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Bardel B, Ayache SS, Lefaucheur JP. The contribution of EEG to assess and treat motor disorders in multiple sclerosis. Clin Neurophysiol 2024; 162:174-200. [PMID: 38643612 DOI: 10.1016/j.clinph.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE Electroencephalography (EEG) can highlight significant changes in spontaneous electrical activity of the brain produced by altered brain network connectivity linked to inflammatory demyelinating lesions and neuronal loss occurring in multiple sclerosis (MS). In this review, we describe the main EEG findings reported in the literature to characterize motor network alteration in term of local activity or functional connectivity changes in patients with MS (pwMS). METHODS A comprehensive literature search was conducted to include articles with quantitative analyses of resting-state EEG recordings (spectrograms or advanced methods for assessing spatial and temporal dynamics, such as coherence, theory of graphs, recurrent quantification, microstates) or dynamic EEG recordings during a motor task, with or without connectivity analyses. RESULTS In this systematic review, we identified 26 original articles using EEG in the evaluation of MS-related motor disorders. Various resting or dynamic EEG parameters could serve as diagnostic biomarkers of motor control impairment to differentiate pwMS from healthy subjects or be related to a specific clinical condition (fatigue) or neuroradiological aspects (lesion load). CONCLUSIONS We highlight some key EEG patterns in pwMS at rest and during movement, both suggesting an alteration or disruption of brain connectivity, more specifically involving sensorimotor networks. SIGNIFICANCE Some of these EEG biomarkers of motor disturbance could be used to design future therapeutic strategies in MS based on neuromodulation approaches, or to predict the effects of motor training and rehabilitation in pwMS.
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Affiliation(s)
- Benjamin Bardel
- Univ Paris Est Creteil, Excitabilité Nerveuse et Thérapeutique (ENT), EA 4391, F-94010 Creteil, France; AP-HP, Henri Mondor University Hospital, Department of Clinical Neurophysiology, DMU FIxIT, F-94010 Creteil, France
| | - Samar S Ayache
- Univ Paris Est Creteil, Excitabilité Nerveuse et Thérapeutique (ENT), EA 4391, F-94010 Creteil, France; AP-HP, Henri Mondor University Hospital, Department of Clinical Neurophysiology, DMU FIxIT, F-94010 Creteil, France; Gilbert and Rose-Marie Chagoury School of Medicine, Department of Neurology, 4504 Byblos, Lebanon; Institut de la Colonne Vertébrale et des NeuroSciences (ICVNS), Centre Médico-Chirurgical Bizet, F-75116 Paris, France
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, Excitabilité Nerveuse et Thérapeutique (ENT), EA 4391, F-94010 Creteil, France; AP-HP, Henri Mondor University Hospital, Department of Clinical Neurophysiology, DMU FIxIT, F-94010 Creteil, France.
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2
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Lechner-Scott J, Maltby V, Giovannoni G, Hawkes C, Levy M, Yeh A. Are we there yet? The holy grail: A biomarker for Multiple Sclerosis. Mult Scler Relat Disord 2023; 78:104998. [PMID: 37738709 DOI: 10.1016/j.msard.2023.104998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Affiliation(s)
- Jeannette Lechner-Scott
- John Hunter Hsopital, Hunter New England Local Health District, Newcastle, Australia; Immune Health Program, Hunter Medical Research Institute, Newcastle, Australia.
| | - Vicki Maltby
- John Hunter Hsopital, Hunter New England Local Health District, Newcastle, Australia; Immune Health Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Gavin Giovannoni
- Department of Neurology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Chris Hawkes
- Department of Neuroimmunology, Queen Mary University of London, United Kingdom
| | - Michael Levy
- Department of Neuroimmunology, Massachusetts General Hospital, Havard Medical School, Boston, USA
| | - Ann Yeh
- Department of Paediatrics (Neurology), The Hospital for SickKids, University of Toronto in Ontario, Canada
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3
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Pape A, Wellman LL, Conran RM. Educational Case: Multiple sclerosis. Acad Pathol 2022; 9:100036. [PMID: 35845179 PMCID: PMC9284444 DOI: 10.1016/j.acpath.2022.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 01/10/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022] Open
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Kunisawa K, Hatanaka N, Shimizu T, Kobayashi K, Osanai Y, Mouri A, Shi Q, Bhat MA, Nambu A, Ikenaka K. Focal loss of the paranodal domain protein Neurofascin155 in the internal capsule impairs cortically induced muscle activity in vivo. Mol Brain 2020; 13:159. [PMID: 33228720 PMCID: PMC7685608 DOI: 10.1186/s13041-020-00698-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/13/2020] [Indexed: 11/12/2022] Open
Abstract
Paranodal axoglial junctions are essential for rapid nerve conduction and the organization of axonal domains in myelinated axons. Neurofascin155 (Nfasc155) is a glial cell adhesion molecule that is also required for the assembly of these domains. Previous studies have demonstrated that general ablation of Nfasc155 disorganizes these domains, reduces conduction velocity, and disrupts motor behaviors. Multiple sclerosis (MS), a typical disorder of demyelination in the central nervous system, is reported to have autoantibody to Nfasc. However, the impact of focal loss of Nfasc155, which may occur in MS patients, remains unclear. Here, we examined whether restricted focal loss of Nfasc155 affects the electrophysiological properties of the motor system in vivo. Adeno-associated virus type5 (AAV5) harboring EGFP-2A-Cre was injected into the glial-enriched internal capsule of floxed-Neurofascin (NfascFlox/Flox) mice to focally disrupt paranodal junctions in the cortico-fugal fibers from the motor cortex to the spinal cord. Electromyograms (EMGs) of the triceps brachii muscles in response to electrical stimulation of the motor cortex were successively examined in these awake mice. EMG analysis showed significant delay in the onset and peak latencies after AAV injection compared to control (Nfasc+/+) mice. Moreover, EMG half-widths were increased, and EMG amplitudes were gradually decreased by 13 weeks. Similar EMG changes have been reported in MS patients. These findings provide physiological evidence that motor outputs are obstructed by focal ablation of paranodal junctions in myelinated axons. Our findings may open a new path toward development of a novel biomarker for an early phase of human MS, as Nfasc155 detects microstructural changes in the paranodal junction.
