title: Comparison of brainstem reflex recordings and evoked potentials with clinical and MRI data to assess brainstem dysfunction in multiple sclerosis: a short-term follow-up.
abstract: Brainstem dysfunctions are associated to high risk of developing severe disability in patients with multiple sclerosis (PwMS), often undetected by conventional routine assessments. In this view, the purpose of this study was to monitor brainstem function over a short-term period in PwMS, comparing clinical and magnetic resonance imaging (MRI) examinations with evoked potentials (EPs) and brainstem reflexes (BSRs). Forty-five PwMS were evaluated at baseline and after 15.1 ± 4.2 months through Expanded Disability Status Scale (EDSS) score, MRI, EPs, vestibulo-masseteric (VMR), acoustic-masseteric (AMR), vestibulo-collic (VCR) and trigemino-collic (TCR) reflexes. At baseline, brainstem alterations were detected by EDSS, MRI, EPs and BSRs in 40, 77.8, 84.4 and 82.2 % of patients, respectively. At follow-up, EDSS and MRI remained unchanged, while EP and BSR deteriorated in 86.7 and 91.1 % of patients, respectively. Changes from 1 to 3 altered EPs and from 1 to 4 altered BSRs were significant only for EPs (p = 0.028). The analysis of grading severity for each test disclosed significant worsening of the VMR, AMR, TCR and P14 wave of the median somatosensory EP. Combined EP/BSR recordings were significantly more sensitive than paired EDSS/MRI assessments at baseline (93.3 versus 80 %; p = 0.006) and follow-up (97.8 versus 82.2 %; p = 0.008). In the short-term VMR, AMR, TCR and P14 wave disclosed a significant functional brainstem deterioration by detecting lesions that remained clinically and MRI silent. Our findings provide evidence for a valuable role of neurophysiological methods, especially BSRs, in investigating and monitoring brainstem dysfunctions in MS, in comparison with the standard clinical and MRI procedures.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Viale S.Pietro 8, 07100, Sassari, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Magnano
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Viale S.Pietro 8, 07100, Sassari, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Pes
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy.
authors.forename: M P
authors.initials: MP
authors.lastname: Cabboi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Viale S.Pietro 8, 07100, Sassari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pilurzi
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ginatempo
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Viale S.Pietro 8, 07100, Sassari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Achene
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Viale S.Pietro 8, 07100, Sassari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Salis
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Viale S.Pietro 8, 07100, Sassari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Conti
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy. deriuf@uniss.it.
authors.forename: Franca
authors.initials: F
authors.lastname: Deriu
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000470:Alkaloids; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004185:Disability Evaluation; D004558:Electric Stimulation; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D012018:Reflex / Q000502:physiology*; D012720:Severity of Illness Index; D013223:Statistics as Topic; D055815:Young Adult
chemical_list: D000470:Alkaloids; C110131:Wilcox compound
keywords: Brainstem reflexes; EDSS; Evoked potentials; Follow-up; MRI; Multiple sclerosis