title: Multimodal neurophysiological evaluation of primary progressive multiple sclerosis - An increasingly valid biomarker, with limits.
abstract: BACKGROUND
  The promising utility of multi-modality evoked potential batteries to objectively measure multi-tract dysfunction has been evaluated by several groups using different methods.
  
  
  OBJECTIVE
  To independently evaluate the use of multi-modality evoked potential batteries as surrogate biomarkers for both physical and cognitive status in a cohort of Primary Progressive Multiple Sclerosis patients and identify the most potentially useful scoring method of those described.
  
  
  METHODS
  28 Patients with Primary Progressive Multiple Sclerosis underwent clinical evaluation with Kurtzke's Modified EDSS and the Multiple Sclerosis Functional Composite (MSFC). 19 Participants also underwent the Minimal Assessment of Cognitive Function in Multiple Sclerosis. Visual, Brainstem Auditory, Somatosensory and Motor Evoked Potentials were recorded on all. Results were graded by variants of the Global Evoked Potential Score, Multiple Evoked Potential Score and Summation of Z transformed Evoked Potential Latencies for correlation against the clinical scores.
  
  
  CONCLUSIONS
  Multi-modal evoked potential batteries generally show moderate and useful correlation with clinical status as measured by the regulatory standard of EDSS (r = .65 vs. mEPS p < .005) and MSFC (r = .39 vs. mEPS p < .05). The graded qualitative mEPS scoring system displayed the strongest relationship although the influence of scoring system applied appeared reassuringly minimal. Non-association with cognitive impairment is an important limitation however.
authors.affiliation: Bristol & Avon MS Centre, Department of Neurosciences, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: L J W
authors.initials: LJ
authors.lastname: Canham
authors.affiliation: Grey Walter Department of Neurophysiology, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: N
authors.initials: N
authors.lastname: Kane
authors.affiliation: Grey Walter Department of Neurophysiology, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: A
authors.initials: A
authors.lastname: Oware
authors.affiliation: Grey Walter Department of Neurophysiology, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: P
authors.initials: P
authors.lastname: Walsh
authors.affiliation: Grey Walter Department of Neurophysiology, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: K
authors.initials: K
authors.lastname: Blake
authors.affiliation: Bristol & Avon MS Centre, Department of Neurosciences, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: K
authors.initials: K
authors.lastname: Inglis
authors.affiliation: Bristol & Avon MS Centre, Department of Neurosciences, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: J
authors.initials: J
authors.lastname: Homewood
authors.affiliation: Bristol & Avon MS Centre, Department of Neurosciences, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: J
authors.initials: J
authors.lastname: Witherick
authors.affiliation: Bristol & Avon MS Centre, Department of Neurosciences, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: H
authors.initials: H
authors.lastname: Faulkner
authors.affiliation: Department of Statistics, University of the West of England, Bristol, UK.
authors.forename: P
authors.initials: P
authors.lastname: White
authors.affiliation: Bristol & Avon MS Centre, Department of Neurosciences, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: A
authors.initials: A
authors.lastname: Lewis
authors.affiliation: Bristol & Avon MS Centre, Department of Neurosciences, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: C
authors.initials: C
authors.lastname: Furse-Roberts
authors.affiliation: Bristol & Avon MS Centre, Department of Neurosciences, Southmead Hospital, North Bristol NHS Trust, UK. Electronic address: david.cottrell@nbt.nhs.uk.
authors.forename: D A
authors.initials: DA
authors.lastname: Cottrell
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D004568:Electrodiagnosis / Q000379:methods*; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D009460:Neurologic Examination / Q000379:methods*
keywords: Biomarker; Evoked potential; Multiple Sclerosis; Primary Progressive