title: Exploring brainstem function in multiple sclerosis by combining brainstem reflexes, evoked potentials, clinical and MRI investigations.
abstract: OBJECTIVE
  To investigate vestibulo-masseteric (VMR), acoustic-masseteric (AMR), vestibulo-collic (VCR) and trigemino-collic (TCR) reflexes in patients with multiple sclerosis (MS); to relate abnormalities of brainstem reflexes (BSRs) to multimodal evoked potentials (EPs), clinical and Magnetic Resonance Imaging (MRI) findings.
  
  
  METHODS
  Click-evoked VMR, AMR and VCR were recorded from active masseter and sternocleidomastoid muscles, respectively; TCR was recorded from active sternocleidomastoid muscles, following electrical stimulation of the infraorbital nerve. EPs and MRI were performed with standard techniques.
  
  
  RESULTS
  Frequencies of abnormal BSRs were: VMR 62.1%, AMR 55.1%, VCR 25.9%, TCR 58.6%. Brainstem dysfunction was identified by these tests, combined into a four-reflex battery, in 86.9% of cases, by EPs in 82.7%, MRI in 71.7% and clinical examination in 37.7% of cases. The sensitivity of paired BSRs/EPs (93.3%) was significantly higher than combined MRI/clinical testing (70%) in patients with disease duration ⩽6.4years. BSR alterations significantly correlated with clinical, EP and MRI findings.
  
  
  CONCLUSIONS
  The four-BSR battery effectively increases the performance of standard EPs in early detection of brainstem impairment, otherwise undetected by clinical examination and neuroimaging.
  
  
  CONCLUSIONS
  Multiple BSR assessment usefully supplements conventional testing and monitoring of brainstem function in MS, especially in newly diagnosed patients.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
authors.forename: Immacolata
authors.initials: I
authors.lastname: Magnano
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
authors.forename: Giovanni Mario
authors.initials: GM
authors.lastname: Pes
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Pilurzi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Cabboi
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ginatempo
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Giaconi
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Italy.
authors.forename: Eusebio
authors.initials: E
authors.lastname: Tolu
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Achene
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salis
authors.affiliation: Sobell Department of Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK.
authors.forename: John C
authors.initials: JC
authors.lastname: Rothwell
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Conti
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Italy. Electronic address: deriuf@uniss.it.
authors.forename: Franca
authors.initials: F
authors.lastname: Deriu
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D001933:Brain Stem / Q000503:physiopathology*; D004558:Electric Stimulation; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000503:physiopathology*; D009334:Neck Muscles / Q000294:innervation*; D012018:Reflex / Q000502:physiology*; D055815:Young Adult
keywords: Acoustic-masseteric reflex (AMR); Multiple sclerosis; Trigemino-collic reflex (TCR); Vestibular-evoked myogenic potentials (VEMPs); Vestibulo-collic reflex (VCR); Vestibulo-masseteric reflex (VMR)