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Affiliation(s)
- Kazuo Kunisawa
- Division of Neurobiology and Bioinformatics, National Institute for Physiological Sciences, Okazaki, 444-8787, Japan
- Department of Physiological Sciences, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, 444-8787, Japan
- Department of Regulatory Science for Evaluation and Development of Pharmaceuticals and Devices, Fujita Health University Graduate School of Health Sciences, Toyoake, 470-1192, Japan
| | - Nobuhiko Hatanaka
- Department of Physiological Sciences, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, 444-8787, Japan.
- Division of System Neurophysiology, National Institute for Physiological Sciences, 38 Nishigonaka, Myodaiji, Okazaki, 444-8585, Japan.
| | - Takeshi Shimizu
- Division of Neurobiology and Bioinformatics, National Institute for Physiological Sciences, Okazaki, 444-8787, Japan
- Department of Physiological Sciences, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, 444-8787, Japan
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan
| | - Kenta Kobayashi
- Department of Physiological Sciences, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, 444-8787, Japan
- Section of Viral Vector Development, National Institute for Physiological Sciences, Okazaki, 444-8585, Japan
| | - Yasuyuki Osanai
- Division of Neurobiology and Bioinformatics, National Institute for Physiological Sciences, Okazaki, 444-8787, Japan
- Department of Physiological Sciences, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, 444-8787, Japan
| | - Akihiro Mouri
- Department of Regulatory Science for Evaluation and Development of Pharmaceuticals and Devices, Fujita Health University Graduate School of Health Sciences, Toyoake, 470-1192, Japan
| | - Qian Shi
- Department of Cellular and Integrative Physiology, School of Medicine, University of Texas Health Science Center, San Antonio, 78229-3900, USA
| | - Manzoor A Bhat
- Department of Cellular and Integrative Physiology, School of Medicine, University of Texas Health Science Center, San Antonio, 78229-3900, USA
| | - Atsushi Nambu
- Department of Physiological Sciences, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, 444-8787, Japan
- Division of System Neurophysiology, National Institute for Physiological Sciences, 38 Nishigonaka, Myodaiji, Okazaki, 444-8585, Japan
| | - Kazuhiro Ikenaka
- Division of Neurobiology and Bioinformatics, National Institute for Physiological Sciences, Okazaki, 444-8787, Japan
- Department of Physiological Sciences, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, 444-8787, Japan
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5
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Mamoei S, Hvid LG, Boye Jensen H, Zijdewind I, Stenager E, Dalgas U. Neurophysiological impairments in multiple sclerosis-Central and peripheral motor pathways. Acta Neurol Scand 2020; 142:401-417. [PMID: 32474916 DOI: 10.1111/ane.13289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/09/2020] [Accepted: 05/24/2020] [Indexed: 12/27/2022]
Abstract
A systematic review of the literature was conducted comparing neurophysiological outcomes in persons with multiple sclerosis (PwMS) to healthy controls (HC), in studies of the central nervous system (CNS) function comprising motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) and in studies of the peripheral nervous system (PNS) function comprising electroneuronography (ENG) outcomes elicited by peripheral nerve stimulation. Studies comparing neuromuscular function, assessed during maximal voluntary contraction (MVC) of muscle, were included if they reported muscle strength along with muscle activation by use of electromyography (EMG) and/or interpolated twitch technique (ITT). Studies investigating CNS function showed prolonged central motor conduction times, asymmetry of nerve conduction motor pathways, and prolonged latencies in PwMS when compared to HC. Resting motor threshold, amplitude, and cortical silent periods showed conflicting results. CNS findings generally correlated with disabilities. Studies of PNS function showed near significant prolongation in motor latency of the median nerve, reduced nerve conduction velocities in the tibial and peroneal nerves, and decreased compound muscle action potential amplitudes of the tibial nerve in PwMS. ENG findings did not correlate with clinical severity of disabilities. Studies of neuromuscular function showed lower voluntary muscle activation and increased central fatigue in PwMS, whereas EMG showed divergent muscle activation (ie, EMG amplitude) during MVC. When comparing the existing literature on neurophysiological motor examinations in PwMS and HC, consistent and substantial impairments of CNS function were seen in PwMS, whereas impairments of the PNS were less pronounced and inconsistent. In addition, impairments in muscle activation were observed in PwMS.
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Affiliation(s)
- Sepehr Mamoei
- Department of Regional Health Research University of Southern Denmark Odense Denmark
- Denmark/MS‐Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg) Department of Neurology University Hospital of Southern Jutland Sønderborg Denmark
| | - Lars G. Hvid
- Exercise Biology Department of Public Health Aarhus University Aarhus C Denmark
| | - Henrik Boye Jensen
- Department of Regional Health Research University of Southern Denmark Odense Denmark
- Department of Neurology Kolding Sygehus Kolding Denmark
| | - Inge Zijdewind
- Department of Biomedical Sciences of Cells and Systems UMCG University of Groningen Groningen The Netherlands
| | - Egon Stenager
- Department of Regional Health Research University of Southern Denmark Odense Denmark
- Denmark/MS‐Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg) Department of Neurology University Hospital of Southern Jutland Sønderborg Denmark
| | - Ulrik Dalgas
- Exercise Biology Department of Public Health Aarhus University Aarhus C Denmark
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6
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Yperman J, Becker T, Valkenborg D, Hellings N, Cambron M, Dive D, Laureys G, Popescu V, Van Wijmeersch B, Peeters LM. Deciphering the Morphology of Motor Evoked Potentials. Front Neuroinform 2020; 14:28. [PMID: 32765249 PMCID: PMC7381179 DOI: 10.3389/fninf.2020.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/26/2020] [Indexed: 11/13/2022] Open
Abstract
Motor Evoked Potentials (MEPs) are used to monitor disability progression in multiple sclerosis (MS). Their morphology plays an important role in this process. Currently, however, there is no clear definition of what constitutes a normal or abnormal morphology. To address this, five experts independently labeled the morphology (normal or abnormal) of the same set of 1,000 MEPs. The intra- and inter-rater agreement between the experts indicates they agree on the concept of morphology, but differ in their choice of threshold between normal and abnormal morphology. We subsequently performed an automated extraction of 5,943 time series features from the MEPs to identify a valid proxy for morphology, based on the provided labels. To do this, we compared the cross-validation performances of one-dimensional logistic regression models fitted to each of the features individually. We find that the approximate entropy (ApEn) feature can accurately reproduce the majority-vote labels. The performance of this feature is evaluated on an independent test set by comparing to the majority vote of the neurologists, obtaining an AUC score of 0.92. The model slightly outperforms the average neurologist at reproducing the neurologists consensus-vote labels. We can conclude that MEP morphology can be consistently defined by pooling the interpretations from multiple neurologists and that ApEn is a valid continuous score for this. Having an objective and reproducible MEP morphological abnormality score will allow researchers to include this feature in their models, without manual annotation becoming a bottleneck. This is crucial for large-scale, multi-center datasets. An exploratory analysis on a large single-center dataset shows that ApEn is potentially clinically useful. Introducing an automated, objective, and reproducible definition of morphology could help overcome some of the barriers that are currently obstructing broad adoption of evoked potentials in daily care and patient follow-up, such as standardization of measurements between different centers, and formulating guidelines for clinical use.
