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P303 Serial MRI, VEP, SEP and biotesiometry in acute optic neuritis: Value of baseline results to predict the development of new lesions at one year follow up
Poster Session: Sensory Evoked Potentials (AEP, VEP SEP)
352
DIAGNOSTIC AND PREDICTIVE VALUE OF LONG LATENCY REFLEXES, BLINK REFLEX AND SOMATOSENSORY EVOKED POTENTIALS IN THE PATIENT WITH TIA, RIA AND BRAIN INFARCTION
D. Djordjevic, A. Jovicic, D. Veljancic, S. Petkovic. Department of Neurology, Military_Medical Academy Belgrade, Yugoslavia The aim of this study was to evaluate diagnostic and prognostic value of long latency reflexes (LLR), blink reflex (BR), and somatosensory evoked potentials (SSEP) in patients with TIA, RIA and brain infarction. Investigations were done in l0 patients with TIA, 8 with R/A and 26 with brain infarction. Control group was consisted of 15 neurological healthy individuals. Electrophysiological recordings were performed within first week of disease onset and repeated after three and six months. Parameter changes of applied electrophysiological tests were analysed in relation to localization, extent and severity of ischemic lesions, as well as neurological and functional outcome. The results of performed investigations showed that parameter changes were dependent on localization, size and degree of ischemic lesions: changes of the amplitude in cortical lesions, prolonged latency in subcortica] lesions, and both in corticosubcortical ischemic lesions. The amplitude reduction or the absence of certain components was correlated to the extent of ischemic lesions. The amplitude reduction of LLR R2 component for median nerve were in correlation to arm deficit recovery, LLR R2 for peroneal nerve to leg deficit recovery. R2 of BR were in correlation to speech deficit recovery and SSEP to outcome of cortical sensory disorders. It was concluded that LLR, BR and SSEPs might have high sensitivity and certain specificity in diagnostic detection of ischemic brain lesions, and considerable predictive value for clinical recovery.
[-~-0~
SERIAL VEP AND MRI STUDY OF PATIENTS WITH ACUTE OPTIC NEURITIS: RESULTS OF A DOUBLE-BUND METHYLPREDNISOLONE TREATMENT TRIAL
A. Brusa, S. Jones, D. Miller, R. Kapoor, G. Plant, I. Moseley. The
National Hospital for Neurology, London, UK A recent multi-centre trial studied the effects of corticosteroid treatment in optic neuritis, showing a shorter duration of acute visual impairment, but little benefit in the longer term. However, this was based on clinical criteria and no treatment trial has so far included a serial recording of visual evoked potentials (VEP) or magnetic resonance imaging (MRI) of the optic nerve. We studied 59 patients presenting within 30 days after the onset of optic neuritis by means of MRI of the optic nerve, whole and central field VEP (recorded before, 2 weeks and 6 months after treatment), contrast sensitivity and visual fields at 6 months. Patients were randomly selected to be administered IV methylprednisolone or 1V saline. VEPs recorded 2 weeks after treatment were of significantly larger amplitude in the patients treated with methylprednisolone. At 6 months, however, there were no statistically significant differences in amplitude or latency. No significant differences were seen in clinical and psychophysical tests nor in follow-up MR/. An interesting result was the significant correlation between VEP amplitude at 2 weeks and the length of the optic nerve lesion at 6 months for both the treated and the placebo groups. The implications of this finding are that the ultimate extent of optic nerve damage seems to be related to the severity and/or duration of inflammation and that treatment may be beneficial (albeit perhaps at a subclinical level) if administered immediately after the onset of symptoms.
