title: Pupillary response to sparse multifocal stimuli in multiple sclerosis patients.
abstract: The objective of this paper is to investigate the pattern of abnormalities and establish the diagnostic power of multifocal objective pupil perimetry (mfPOP) in multiple sclerosis (MS).
  
  
  
  A prospective study enrolling 35 normal (47.9 ± 16.8 years, 22 females) and 85 MS subjects (49.8 ± 11.3 years, 62 females; 72 relapsing-remitting (RR), and 13 primary or secondary progressives (PorS)). EDSS scores for the RR and PorS groups were 3.53 ± 1.04 (mean ± SD), and 5.9 ± 1.43, respectively. mfPOP responses were obtained from 44 regions/visual field. Each region was analysed according to response time-to-peak and standardised amplitude (AmpStd). Predictive power was measured by percentage area under the receiver operator curve (%AUC).
  
  
  
  mfPOP responses showed a significant reduction of 0.69 ± 0.04 dB (mean ± SE) in AmpStd and significantly delayed time-to-peak of 25.95 ± 0.89 ms (mean ± SE) in MS subjects compared to control subjects (p<0.001). %AUC was greater for time-to-peak than AmpStd both for RR and PorS patients. Diagnostic power followed the EDSS scores but not a history of optic neuritis.
  
  
  
  mfPOP is well tolerated and potentially has a role in the diagnosis and assessment of patients with MS.
authors.affiliation: Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Australia eman_c5@yahoo.com.
authors.forename: E N
authors.initials: EN
authors.lastname: Ali
authors.affiliation: Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Maddess
authors.affiliation: Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: James
authors.affiliation: Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Voicu
authors.affiliation: Department of Neurology, The Canberra Hospital, Australian National University Medical School, Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: Lueck
mesh_terms: D000328:Adult; D019540:Area Under Curve; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis / Q000503:physiopathology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000503:physiopathology*; D010775:Photic Stimulation / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011680:Pupil; D012372:ROC Curve; D015203:Reproducibility of Results; D058609:Visual Field Tests / Q000379:methods*
keywords: Multiple sclerosis; clinical neurophysiology; diagnostic test assessment; optic neuritis; perimetry; pupils