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Affiliation(s)
- Jan Yperman
- Theoretical Physics, Hasselt University, Diepenbeek, Belgium.,I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium.,BIOMED, Hasselt University, Diepenbeek, Belgium
| | - Thijs Becker
- Theoretical Physics, Hasselt University, Diepenbeek, Belgium.,I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Dirk Valkenborg
- I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Melissa Cambron
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Neurology, AZ Sint-Jan, Brugge, Belgium
| | | | - Guy Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - Veronica Popescu
- BIOMED, Hasselt University, Diepenbeek, Belgium.,Revalidation and MS Center Pelt, Pelt, Belgium
| | - Bart Van Wijmeersch
- BIOMED, Hasselt University, Diepenbeek, Belgium.,Revalidation and MS Center Pelt, Pelt, Belgium
| | - Liesbet M Peeters
- I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium.,BIOMED, Hasselt University, Diepenbeek, Belgium
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7
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Thompson AK, Sinkjær T. Can Operant Conditioning of EMG-Evoked Responses Help to Target Corticospinal Plasticity for Improving Motor Function in People With Multiple Sclerosis? Front Neurol 2020; 11:552. [PMID: 32765389 PMCID: PMC7381136 DOI: 10.3389/fneur.2020.00552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022] Open
Abstract
Corticospinal pathway and its function are essential in motor control and motor rehabilitation. Multiple sclerosis (MS) causes damage to the brain and descending connections, and often diminishes corticospinal function. In people with MS, neural plasticity is available, although it does not necessarily remain stable over the course of disease progress. Thus, inducing plasticity to the corticospinal pathway so as to improve its function may lead to motor control improvements, which impact one's mobility, health, and wellness. In order to harness plasticity in people with MS, over the past two decades, non-invasive brain stimulation techniques have been examined for addressing common symptoms, such as cognitive deficits, fatigue, and spasticity. While these methods appear promising, when it comes to motor rehabilitation, just inducing plasticity or having a capacity for it does not guarantee generation of better motor functions. Targeting plasticity to a key pathway, such as the corticospinal pathway, could change what limits one's motor control and improve function. One of such neural training methods is operant conditioning of the motor-evoked potential that aims to train the behavior of the corticospinal-motoneuron pathway. Through up-conditioning training, the person learns to produce the rewarded neuronal behavior/state of increased corticospinal excitability, and through iterative training, the rewarded behavior/state becomes one's habitual, daily motor behavior. This minireview introduces operant conditioning approach for people with MS. Guiding beneficial CNS plasticity on top of continuous disease progress may help to prolong the duration of maintained motor function and quality of life in people living with MS.
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Affiliation(s)
- Aiko K Thompson
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Thomas Sinkjær
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Lundbeck Foundation, Copenhagen, Denmark
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8
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Machine learning analysis of motor evoked potential time series to predict disability progression in multiple sclerosis. BMC Neurol 2020; 20:105. [PMID: 32199461 PMCID: PMC7085864 DOI: 10.1186/s12883-020-01672-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/02/2020] [Indexed: 11/25/2022] Open
Abstract
Background Evoked potentials (EPs) are a measure of the conductivity of the central nervous system. They are used to monitor disease progression of multiple sclerosis patients. Previous studies only extracted a few variables from the EPs, which are often further condensed into a single variable: the EP score. We perform a machine learning analysis of motor EP that uses the whole time series, instead of a few variables, to predict disability progression after two years. Obtaining realistic performance estimates of this task has been difficult because of small data set sizes. We recently extracted a dataset of EPs from the Rehabiliation & MS Center in Overpelt, Belgium. Our data set is large enough to obtain, for the first time, a performance estimate on an independent test set containing different patients. Methods We extracted a large number of time series features from the motor EPs with the highly comparative time series analysis software package. Mutual information with the target and the Boruta method are used to find features which contain information not included in the features studied in the literature. We use random forests (RF) and logistic regression (LR) classifiers to predict disability progression after two years. Statistical significance of the performance increase when adding extra features is checked. Results Including extra time series features in motor EPs leads to a statistically significant improvement compared to using only the known features, although the effect is limited in magnitude (ΔAUC = 0.02 for RF and ΔAUC = 0.05 for LR). RF with extra time series features obtains the best performance (AUC = 0.75±0.07 (mean and standard deviation)), which is good considering the limited number of biomarkers in the model. RF (a nonlinear classifier) outperforms LR (a linear classifier). Conclusions Using machine learning methods on EPs shows promising predictive performance. Using additional EP time series features beyond those already in use leads to a modest increase in performance. Larger datasets, preferably multi-center, are needed for further research. Given a large enough dataset, these models may be used to support clinicians in their decision making process regarding future treatment.
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9
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Vural G, Gümüşyayla Ş, Deniz O, Neşelioğlu S, Erel Ö. Relationship between thiol-disulphide homeostasis and visual evoked potentials in patients with multiple sclerosis. Neurol Sci 2018; 40:385-391. [PMID: 30506120 DOI: 10.1007/s10072-018-3660-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/23/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine the thiol-disulphide homeostasis during an optic neuritis episode in patients with multiple sclerosis and the relationship between this homeostasis and P100 wave latency. MATERIALS AND METHOD Visual evoked potential reviews of multiple sclerosis patients who presented with an optic neuritis episode were conducted and P100 latencies were measured. Peripheral blood samples were collected from all patients. Native thiol and total thiol concentrations were measured with the automated method that was recently developed. Their amount of disulphide bonds, disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios were calculated. The relationship between P100 latency and thiol-disulphide homeostasis was investigated. RESULTS A significant positive correlation was determined between the disulphide/native thiol ratio and both mean P100 latency and maximum P100 latency (p = 0.021, r = 0.136; p = 0.030, r = 0.177, respectively). DISCUSSION As the balance of the plasma dominated by antioxidants moves towards the oxidant side, in other words as a higher rate of thiol is oxidised from the thiol pool, P100 latency is extended. N-acetylcysteine and alpha lipoic acid as well as thiol supplements can improve the thiol-disulphide balance, reinforce antioxidant defence and it can help in slowing down the demyelinating damage.