•0•
SERIAL MRI, VEP, SEP AND BIOTESIOMETRY IN ACUTE OPTIC NEURITIS: VALUE OF BASELINE RESULTS TO PREDICT THE DEVELOPMENT OF NEW LESIONS AT ONE YEAR FOLLOW UP
J.L. Frederiksen ~, J. Petrera 2, H.B.W. Larsson 3, B. Stigsby 2 j. Olesen
I Dept. of Neurology, Glostrup Hospital, University of Copenhagen, DK; 2 Dept. of Clinical Neurophysiology, Gentofte Hospital, University of Copenhagen, DK; 3 Dept. of MRl, Hvidovre Hospital, University of Copenhagen, DK To establish the value of MR/, VEP, SEP, and biotesiometry in monitoring disease evolution we undertook a one year follow up study of 70 untreated patients with acute optic neuritis (ON), in 48 monosymptomatic (bilateral
in 10) (AMON), and in 22 part of clinically definite multiple sclerosis (CDMS). Only minor changes in quantitative test scores were observed except for VEP in the eye with acute ON, which improved significantly in patients with AMON. The median MRI lesion load increased at follow up in both groups. Eight of 32 patients, characterized by at least one abnormal paraclinical test at onset of AMON, had developed CDMS versus none of 16 patients with normal paraclinical results at onset (p = 0.03). No single test predicted the evolution of CDMS. In conclusion, these repeated measurements give support for selecting patients with subclinical abnormalities at onset for trials concerning early treatment of MS.
~ - ~
ACUTE UNILATERAL PAPILLITIS VERSUS RETROBULBAR NEURITIS: RELATION TO MULTIPLE SCLEROSIS
J.L. Frederiksen I, j. Olesen 1, j. Petrera 2, H.B.W. Larsson 3, F.T. Sellebjerg 1. J Department of Neurology, Glostrup Hospital,
University of Copenhagen, Denmark; 2 Department of Clinical Neurophysiology, Gentofte Hospital, Unfi~ersityof Copenhagen, Denmark; 3 Department of MRL Hvidovre Hospital, University of Copenhagen, Denmark Prospectively referred patients from a defined uptake area with unilateral acute optic neuritis (ON) (n = 223; aged 12-57; 158 women), either idiopathic or part of clinically definite multiple sclerosis (CDMS), were systematically examined by the same physician. We analysed, if the 161 patients with retrobulbar neuritis and the 62 patients with papillitis differed from each other clinically or according to the following paraclinical tests: cerebral MR/, VEP, SEP from median and tibial nerves, biotesiometry, CSF oligoclonal bands, IgG-index, CSF leucocyte count and HLA-DQ and-DR tissue typing. Abnormal results in retrobulbar ON and in papillitis did not differ significantly, neither when the idiopathic cases and cases with CDMS were analysed separately. In conclusion, our data document that unilateral retrobulbar ON and papillitis are both part of the MS spectrum and not different from each other with regard to clinical and paraclinical parameters. These findings are important for selecting patients for clinical trials of MS.
•3•
EVOKED POTENTIALS IN VIRAL ENCEPHALITIS IN CHILDREN
N. Beaud, G. Jacobi, P. Hern,5.iz Driever. Abteilung Pgidiatrische Neurologie, Zentrum der Kinderheilkunde und Jugendmedizin, Klinikurn der Johann Wolfgang Goethe-Universiti~t, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany Viral encephalitis in childhood has a variable symptomatology, depending on the virus, the developmental and immunologic status of the host. Apart from clinical examination, biochemical serum and spinal fluid analysis as well as imaging techniques, EEG and evoked potentials represent important clues for diagnosis and prognosis in this central nervous disease. We analyzed retrospectively 45 Patients with viral encephalitis and aseptic encephalitis: Aseptic encephalitis (14 patients), HSV-1 (8 patients), VZV (6 patients), Mumps (2 patients), Measles (12 patients), connatal CMV, Coxsackie, FSME (each one patient). All patients received EEG recordings. 14 patients received BAEP. 7 patients received VEP and SSEP. The initial EEG recordings showed moderate to severe alterations. In HSV-encephalitis we were able to show PLED activity. Persistance of severe alterations correlated with worse outcome. All evoked potentials showed initially slight to moderate alterations concerning latency, central conduction time, amplitude and dispersion. Normalization went in parallel to recovery of the patients. In patients with severe mental defect we were able to show absent or minimal normalization of the evoked potentials. We conclude that the pathologic alterations of the evoked potentials correlated with functional central nervous inhibition due to the inflammation. Further prospective studies are underway.
