Do multimodal evoked potentials add information to MRI in clinically isolated syndromes?

Abstract

The role of multimodal evoked potentials (MMEPs) in establishing multiple sclerosis (MS) diagnosis and prognosis has diminished nowadays. The objective of this article is to evaluate whether MMEPs add information to MRI in identifying patients with higher risk of relapse or development of disability after a clinically isolated syndrome (CIS). Patients who underwent visual, somato-sensory and brainstem auditory evoked potentials (EPs) were identified from a cohort of consecutive CIS. Patients also underwent brain MRI within 3 months of first attack. We analysed time to second attack and to Expanded Disability Status Scale (EDSS) score of 3.0 according to number of Barkhof criteria and number of abnormal MMEPs. A complete study was performed in 245 patients who were followed for a mean of 76.4 months (interquartile range: 61 to 96). Seventy-one patients (29%) had the three EPs normal, 115 patients (47%) had one abnormal EP; 40 patients (16%) had two; and 19 patients (8%) had three abnormal EPs. Baseline MRI determined the risk for converting to clinically definite MS and correlated with disability according to previous studies. EPs individually did not modify the risk of conversion or disability. However, the presence of three abnormal EPs increased the risk of reaching moderate disability (hazard ratio 7.0; 1.4—34.9) independently of baseline MRI. In conclusion, in the presence of three abnormal EPs could help identify CIS patients with a higher risk of developing disability, independently of MRI findings. However, the utility of MMEPs is limited by the low percentage of CIS patients having the three abnormal at baseline.

Keywords

clinically isolated syndrome evoked potentials multiple sclerosis predictors of disability

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References

Tintoré M. , Rovira A. , Rio J. , et al. Are optic neuritis really more benign than other first attacks? Ann Neurol 2005; 57: 210-215.

Tintoré M. , Rovira A. , Brieva L. , et al. Isolated demyelinating syndromes: comparison of CSF oligoclonal bands and different MRI criteria to predict conversion to CDMS. Mult Scler 2001; 7: 359-363.

Morrissey SP , Miller DH , Kendall BE , et al. The significance of brain magnetic resonance imaging abnormalities at presentation with clinically isolated syndromes suggestive of multiple sclerosis. A 5-year follow-up study. Brain 1993; 116: 135-146.

O’Riordan JI , Thompson AJ , Kingsley DP , et al. The prognostic value of brain MRI in clinically isolated syndromes of the CNS: a 10 year follow-up. Brain 1998; 121: 495-503.

Brex PA , Ciccarelli O. , O’Riordan JI , et al. A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. N Engl J Med 2002 ; 346: 158-164.

Optic Neuritis Study Group. The 5-year risk of MS after optic neuritis: experience of the Optic Neuritis Treatment Trial. Neurology 1997; 49: 1404-1413.

Fisniku LK , Brex PA , Altmann DR , et al. Disability and T2 MRI lesions: a 20-year follow-up of patients with relapse onset of multiple sclerosis. Brain 2008; 131: 808-817.

Tintoré M. , Rovira A. , Río J. , et al. Do oligoclonal bans add information to MRI in first attacks of multiple sclerosis? Neurology 2008; 70: 1079-1083.

Kuhle J. , Pohl C. , Mehling M. , et al. Lack of association between antimyelin antibodies and progression to multiple sclerosis. N Engl J Med 2007; 356: 371-378.

10.

Pelayo R. , Tintoré Montalban X. , et al. Antimyelin antibodies with no progression to multiple sclerosis . N Engl J Med 2007; 356: 426-428.

11.

McDonald WI , Compston A. , Edan G. , et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 2001; 50: 121-127.

12.

Polman CH , Reingold SC , Edan G. , et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the ‘‘McDonald Criteria’’. Ann Neurol 2005; 58: 840-846.

13.

Gronseth GS , Ashman EJ Practice parameter: the usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 54: 1720-1725.

14.