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Affiliation(s)
- Gönül Vural
- Department of Neurology, Faculty of Medicine, Yıldırım Beyazıt University, 06800, Ankara, Turkey.
| | - Şadiye Gümüşyayla
- Department of Neurology, Faculty of Medicine, Yıldırım Beyazıt University, 06800, Ankara, Turkey
| | - Orhan Deniz
- Department of Neurology, Faculty of Medicine, Yıldırım Beyazıt University, 06800, Ankara, Turkey
| | - Salim Neşelioğlu
- Department of Clinical Biochemistry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Özcan Erel
- Department of Clinical Biochemistry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Operant Up-Conditioning of the Tibialis Anterior Motor-Evoked Potential in Multiple Sclerosis: Feasibility Case Studies. Neural Plast 2018; 2018:4725393. [PMID: 30123249 PMCID: PMC6079394 DOI: 10.1155/2018/4725393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/12/2018] [Indexed: 11/18/2022] Open
Abstract
Damage to the corticospinal pathway often results in weak dorsiflexion of the ankle, thereby limiting the mobility of people with multiple sclerosis (MS). Thus, strengthening corticospinal connectivity may improve locomotion. Here, we investigated the feasibility of tibialis anterior (TA) motor-evoked potential (MEP) operant conditioning and whether it can enhance corticospinal excitability and alleviate locomotor problems in people with chronic stable MS. The protocol consisted of 6 baseline and 24 up-conditioning sessions over 10 weeks. In all sessions, TA MEPs were elicited at 10% above active threshold while the sitting subject provided 30–35% maximum voluntary contraction (MVC) level of TA background EMG. During baseline sessions, MEPs were simply measured. During conditioning trials of the conditioning sessions, the subject was encouraged to increase MEP and was given immediate feedback indicating whether MEP size was above a criterion. In 3/4 subjects, TA MEP increased 32–75%, MVC increased 28–52%, locomotor EMG modulation improved in multiple leg muscles, and foot drop became less severe. In one of them, MEP and MVC increases were maintained throughout 3 years of extensive follow-up sessions. These initial results support a therapeutic possibility of MEP operant conditioning for improving locomotion in people with MS or other CNS disorders, such as spinal cord injury and stroke.
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11
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Peeters LM, Vanheusden M, Somers V, Van Wijmeersch B, Stinissen P, Broux B, Hellings N. Cytotoxic CD4+ T Cells Drive Multiple Sclerosis Progression. Front Immunol 2017; 8:1160. [PMID: 28979263 PMCID: PMC5611397 DOI: 10.3389/fimmu.2017.01160] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/01/2017] [Indexed: 12/27/2022] Open
Abstract
Multiple sclerosis (MS) is the leading cause of chronic neurological disability in young adults. The clinical disease course of MS varies greatly between individuals, with some patients progressing much more rapidly than others, making prognosis almost impossible. We previously discovered that cytotoxic CD4+ T cells (CD4+ CTL), identified by the loss of CD28, are able to migrate to sites of inflammation and that they contribute to tissue damage. Furthermore, in an animal model for MS, we showed that these cells are correlated with inflammation, demyelination, and disability. Therefore, we hypothesize that CD4+ CTL drive progression of MS and have prognostic value. To support this hypothesis, we investigated whether CD4+ CTL are correlated with worse clinical outcome and evaluated the prognostic value of these cells in MS. To this end, the percentage of CD4+CD28null T cells was measured in the blood of 176 patients with relapsing-remitting MS (=baseline). Multimodal evoked potentials (EP) combining information on motoric, visual, and somatosensoric EP, as well as Kurtzke expanded disability status scale (EDSS) were used as outcome measurements at baseline and after 3 and 5 years. The baseline CD4+CD28null T cell percentage is associated with EP (P = 0.003, R2 = 0.28), indicating a link between these cells and disease severity. In addition, the baseline CD4+CD28null T cell percentage has a prognostic value since it is associated with EP after 3 years (P = 0.005, R2 = 0.29) and with EP and EDSS after 5 years (P = 0.008, R2 = 0.42 and P = 0.003, R2 = 0.27). To the best of our knowledge, this study provides the first direct link between the presence of CD4+ CTL and MS disease severity, as well as its prognostic value. Therefore, we further elaborate on two important research perspectives: 1° investigating strategies to block or reverse pathways in the formation of these cells resulting in new treatments that slow down MS disease progression, 2° including immunophenotyping in prediction modeling studies to aim for personalized medicine.