352
DIAGNOSTIC AND PREDICTIVE VALUE OF LONG LATENCY REFLEXES, BLINK REFLEX AND SOMATOSENSORY EVOKED POTENTIALS IN THE PATIENT WITH TIA, RIA AND BRAIN INFARCTION
D. Djordjevic, A. Jovicic, D. Veljancic, S. Petkovic. Department of Neurology, Military_Medical Academy Belgrade, Yugoslavia The aim of this study was to evaluate diagnostic and prognostic value of long latency reflexes (LLR), blink reflex (BR), and somatosensory evoked potentials (SSEP) in patients with TIA, RIA and brain infarction. Investigations were done in l0 patients with TIA, 8 with R/A and 26 with brain infarction. Control group was consisted of 15 neurological healthy individuals. Electrophysiological recordings were performed within first week of disease onset and repeated after three and six months. Parameter changes of applied electrophysiological tests were analysed in relation to localization, extent and severity of ischemic lesions, as well as neurological and functional outcome. The results of performed investigations showed that parameter changes were dependent on localization, size and degree of ischemic lesions: changes of the amplitude in cortical lesions, prolonged latency in subcortica] lesions, and both in corticosubcortical ischemic lesions. The amplitude reduction or the absence of certain components was correlated to the extent of ischemic lesions. The amplitude reduction of LLR R2 component for median nerve were in correlation to arm deficit recovery, LLR R2 for peroneal nerve to leg deficit recovery. R2 of BR were in correlation to speech deficit recovery and SSEP to outcome of cortical sensory disorders. It was concluded that LLR, BR and SSEPs might have high sensitivity and certain specificity in diagnostic detection of ischemic brain lesions, and considerable predictive value for clinical recovery.
[-~-0~
SERIAL VEP AND MRI STUDY OF PATIENTS WITH ACUTE OPTIC NEURITIS: RESULTS OF A DOUBLE-BUND METHYLPREDNISOLONE TREATMENT TRIAL
A. Brusa, S. Jones, D. Miller, R. Kapoor, G. Plant, I. Moseley. The
National Hospital for Neurology, London, UK A recent multi-centre trial studied the effects of corticosteroid treatment in optic neuritis, showing a shorter duration of acute visual impairment, but little benefit in the longer term. However, this was based on clinical criteria and no treatment trial has so far included a serial recording of visual evoked potentials (VEP) or magnetic resonance imaging (MRI) of the optic nerve. We studied 59 patients presenting within 30 days after the onset of optic neuritis by means of MRI of the optic nerve, whole and central field VEP (recorded before, 2 weeks and 6 months after treatment), contrast sensitivity and visual fields at 6 months. Patients were randomly selected to be administered IV methylprednisolone or 1V saline. VEPs recorded 2 weeks after treatment were of significantly larger amplitude in the patients treated with methylprednisolone. At 6 months, however, there were no statistically significant differences in amplitude or latency. No significant differences were seen in clinical and psychophysical tests nor in follow-up MR/. An interesting result was the significant correlation between VEP amplitude at 2 weeks and the length of the optic nerve lesion at 6 months for both the treated and the placebo groups. The implications of this finding are that the ultimate extent of optic nerve damage seems to be related to the severity and/or duration of inflammation and that treatment may be beneficial (albeit perhaps at a subclinical level) if administered immediately after the onset of symptoms.
