Italy

Tiziana Locatelli

Department of Clinical Neurophysiology, MS Centre, University of Milan, Scientific Institute H San Raffaele, Milan, Italy

Vittorio Martinelli

Department of Neurology, MS Centre, University of Milan, Scientific Institute H San Raffaele, Milan, Italy

Giuseppe Santuccio

Department of Neurology, MS Centre, University of Milan, Scientific Institute H San Raffaele, Milan, Italy

Paolo Rossi

Department of Neurology, MS Centre, University of Milan, Scientific Institute H San Raffaele, Milan, Italy

Evoked potentials (EPs) have been widely utilised in Multiple Sclerosis (MS) patients to demonstrate the involvement of sensory and motor pathways. Their diagnostic value is based on the ability to reveal clinically silent lesions and to objectivate the central nervous system damage in patients who complain frequently of vague and indefinite disturbances which frequently occurs in the early phases of the disease. The advent of magnetic resonance imaging (MRI) techniques has greatly reduced the clinical utilisation of EPs, which is not fully justifiable, as the information provided by EPs are quite different from those provided by MRI. The abnormalities of evoked responses reflect the global damage of the evoked nervous pathway and are significantly correlated with the clinical findings, while the vast majority of MRI lesions are not associated to symptoms and signs. Transversal and longitudinal studies have demonstrated that EP changes in MS are more strictly related to disability than MRI lesion burden. On the contrary, MRI is more sensitive than EPs in revealing the disease activity. Evoked responses modifications observed in MS are not disease-specific; moreover longitudinal studies showed latency and morphology changes of evoked responses not always related to clinical changes. Such a dissociation can be explained both by technical factors and by subclinical disease activity. To reduce the negative impact of technical aspects, only reproducible parameters of the evoked responses should be used to monitor disease evolution and therapeutic interventions.

Key Words: visual evoked potentials • somatosensory evoked potentials • auditory evoked potentials • magnetic resonance imaging • prognosis

Multiple Sclerosis, Vol. 5, No. 4, 263-267 (1999)
DOI: 10.1177/135245859900500412


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