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Affiliation(s)
- Liesbet M. Peeters
- School of Life Sciences, Biomedical Research Institute, Hasselt University, Transnationale Universiteit Limburg, Diepenbeek, Belgium
| | - Marjan Vanheusden
- School of Life Sciences, Biomedical Research Institute, Hasselt University, Transnationale Universiteit Limburg, Diepenbeek, Belgium
| | - Veerle Somers
- School of Life Sciences, Biomedical Research Institute, Hasselt University, Transnationale Universiteit Limburg, Diepenbeek, Belgium
| | - Bart Van Wijmeersch
- School of Life Sciences, Biomedical Research Institute, Hasselt University, Transnationale Universiteit Limburg, Diepenbeek, Belgium
| | - Piet Stinissen
- School of Life Sciences, Biomedical Research Institute, Hasselt University, Transnationale Universiteit Limburg, Diepenbeek, Belgium
| | - Bieke Broux
- School of Life Sciences, Biomedical Research Institute, Hasselt University, Transnationale Universiteit Limburg, Diepenbeek, Belgium
| | - Niels Hellings
- School of Life Sciences, Biomedical Research Institute, Hasselt University, Transnationale Universiteit Limburg, Diepenbeek, Belgium
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Genç G, Demirkaya Ş, Bek S, Odabaşi Z. Clinical, Radiological and Electrophysiological Comparison of Immunomodulatory Therapies in Multiple Sclerosis. Noro Psikiyatr Ars 2016; 54:116-124. [PMID: 28680308 DOI: 10.5152/npa.2016.12621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/18/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Although it has been shown that immunomodulatory therapies (IMTs) in multiple sclerosis (MS) can modify the course of the disease by reducing the relapse rate and delaying the progression of disability, no study comparing IMTs head-to-head in terms of clinical, radiological, and electrophysiological changes is available. We aimed to investigate the effects of interferon-beta (IFN-B) 1b, IFN-B-1a subcutaneous (sc), IFN-B-1a intramuscular (im), and glatiramer acetate (GA) therapies on clinical, electrophysiological, and radiological findings. METHODS We studied a cohort of 85 MS patients who were followed up for at least 2 years and had complete charting, including pre-treatment and post-treatment clinical, radiological, and electrophysiological findings. We compared the IMTs' effects on these findings retrospectively. RESULTS Annual relapse rates were 0.1 for IFN-B-1a sc, 0.2 for IFN-B-1b, 0.3 for GA, and 0.5 for IFN-B-1 a im (p=0.01). The percentages of relapse-free patients after one year were 54.5% for IFN-B-1a im and GA, 82.9% for IFN-B-1a sc, and 86.4% for IFN-B-1b, and after two years the percentages were 27.3% for IFN-B-1a im, 54.5% for GA, 72.7% for IFN-B-1b, and 78% for IFN-B-1a sc (p<0.05). Disability scores after 2 years increased for IFN-B-1a im, decreased for IFN-B-1a sc (with a 0.1-point increase compared to the first year), and did not change for IFN-B-1b or GA compared to before treatment. Within the 2-year treatment period, no significant increase in the number of magnetic resonance T2 lesions was observed. No significant differences were found for any of the therapies in terms of evoked potentials. CONCLUSION Our results revealed that high dose and more frequent regimens were more effective in terms of reducing the relapse rate, whereas there were no differences in terms of efficacy on radiological and electrophysiological findings between groups. Additional prospective studies comparing the efficacy of IMTs on MS are needed.
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Affiliation(s)
- Gençer Genç
- Department of Neurology, Gümüşsuyu Military Hospital, İstanbul, Turkey
| | - Şeref Demirkaya
- Department of Neurology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Semai Bek
- Department of Neurology, Başkent University Adana Practicing and Research Center, Adana, Turkey
| | - Zeki Odabaşi
- Department of Neurology, Gülhane Training and Research Hospital, Ankara, Turkey
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Neva JL, Lakhani B, Brown KE, Wadden KP, Mang CS, Ledwell NHM, Borich MR, Vavasour IM, Laule C, Traboulsee AL, MacKay AL, Boyd LA. Multiple measures of corticospinal excitability are associated with clinical features of multiple sclerosis. Behav Brain Res 2016; 297:187-95. [PMID: 26467603 PMCID: PMC4904787 DOI: 10.1016/j.bbr.2015.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/04/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
In individuals with multiple sclerosis (MS), transcranial magnetic stimulation (TMS) may be employed to assess the integrity of corticospinal system and provides a potential surrogate biomarker of disability. The purpose of this study was to provide a comprehensive examination of the relationship between multiple measures corticospinal excitability and clinical disability in MS (expanded disability status scale (EDSS)). Bilateral corticospinal excitability was assessed using motor evoked potential (MEP) input-output (IO) curves, cortical silent period (CSP), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF) and transcallosal inhibition (TCI) in 26 individuals with MS and 11 healthy controls. Measures of corticospinal excitability were compared between individuals with MS and controls. We evaluated the relationship(s) between age and clinical demographics such as age at MS onset (AO), disease duration (DD) and clinical disability (EDSS) with measures of corticospinal excitability. Corticospinal excitability thresholds were higher, MEP latency and CSP onset delayed and MEP durations prolonged in individuals with MS compared to controls. Age, DD and EDSS correlated with corticospinal excitability thresholds. Also, TCI duration and the linear slope of the MEP amplitude IO curve correlated with EDSS. Hierarchical regression modeling demonstrated that combining multiple TMS-based measures of corticospinal excitability accounted for unique variance in clinical disability (EDSS) beyond that of clinical demographics (AO, DD). Our results indicate that multiple TMS-based measures of corticospinal and interhemispheric excitability provide insights into the potential neural mechanisms associated with clinical disability in MS. These findings may aid in the clinical evaluation, disease monitoring and prediction of disability in MS.
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Affiliation(s)
- J L Neva
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - B Lakhani
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - K E Brown
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - K P Wadden
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - C S Mang
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - N H M Ledwell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M R Borich
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - I M Vavasour
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada
| | - C Laule
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada; Department of Pathology & Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - A L Traboulsee
- Division of Neurology, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - A L MacKay
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada; Department of Physics & Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - L A Boyd
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Simpson M, Macdonell R. The use of transcranial magnetic stimulation in diagnosis, prognostication and treatment evaluation in multiple sclerosis. Mult Scler Relat Disord 2015; 4:430-436. [PMID: 26346791 DOI: 10.1016/j.msard.2015.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/10/2015] [Accepted: 06/22/2015] [Indexed: 11/26/2022]
Abstract
Despite advances in brain imaging which have revolutionised the diagnosis and monitoring of patients with Multiple Sclerosis (MS), current imaging techniques have limitations, including poor correlation with clinical disability and prognosis. There is growing evidence that electrophysiological techniques may provide complementary functional information which can aid in diagnosis, prognostication and perhaps even monitoring of treatment response in patients with MS. Transcranial magnetic stimulation (TMS) is an underutilised technique with potential to assist diagnosis, predict prognosis and provide an objective surrogate marker of clinical progress and treatment response. This review explores the existing body of evidence relating to the use of TMS in patients with MS, outlines the practical aspects and scope of TMS testing and reviews the current evidence relating to the use of TMS in diagnosis, disease classification, prognostication and response to symptomatic and disease-modifying therapies.
