The bifid visual evoked potential-normal variant or a sign of demyelination?

Fullfield and extrafoveal visual evoked potentials in healthy eyes: reference data for a curved OLED display

PURPOSE

Visual evoked potentials (VEP) present an important diagnostic tool in various ophthalmologic and neurologic diseases. Quantitative response data varied among patients but are also dependent on the recording and stimulating equipment. We established VEP reference values for our setting which was recently modified by using a curved OLED display as visual stimulator. Distinction is made between fullfield (FF) and extrafoveal (EF) conduction, and the effect of sex, age and lens status was determined.

METHODS

This prospective cross-sectional study included 162 healthy eyes of 162 test persons older than 10 years. A fullfield pattern-reversal visual evoked potential (FF-PR-VEP) with two stimulus sizes (ss) (20.4' and 1.4°) as well as an extrafoveal pattern onset-offset VEP (EF-P-ON/OFF-VEP) (ss 1.4° and 2.8°) was derived in accordance with the International Society for Clinical Electrophysiology of Vision guidelines. Amplitudes and latencies were recorded, and the mean values as well as standard deviations were calculated. Age- and sex-dependent influences and the difference between phakic and pseudophakic eyes were examined. A subanalysis of EF-P-ON/OFF-VEP and fullfield pattern onset-offset VEP (FF-P-ON/OFF-VEP) was performed. A 55-inch curved OLED display (LG55EC930V, LG Electronics Inc., Seoul, South Korea) was used as visual stimulator.

RESULTS

Mean P100 latency of the FF-PR-VEP was 103.81 ± 7.77 ms (ss 20.4') and 102.58 ± 7.26 ms (ss 1.4°), and mean C2 latency of the EF-P-ON/OFF-VEP was 102.95 ± 11.84 ms (ss 1.4°) and 113.58 ± 9.87 ms (ss 2.8°). For all stimulation settings (FF-PR-VEP, EF-P-ON/OFF-VEP), a significant effect of age with longer latencies and smaller amplitudes in older subjects and higher amplitudes in women was observed. We saw no significant difference in latency or amplitude between phakic and pseudophakic eyes and between EF-P-ON/OFF-VEP and FF-P-ON/OFF-VEP.

CONCLUSIONS

A curved OLED visual stimulator is well suited to obtain VEP response curves with a reasonable interindividual variability. We found significant effects of age and gender in our responses but no effect of the lens status. EF-P-ON/OFF-VEP tends to show smaller amplitudes.

Clinical electrophysiology of the optic nerve and retinal ganglion cells

Clinical electrophysiological assessment of optic nerve and retinal ganglion cell function can be performed using the Pattern Electroretinogram (PERG), Visual Evoked Potential (VEP) and the Photopic Negative Response (PhNR) amongst other more specialised techniques. In this review, we describe these electrophysiological techniques and their application in diseases affecting the optic nerve and retinal ganglion cells with the exception of glaucoma. The disease groups discussed include hereditary, compressive, toxic/nutritional, traumatic, vascular, inflammatory and intracranial causes for optic nerve or retinal ganglion cell dysfunction. The benefits of objective, electrophysiological measurement of the retinal ganglion cells and optic nerve are discussed, as are their applications in clinical diagnosis of disease, determining prognosis, monitoring progression and response to novel therapies.

VEP and PERG in patients with multiple sclerosis, with and without a history of optic neuritis

PURPOSE

Visual electrophysiology is routinely used to detect the visual complications of multiple sclerosis, but the analysis mostly focuses on visual evoked potential (VEP) and especially the P100 component. Our goal was to analyze the components and waveform alterations of VEPs and pattern electroretinograms (PERGs) in patients with multiple sclerosis (MS) with good vision.

METHODS

The main VEP and PERG components of 85 patients with MS were analyzed in two groups: 38 patients who had optic neuritis in their history (ON group) and 47 patients who had never had optic neuritis (MS group). The results were compared against a control group of 47 healthy subjects.