•0•
SERIAL MRI, VEP, SEP AND BIOTESIOMETRY IN ACUTE OPTIC NEURITIS: VALUE OF BASELINE RESULTS TO PREDICT THE DEVELOPMENT OF NEW LESIONS AT ONE YEAR FOLLOW UP
J.L. Frederiksen ~, J. Petrera 2, H.B.W. Larsson 3, B. Stigsby 2 j. Olesen
I Dept. of Neurology, Glostrup Hospital, University of Copenhagen, DK; 2 Dept. of Clinical Neurophysiology, Gentofte Hospital, University of Copenhagen, DK; 3 Dept. of MRl, Hvidovre Hospital, University of Copenhagen, DK To establish the value of MR/, VEP, SEP, and biotesiometry in monitoring disease evolution we undertook a one year follow up study of 70 untreated patients with acute optic neuritis (ON), in 48 monosymptomatic (bilateral
in 10) (AMON), and in 22 part of clinically definite multiple sclerosis (CDMS). Only minor changes in quantitative test scores were observed except for VEP in the eye with acute ON, which improved significantly in patients with AMON. The median MRI lesion load increased at follow up in both groups. Eight of 32 patients, characterized by at least one abnormal paraclinical test at onset of AMON, had developed CDMS versus none of 16 patients with normal paraclinical results at onset (p = 0.03). No single test predicted the evolution of CDMS. In conclusion, these repeated measurements give support for selecting patients with subclinical abnormalities at onset for trials concerning early treatment of MS.
~ - ~
ACUTE UNILATERAL PAPILLITIS VERSUS RETROBULBAR NEURITIS: RELATION TO MULTIPLE SCLEROSIS
J.L. Frederiksen I, j. Olesen 1, j. Petrera 2, H.B.W. Larsson 3, F.T. Sellebjerg 1. J Department of Neurology, Glostrup Hospital,
University of Copenhagen, Denmark; 2 Department of Clinical Neurophysiology, Gentofte Hospital, Unfi~ersityof Copenhagen, Denmark; 3 Department of MRL Hvidovre Hospital, University of Copenhagen, Denmark Prospectively referred patients from a defined uptake area with unilateral acute optic neuritis (ON) (n = 223; aged 12-57; 158 women), either idiopathic or part of clinically definite multiple sclerosis (CDMS), were systematically examined by the same physician. We analysed, if the 161 patients with retrobulbar neuritis and the 62 patients with papillitis differed from each other clinically or according to the following paraclinical tests: cerebral MR/, VEP, SEP from median and tibial nerves, biotesiometry, CSF oligoclonal bands, IgG-index, CSF leucocyte count and HLA-DQ and-DR tissue typing. Abnormal results in retrobulbar ON and in papillitis did not differ significantly, neither when the idiopathic cases and cases with CDMS were analysed separately. In conclusion, our data document that unilateral retrobulbar ON and papillitis are both part of the MS spectrum and not different from each other with regard to clinical and paraclinical parameters. These findings are important for selecting patients for clinical trials of MS.
•3•
EVOKED POTENTIALS IN VIRAL ENCEPHALITIS IN CHILDREN
N. Beaud, G. Jacobi, P. Hern,5.iz Driever. Abteilung Pgidiatrische Neurologie, Zentrum der Kinderheilkunde und Jugendmedizin, Klinikurn der Johann Wolfgang Goethe-Universiti~t, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany Viral encephalitis in childhood has a variable symptomatology, depending on the virus, the developmental and immunologic status of the host. Apart from clinical examination, biochemical serum and spinal fluid analysis as well as imaging techniques, EEG and evoked potentials represent important clues for diagnosis and prognosis in this central nervous disease. We analyzed retrospectively 45 Patients with viral encephalitis and aseptic encephalitis: Aseptic encephalitis (14 patients), HSV-1 (8 patients), VZV (6 patients), Mumps (2 patients), Measles (12 patients), connatal CMV, Coxsackie, FSME (each one patient). All patients received EEG recordings. 14 patients received BAEP. 7 patients received VEP and SSEP. The initial EEG recordings showed moderate to severe alterations. In HSV-encephalitis we were able to show PLED activity. Persistance of severe alterations correlated with worse outcome. All evoked potentials showed initially slight to moderate alterations concerning latency, central conduction time, amplitude and dispersion. Normalization went in parallel to recovery of the patients. In patients with severe mental defect we were able to show absent or minimal normalization of the evoked potentials. We conclude that the pathologic alterations of the evoked potentials correlated with functional central nervous inhibition due to the inflammation. Further prospective studies are underway.