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Affiliation(s)
- Marion Simpson
- Department of Neurology, Austin Health and Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia.
| | - Richard Macdonell
- Department of Neurology, Austin Health and Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia
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15
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Some neuropsychiatric and MRI manifestations in patients with multiple sclerosis. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000458885.02819.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Comparison of neurophysiological and MRI findings of patients with multiple sclerosis using oligoclonal band technique. Ann Neurosci 2014; 20:149-54. [PMID: 25206039 PMCID: PMC4117134 DOI: 10.5214/ans.0972.7531.200406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/28/2013] [Accepted: 11/28/2013] [Indexed: 12/13/2022] Open
Abstract
Background The correlation of oligoclonal bands (OCBs) and intrathecal IgG synthesis are not yet clear in multiple sclerosis (MS). Purpose In this study, we investigated the OCB situation and IgG index, cranial and cervical magnetic resonance imaging (MRI) findings and also compared visual evoked potentials (VEP) and somatosensorial evoked potentials (SEP) in order to better understand the OCB pattern and pathogenesis. Methods Retrospective study included 40 patients (19 male, 21 female, mean age 29 ± 4,24) with precise MS diagnosis according to McDonald criteria. Result Sixteen of the patients were OCB negative, and 24 patients were positive. The different between the OCB situation and number of plaques in cranial and cervical MRI, atrophy, oedema and contrast material retention were insignificant. The different between the OCB situation and VEP and SEP were insignificant. Conclusion These laboratory findings are all specific, all developing via independent mechanisms and are not related to each other during the silence periods of patients.
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17
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Brown KE, Neva JL, Ledwell NM, Boyd LA. Use of transcranial magnetic stimulation in the treatment of selected movement disorders. Degener Neurol Neuromuscul Dis 2014; 4:133-151. [PMID: 32669907 PMCID: PMC7337234 DOI: 10.2147/dnnd.s70079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/23/2014] [Indexed: 11/23/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a valuable technique for assessing the underlying neurophysiology associated with various neuropathologies, and is a unique tool for establishing potential neural mechanisms responsible for disease progression. Recently, repetitive TMS (rTMS) has been advanced as a potential therapeutic technique to treat selected neurologic disorders. In healthy individuals, rTMS can induce changes in cortical excitability. Therefore, targeting specific cortical areas affected by movement disorders theoretically may alter symptomology. This review discusses the evidence for the efficacy of rTMS in Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, and multiple sclerosis. It is hoped that gaining a more thorough understanding of the timing and parameters of rTMS in individuals with neurodegenerative disorders may advance both clinical care and research into the most effective uses of this technology.
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Affiliation(s)
| | - Jason L Neva
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Lara A Boyd
- Graduate Program in Rehabilitation Science.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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18
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Ehler J, Koball S, Sauer M, Hickstein H, Mitzner S, Benecke R, Zettl UK. Therapeutic Plasma Exchange in Glucocorticosteroid-Unresponsive Patients With Clinically Isolated Syndrome. Ther Apher Dial 2014; 18:489-96. [DOI: 10.1111/1744-9987.12176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Johannes Ehler
- Department of Anaesthesiology and Intensive Care Medicine; University of Rostock; Rostock Germany
- Department of Neurology; University of Rostock; Rostock Germany
| | - Sebastian Koball
- Division of Nephrology; Department of Internal Medicine; University of Rostock; Rostock Germany
| | - Martin Sauer
- Department of Anaesthesiology and Intensive Care Medicine; University of Rostock; Rostock Germany
| | - Heiko Hickstein
- Division of Nephrology; Department of Internal Medicine; University of Rostock; Rostock Germany
| | - Steffen Mitzner
- Division of Nephrology; Department of Internal Medicine; University of Rostock; Rostock Germany
| | - Reiner Benecke
- Department of Neurology; University of Rostock; Rostock Germany
| | - Uwe K Zettl
- Department of Neurology; University of Rostock; Rostock Germany
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19
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Short interval intracortical facilitation correlates with the degree of disability in multiple sclerosis. Brain Stimul 2013; 6:67-71. [DOI: 10.1016/j.brs.2012.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/23/2012] [Accepted: 02/06/2012] [Indexed: 11/19/2022] Open
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Abstract
No single test to diagnose multiple sclerosis is available, and its cause is unknown. The diagnosis relies on recognition of the clinical patterns of the disease as well as exclusion of other possible mimics. Waxing and waning neurologic deficits that localize to the CNS are the hallmark of the disease in most patients. The diagnosis can be supported by laboratory studies, including MRI of the brain and spinal cord, analysis of CSF, and evoked-potential studies of the visual and somatosensory pathways.
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21
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Ocular and cervical vestibular evoked myogenic potentials in multiple sclerosis patients. Clin Neurophysiol 2012; 123:1872-9. [DOI: 10.1016/j.clinph.2012.01.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 11/24/2022]
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22
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Margaritella N, Mendozzi L, Garegnani M, Nemni R, Colicino E, Gilardi E, Pugnetti L. Exploring the predictive value of the evoked potentials score in MS within an appropriate patient population: a hint for an early identification of benign MS? BMC Neurol 2012; 12:80. [PMID: 22913733 PMCID: PMC3488473 DOI: 10.1186/1471-2377-12-80] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/31/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prognostic value of evoked potentials (EPs) in multiple sclerosis (MS) has not been fully established. The correlations between the Expanded Disability Status Scale (EDSS) at First Neurological Evaluation (FNE) and the duration of the disease, as well as between EDSS and EPs, have influenced the outcome of most previous studies. To overcome this confounding relations, we propose to test the prognostic value of EPs within an appropriate patient population which should be based on patients with low EDSS at FNE and short disease duration. METHODS We retrospectively selected a sample of 143 early relapsing remitting MS (RRMS) patients with an EDSS < 3.5 from a larger database spanning 20 years. By means of bivariate logistic regressions, the best predictors of worsening were selected among several demographic and clinical variables. The best multivariate logistic model was statistically validated and prospectively applied to 50 patients examined during 2009-2011. RESULTS The Evoked Potentials score (EP score) and the Time to EDSS 2.0 (TT2) were the best predictors of worsening in our sample (Odds Ratio 1.10 and 0.82 respectively, p=0.001). Low EP score (below 15-20 points), short TT2 (lower than 3-5 years) and their interaction resulted to be the most useful for the identification of worsening patterns. Moreover, in patients with an EP score at FNE below 6 points and a TT2 greater than 3 years the probability of worsening was 10% after 4-5 years and rapidly decreased thereafter. CONCLUSIONS In an appropriate population of early RRMS patients, the EP score at FNE is a good predictor of disability at low values as well as in combination with a rapid buildup of disability. Interestingly, an EP score at FNE under the median together with a clinical stability lasting more than 3 years turned out to be a protective pattern. This finding may contribute to an early identification of benign patients, well before the term required to diagnose Benign MS (BMS).
