Background: Little is known about the predictive value of neurophysiological measures for the long-term course of multiple sclerosis (MS).
Objective: To prospectively investigate whether combined visual (VEP) and motor evoked potentials (MEP) allow prediction of disability over 14 years.
Methods: A total of 30 patients with relapsing–remitting and secondary progressive MS were prospectively investigated with VEPs, MEPs and the Expanded Disability Status Scale (EDSS) at entry (T0) and after 6, 12 and 24 months, and with cranial MRI scans at entry (T2-weighted and gadolinium-enhanced T1-weighted images). EDSS was again assessed at year 14 (T4). The association between evoked potential (EP), magnetic resonance (MR) data and EDSS was measured using Spearman’s rank correlation. Multivariable linear regression was performed to predict EDSST4 as a function of z-transformed EP-latenciesT0. The model was validated using a jack-knife procedure and the potential for improving it by inclusion of additional baseline variables was examined.
Results: EDSS valuesT4 correlated with the sum of z-transformed EP-latenciesT0 (rho = 0.68, p < 0.0001), but not with MR-parametersT0. EDSST4 as predicted by the formula EDSST4 = 4.194 + 0.088 * z-score P100T0 + 0.071 * z-score CMCTUE, T0 correlated with the observed values (rho = 0.69, p < 0.0001).
Conclusion: Combined EPs allow prediction of long-term disability in small groups of patients with MS. This may have implications for the choice of monitoring methods in clinical trials and for daily practice decisions.
RunmarkerBAnderssonCOdénAAndersenO. Prediction of outcome in multiple sclerosis based on multivariate models. J Neurol1994; 241: 597–604.
2.
ConfavreuxCVukusicSMoreauTAdeleineP. Relapses and progression of disability in multiple sclerosis. N Engl J Med2000; 343: 1430–1438.
3.
ConfavreuxCVukusicSAdeleineP. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain2003; 126: 770–782.
4.
FilippiMHorsfieldMAMorrisseySPMacManusDGRudgePMcDonaldWI. Quantitative brain MRI lesion load predicts the course of clinically isolated syndromes suggestive of multiple sclerosis. Neurology1994; 44: 635–641.
5.
O’RiordanJIThompsonAJKingsleyDPMacManusDGKendallBERudgeP. The prognostic value of brain MRI in clinically isolated syndromes of the CNS. A 10-year follow-up. Brain1998; 121: 495–503.
6.
SailerMO’RiordanJIThompsonAJKingsleyDPMacManusDGMcDonaldWI. Quantitative MRI in patients with clinically isolated syndromes suggestive of demyelination. Neurology1999; 52: 599–606.
7.
SwantonJKRoviraATintoreMAltmannDRBarkhofFFilippiM. MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study. Lancet Neurol2007; 6: 677–686.
8.
TintoréMRoviraARíoJNosCGrivéETéllezN. Baseline MRI predicts future attacks and disability in clinically isolated syndromes. Neurology2006; 67: 968–972.
9.
BrexPACiccarelliOO’RiordanJISailerMThompsonAJMillerDH. A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. N Engl J Med2002; 346: 158–164.
10.
FisnikuLKBrexPAAltmannDRMiszkielKABentonCELanyonR. Disability and T2 MRI lesions: a 20-year follow-up of patients with relapse onset of multiple sclerosis. Brain2008; 131: 808–817.
11.
FuhrPBorggrefe-ChappuisASchindlerCKapposL. Visual and motor evoked potentials in the course of multiple sclerosis. Brain2001; 124: 2162–2168.
Lechner-ScottJKapposLHofmanMPolmanCHRonnerHMontalbanX. Can the Expanded Disability Status Scale be assessed by telephone?Mult Scler2003; 9: 154–159.
14.
StoehrM. Somatosensible Reizantworten von Nerven, Rückenmark und Gehirn. In: StoehrMDichgansJBuettnerUWHessCW. Evozierte PotentialeVol. 2, 4th edition. Heidelberg: Springer-Verlag, 1996; p.63.
15.
PittockSJMayrWTMcClellandRLJorgensenNWWeigandSDNoseworthyJH. Change in MS-related disability in a population-based cohort: a 10-year follow-up study. Neurology2004; 62: 51–59.
16.
HirstCIngramGSwinglerRCompstonDAPickersgillTRobertsonNP. Change in disability in patients with multiple sclerosis: a 20-year prospective population-based analysis. J Neurol Neurosurg Psychiatry2008; 79: 1137–1143.
17.
O’ConnorPMarchettiPLeeLPereraM. Evoked potential abnormality scores are a useful measure of disease burden in relapsing–remitting multiple sclerosis. Ann Neurol1998; 44: 404–407.
18.
LeocaniLRovarisMBoneschiFMMedagliniSRossiPMartinelliV. Multimodal evoked potentials to assess the evolution of multiple sclerosis: a longitudinal study. J Neurol Neurosurg Psychiatry2006; 77: 1030–1035.
19.
JungPBeyerleAZiemannU. Multimodal evoked potentials measure and predict disability progression in early relapsing–remitting multiple sclerosis. Mult Scler2008; 14: 553–556.
20.
SchlaegerRD’SouzaMSchindlerCGrizeLKapposLFuhrP. Combined evoked potentials as markers and predictors of disability in early multiple sclerosis. Clin Neurophysiol, DOI: 10.1016/j.clinph.2011.06.02110.1016/j.clinph.2011.06.021.
21.
ComiGLeocaniLMedagliniSLocatelliTMartinelliVSantuccioG. Measuring evoked responses in multiple sclerosis. Mult Scler1999; 5: 263–267.
22.
EmersonRG. Evoked potentials in clinical trials for multiple sclerosis. J Clin Neurophysiol1998; 15: 109–116.
23.
KallmannBAFackelmannSToykaKVRieckmannPReinersK. Early abnormalities of evoked potentials and future disability in patients with multiple sclerosis. Mult Scler2006; 12: 58–65.
24.
PelayoRMontalbanXMinovesTMonchoDRioJNosC. Do multimodal evoked potentials add information to MRI in clinically isolated syndromes?Mult Scler2010; 16: 55–61.
25.
RovarisMAgostaFSormaniMPIngleseMMartinelliVComiG. Conventional and magnetization transfer MRI predictors of clinical multiple sclerosis evolution: a medium-term follow-up study. Brain2003; 126: 2323–2332.
26.
RudickRALeeJSimonJFisherE. Significance of T2 lesions in multiple sclerosis: A 13-year longitudinal study. Ann Neurol2006; 60: 236–242.
27.
LiDKPatyDW. Magnetic resonance imaging results of the PRISMS trial: a randomized, double-blind, placebo-controlled study of interferon-beta1a in relapsing–remitting multiple sclerosis. Prevention of Relapses and Disability by Interferon-beta1a Subcutaneously in Multiple Sclerosis. Ann Neurol1999; 46: 197–206.
28.
DaumerMNeuhausAMorrisseySHintzenREbersGC. MRI as an outcome in multiple sclerosis clinical trials. Neurology2009; 72: 705–711.
BakshiRThompsonAJRoccaMAPelletierDDoussetVBarkhofF. MRI in multiple sclerosis: current status and future prospects. Lancet Neurol2008; 7: 615–625.
31.
KuhleJPohlCMehlingMEdanGFreedmanMSHartungHP. Lack of association between antimyelin antibodies and progression to multiple sclerosis. N Engl J Med2007; 356: 371–378.