O’Connor P. , Marchetti P. , Lee L. , et al. Evoked potential abnormality scores are a useful measure of disease burden in relapsing-remitting multiple sclerosis . Ann Neurol 1998; 44: 404-407.

15.

Fuhr P. , Borggrefe-Chappuis A. , Schindler C. , et al. Visual and motor evoked potentials in the course of multiple sclerosis. Brain 2001; 124: 2162-2168.

16.

Leocani L. , Rovaris M. , Boneschi FM , et al. Multimodal evoked potentials to assess the evolution of multiple sclerosis: a longitudinal study. J Neurol Neurosurg Psychiatry 2006; 77: 1030-1035.

17.

Ghezzi A. , Martinelli V. , Torri V. , et al. Long-term follow-up of isolated optic neuritis: the risk of developing multiple sclerosis, its outcome, and the prognostic role of paraclinical tests. J Neurol 1999; 246: 770-775.

18.

Kallmann BA , Fackelmann S. , Toyka KV , et al. Early abnormalities of evoked potentials and future disability in patients with multiple sclerosis. Mult Scler 2006; 12: 58-65.

19.

Casanova B. , Coret F. , Parra S. , et al. Predictive value of evoked potentials in multiple sclerosis. A 12-years follow-up study. J Neurol 2005; 252 (Suppl 2): 11/92.

20.

Jung P. , Beyerle A. , Ziemann U. Multimodal evoked potentials measure and predict disability progression in early relapsing-remitting multiple sclerosis. Mult Scler 2008; 14: 553-556.

21.

Schlaeger R. , Schindler C. , Grize L. , et al. Combined visual, motor and somatosensory evoked potentials as markers of clinical disability in early multiple sclerosis . Clin Neurophysiol 2007; 118: e5.

22.

Tintore M. , Rovira A. , Martínez MJ , et al. Isolated demyelinating syndromes: comparison of different MRI criteria to predict conversion to clinically definite multiple sclerosis. Am J Neuroradiol 2000; 21: 702-706.

23.

Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. The utility of MRI in suspected MS. Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 2003; 61: 602-611.

24.

Deuschl G. , Eisen A. Recommendations for the practice of clinical neurophysiology: Guidelines of the international Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol 1999; 52(Suppl): 192-211.

25.

Poser CM , Paty DW , Scheinberg L. , et al. New diagnostic criteria for multiple sclerosis: guidelines for research proposals. Ann Neurol 1983; 13: 227-231.

26.

Kurtzke JF Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS). Neurology 1983; 33: 1444-1452.

27.

Klistorner A. , Graham S. , Fraser C. , et al. Electrophysiological evidence for heterogeneity of lesions in optic neuritis. Invest Ophthalmol Vis Sci 2007; 48: 4549-4556.

28.

Fraser C. , Klistorner A. , Graham S. , et al. Multifocal visual evoked potential latency analysis: predicting progression to multiple sclerosis. Arch Neurol 2006; 63: 847-850.

29.

Samsen P. , Chuenkongkaew WL , Masayaanon P. , et al. A comparative study of visual evoked potentials in optic neuritis and optic neuritis with multiple sclerosis. J Med Assoc Thai 2007; 90: 313-318.

30.

Walsh JC , Garrick R. , Cameron J. , et al. Evoked potentials changes in clinically definite multiple sclerosis: a two years follow up study. J Neurol Neurosurg Psychiatry 1982; 45: 494-500.

31.

Nuwer MR , Packwood JW , Myers LW , et al. Evoked potentials predict the clinical changes in a multiple sclerosis drugs study. Neurology 1987; 37: 1754-1761.

32.

Andersson T. , Siden A. Multimodality evoked potentials and neurological phenomenology in patients with multiple sclerosis and potentially related conditions. Electromyogr Clin Neurophysiol 1991; 31: 109-117.

33.

Sater RA , Rostami AM , Galetta S. , et al. Serial evoked potentials studies and MRI imaging in chronic progressive multiple sclerosis. J Neurol Sci 1999; 171: 79-83.