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Affiliation(s)
- Nicolò Margaritella
- Laboratory of Clinical Neurophysiology, Scientific Institute (IRCCS) S, Maria Nascente, don C. Gnocchi Foundation, Via Capecelatro 66, Milan, 20148, Italy
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23
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Taşdemir N, Karaca EE, Ece A, Yücel Y, Dikici S, Taşdemir MS. Multiple Sclerosis: Relationships Between Cytokines, MRI Lesion Burden, Visual Evoked Potentials and Disability Scores. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2010. [DOI: 10.29333/ejgm/82845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Garcea O, Villa A, Cáceres F, Adoni T, Alegría M, Barbosa Thomaz R, Buzo R, Llamas López L, Rivera Kindel M. Early treatment of multiple sclerosis: a Latin American experts meeting. Mult Scler 2010; 15 Suppl 3:S1-S12. [PMID: 19965556 DOI: 10.1177/1352458509106419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with clinically isolated syndrome (CIS) by definition do not have multiple sclerosis (MS) but are at risk of developing it. While studies show earlier immunomodulating drug use is effective, treatment must consider likely patient prognosis. In this paper we review current diagnosis, prognosis, and treatment literature for patients with CIS within Latin American clinical settings. Latin American MS experts, convened by ACINDES (The Civil Association for Research and Development in Health), reviewed current CIS (and early MS) literature and drew consensus conclusions. Three subgroups addressed separate questionnaires on CIS issues: prognosis, diagnosis, and treatment. MRI can contribute to predicting MS risk in patients with CIS; in Latin America, investigation of haplotype presence associated with CIS would be appropriate. McDonald's criteria and subsequent revisions enable earlier, more accurate MS diagnosis. Type A evidence exists supporting all leading immunomodulating MS drugs for effective treatment of CIS with a high risk of conversion to MS. In conclusion, patients with CIS are usually young, with often-limited symptomatic manifestations, and must be adequately prepared to receive preventive treatment. This consensus review should contribute to the dialogue between physicians and patients.
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Affiliation(s)
- O Garcea
- Clinical Neuroimmunology and Multiple Sclerosis. Hospital Ramos Mejía, University Center of Neurology, School of Medicine. Buenos Aires University. Urquiza 609 (1221), Buenos Aires, Argentina.
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Kale N, Agaoglu J, Onder G, Tanik O. Correlation between disability and transcranial magnetic stimulation abnormalities in patients with multiple sclerosis. J Clin Neurosci 2009; 16:1439-42. [DOI: 10.1016/j.jocn.2009.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 03/11/2009] [Accepted: 03/30/2009] [Indexed: 01/23/2023]
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26
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Kale N, Agaoglu J, Tanik O. Electrophysiological and clinical correlates of corpus callosum atrophy in patients with multiple sclerosis. Neurol Res 2009; 32:886-90. [PMID: 19825276 DOI: 10.1179/016164109x12445616596526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Multiple sclerosis (MS) is an idiopathic inflammatory demyelinating disorder of the central nervous system (CNS) characterized by demyelination and axonal degeneration. Corpus callosum (CC) is commonly involved during the disease process leading to atrophy (93%). Currently, there are no established markers of disease progression and the interplay of processes leading to brain atrophy in MS remains unknown. The primary aim of this study was to assess the frequency of CC atrophy in MS patients. Furthermore, the relationship between expanded disability status scale (EDSS) and transcranial magnetic stimulation (TMS) evoked motor potentials (MEP) were assessed to capture disease effects by independent parameters. Seventy-nine MS patients and 50 controls were included and their CC volumes were assessed. Out of 79 patients, 31 patients (39·2%) had CC atrophy. The distribution of EDSS scores among the group with CC atrophy [13 (32%) patients with EDSS 0-2; 11 (58%) patients with EDSS 2-4; 19 (24%) patients with EDSS ≥4] was not statistically significant (p>0·05). MEP latency was abnormal in 34 (43%) patients, 67 (85%) patients had abnormal MEP amplitude and CMCT was abnormal in 32 (41%) patients. The relation between EDSS and MEP was statistically significant among the patient population including the subgroup of patients with CC atrophy (p<0.05). Our results lacked to provide an association between disability and CC atrophy, but there was a correlation between CC atrophy and TMS evoked motor potentials. Early evolution of axonal degeneration and brain atrophy should be considered in terms of follow-up measures to provide long-term efficiency impacting disability, progression and brain atrophy.
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Affiliation(s)
- N Kale
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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27
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Increasing the Diagnostic Value of Evoked Potentials in Multiple Sclerosis by Quantitative Topographic Analysis of Multichannel Recordings. J Clin Neurophysiol 2009; 26:316-25. [DOI: 10.1097/wnp.0b013e3181baac00] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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28
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Conte A, Lenzi D, Frasca V, Gilio F, Giacomelli E, Gabriele M, Marini Bettolo C, Iacovelli E, Pantano P, Pozzilli C, Inghilleri M. Intracortical excitability in patients with relapsing–remitting and secondary progressive multiple sclerosis. J Neurol 2009; 256:933-8. [DOI: 10.1007/s00415-009-5047-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 01/15/2009] [Accepted: 01/20/2009] [Indexed: 11/30/2022]
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29
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Nociti V, Batocchi AP, Bartalini S, Caggiula M, Patti F, Profice P, Quattrone A, Tonali P, Ulivelli M, Valentino P, Virdis D, Zappia M, Padua L. Somatosensory evoked potentials reflect the upper limb motor performance in multiple sclerosis. J Neurol Sci 2008; 273:99-102. [PMID: 18684472 DOI: 10.1016/j.jns.2008.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 03/27/2008] [Accepted: 06/25/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this multicentric study was to multidimensionally evaluate the relationship among somatosensory evoked potentials (SEPs) parameters, patient's perspective and clinical measures of the upper limb impairment in patients with multiple sclerosis (MS). METHODS We consecutively enrolled 39 MS patients. For median nerve SEPs we acquired the N9, P14, N20 responses and the N9-P14 and P14-N20 interpeak latencies on the dominant side. We also used a validated patient-oriented questionnaire (Disabilities of the Arm, Shoulder and Hand - DASH) and a test of dexterity quantification as the 9-Hole Peg Test (9-HPT). RESULTS A significant longer time to complete the 9-HPT (p<0.00006) was observed in patients with abnormal SEPs. Patients with undetectable N20 or P14 responses performed the 9-HPT in a significant longer time than patients with detectable responses (p<0.0006 and p<0.001 respectively). Concerning the perspective of patient (evaluated with the DASH questionnaire) significant differences in patients with undetectable P14 response (p<0.01) were observed. CONCLUSIONS Our data provide further information useful for interpretation of SEPs results, being the median nerve SEPs related to the upper limb performance in MS patients. SIGNIFICANCE These data increase the significance of SEPs both in clinical practice and in experimental studies in MS.