RESULTS

Both VEP and PERG alterations occurred in a greater number of patients than expected, and these alterations were not necessarily linked to ON in the history or a deterioration of visual acuity.

CONCLUSIONS

Both VEP and PERG can detect dysfunction in the visual system in MS, even if the patient has no subjective symptoms. Even if PERG is not routinely used in neuro-ophthalmology, the results suggest that PERG assessment may provide useful information describing the retinal defect in MS.

The Development and Aging of the Magnocellular and Parvocellular Visual Pathways as Indicated by VEP Recordings between 5 and 84 Years of Age

It is well known that pattern reversal visual evoked potentials (VEPs) are age-sensitive. Through the use of this technique, it is possible to assess both of the major visual pathways (i.e., the magnocellular and parvocellular ones) in terms of function and development. What developmental path these pathways follow, and if they develop/age in parallel across the human lifespan is a matter of ongoing debate, yet, only a few VEP studies have dealt with this issue. This cross-sectional study examined a sample of 115 healthy volunteers aged 5 to 84 years. Beyond the standard checkerboard pattern reversal stimulation at 97% contrast, we recorded pattern-reversal VEPs at 6% contrast to selectively stimulate the M pathway and isoluminant red and green checkerboard stimulation was also used to selectively stimulate the P pathway. Our results do not support the developmental advantage of any of the pathways. The development of both pathways appear to take a remarkably long time (well into the 30s), and the signs of aging become marked over 50 years of age, especially in the case of the magnocellular pathway.

Double peaked P1 visual evoked potentials in healthy ageing

OBJECTIVES

To robustly examine the prevalence of the double peaked P1 visual evoked potential in healthy younger and older adult populations.

METHODS

The evoked potentials and spectral power changes to simple visual stimuli of 26 healthy younger (M=20.0 y) and 26 healthy older adults (M=76.0 y) were examined.

RESULTS

Group and individual analyses showed a clear effect of age on P1 morphology and amplitude. Older adults showed significantly lower P1 amplitude and 44% of older adults showed a double peaked P1 compared to 12% of younger adults. Double peaked P1 responses were associated with an increase in spectral power in the gamma range.

CONCLUSIONS

The double peaked P1 may be more prevalent in older adults than previously demonstrated and may represent a de-synchronisation of the cortical sources of the visual P1 in healthy ageing. Increased power in post stimulus gamma in the double peak group may be indicative of compensatory neural processing.

SIGNIFICANCE

Clinically the prevalence of the double peaked P1 may have been underestimated, and its reflectance of demyelinating disease overestimated. Experimentally the results suggest that any investigation of visual processing in older adults must control for early changes in P1 morphology.

Pattern VEP alterations in psoriatic patients may indicate a sub clinic optic neuritis

We examined 44 subject (Group A) of both sexes (27 males and 17 females) aging between 16 and 80 (average: 45+/-16.6), divided into age bands, affected by mild-medium psoriasis with PASI (psoriasis area and severity index) between 1.2 and 48.6 (average: 11.2+/-9.7) without any other disease and we performed pattern transient VEP (Visual Evoked Potential) at the frequencies usually used in clinical experience (73', 36', 18' check size). For a good statistic comparison we choose 55 healthy subjects (group B) divided into age bands on which we performed the same test. Comparison of VEP parameters between psoriatic and healthy subjects, showed in group A 10 normal (22.7%) and 34 pathological (77.3%). In the latter group there are 16 subjects who show only a P100 reduced amplitude (36.3%), 3 with only increased latency (6.8%), 15 with alterations of both values (34%). The achieved data show that more than 3/4 of group A subjects have VEP alterations as index of the presence of a sub clinic optic neuritis with a probably toxic autoimmune origin due to the action of TNFalpha, of IgG, of ECP or of other cytokines (IL6, IL7, etc) that are increased in the blood of this patients. The electro physiologic monitoring of optic nerve seems to represent a good routine test to evaluate the global conditions of psoriatic patients.