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Affiliation(s)
- Viviana Nociti
- Institute of Neurology, Catholic University, Roma, Italy
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30
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Vázquez-Marrufo M, González-Rosa JJ, Vaquero E, Duque P, Escera C, Borges M, Izquierdo G, Gómez CM. Abnormal ERPs and high frequency bands power in multiple sclerosis. Int J Neurosci 2008; 118:27-38. [PMID: 18041604 DOI: 10.1080/00207450601041906] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Event-related potentials (ERPs) and power spectral density (PSD) were registered during an auditory-oddball paradigm in 11 MS patients. These patients showed a decrease in the amplitude of P2 and N2 components and a delayed P3 latency compared to control subjects suggesting that the attentional orienting mechanism in the auditory modality is affected in MS. The PSD analysis showed that MS patients exhibited an increased power in beta and gamma bands. The combined analysis of frequency and time domain suggested diverse phenomena that occurred in the MS patient group related with the EEG background or the motivational status.
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Affiliation(s)
- M Vázquez-Marrufo
- Psychobiology Lab, Department of Experimental Psychology, University of Seville, Seville, Spain.
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Gagliardo A, Galli F, Grippo A, Amantini A, Martinelli C, Amato MP, Borsini W. Motor evoked potentials in multiple sclerosis patients without walking limitation: amplitude vs. conduction time abnormalities. J Neurol 2007; 254:220-7. [PMID: 17308868 DOI: 10.1007/s00415-006-0334-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2005] [Accepted: 04/05/2006] [Indexed: 10/23/2022]
Abstract
We used Motor Evoked Potentials (MEPs), elicited by transcranial magnetic stimulation, for assessing a motor pathways dysfunction in a selected group of Multiple Sclerosis (MS) patients, without limitation in walking. We selected 32 Relapsing Remitting MS patients, in remission phase, with EDSS < or = 3.5 and 20 healthy individuals with similar height and age distribution. We measured the following MEP parameters: motor thresholds; central motor conduction time (CMCT); amplitude and area, both expressed as MEP/CMAP ratio. Patients were divided into two groups according to the EDSS score: non-disabled group (ND; EDSS 0-1.5) and disabled group (D; EDSS 2-3.5). Mean average MEP values were significantly different in the patients compared with the controls. Even in MS patients with no or minor neurological signs (ND group), MEP parameters showed differences from controls and furthermore all MEP parameters were significantly different in the D group compared with the ND group. The 75% of the patients had an amplitude or area alteration; this percentage was significantly higher than the percentage of patients with a CMCT alteration (56.2%). In addition, CMCT increase was always associated with reduced amplitude and area, but amplitude and area alterations were present also in patients with normal CMCT. In early stages of MS, the higher percentage shown in alteration of MEP amplitudes and areas as opposed to CMCTs has not previously been highlighted in the literature. Independently of its pathogenesis (demyelination or axonal loss), the amplitude or area decrease should be considered in clinical trials and in follow-up studies, as a marker of the motor pathways dysfunction, at least as much as CMCT increase.
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Affiliation(s)
- Andrea Gagliardo
- Clinical Neurophysiology Unit, Department of Neurological and Psychiatric Sciences, Careggi Hospital, University of Florence, Viale Morgagni 85, 50100 Florence, Italy.
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Feuillet L, Pelletier J, Suchet L, Rico A, Ali Cherif A, Pouget J, Attarian S. Prospective clinical and electrophysiological follow-up on a multiple sclerosis population treated with interferon beta-1 a. Mult Scler 2007; 13:348-56. [PMID: 17439904 DOI: 10.1177/1352458506070235] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To analyse transcranial magnetic stimulation (TMS) variables in a prospective six-month follow-up pilot study on patients suffering from relapsing-remitting multiple sclerosis (RRMS), satisfying inclusion criteria for interferon (IFN) beta-1a treatment. Background So far, no predictive factors are available as to the course of RRMS treated with IFN beta-1 a. Design/methods Fifteen RRMS patients were studied before (month 0 (M0)) and after IFN beta-1a onset (M3, M6). The parameters analysed were motor functional score (mFS), Expanded Disability Status Scale (EDSS), and TMS variables - central motor conduction time (CMCT) and amplitude ratio (AR). Results Four of the six patients with no motor signs at inclusion, subsequently showed signs of pyramidal dysfunction. All had abnormal M0_TMS variables. The number of M0_TMS abnormalities per patient was greatest in the group that showed mFS worsening, and was significantly correlated with M6_EDSS. The M0_CMCT was significantly correlated with M6_EDSS. During follow-up, the number of patients with abnormal TMS variables decreased from 12/15 to 4/15, and the total number of abnormalities decreased from 33.3 to 16.7%. Conclusions TMS variables might be predictive of disease progression. The improvement observed here in the TMS variables may reflect an improvement in MS patients undergoing IFN beta treatment. Multiple Sclerosis 2007; 13: 348-356. http://msj.sagepub.com
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Affiliation(s)
- L Feuillet
- Department of Neurology, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de La Timone, Marseille, France.
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Chang KH, Lyu RK, Chen CM, Hsu WC, Wu YR, Chen ST, Ro LS. Clinical characteristics of multiple sclerosis in Taiwan: a cross-sectional study. Mult Scler 2006; 12:501-6. [PMID: 16900765 DOI: 10.1191/1352458506ms1297oa] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study reviewed the clinical characteristics of multiple sclerosis (MS) in Taiwanese patients from 1993 to 2001. Of the 75 MS patients with a mean age of onset of 35.6 +/- 12.6 years, the female-to-male ratio was 4.4 (61/14). In 42 (56%) optico-spinal MS (OS-MS) patients, the age of onset (37.6 +/- 11.1 years) tended to be older than conventional MS (C-MS) patients (33.1 +/- 14.1 years, P = 0.08). In 60 cerebrospinal fluid (CSF) specimens, raised IgG index (>0.7) and oligoclonal bands were noted in 26 (43.3%) and two (3.3%) cases, respectively. The frequency of raised IgG index was lower in OS-MS (31.3%) than in C-MS (57.1%, P = 0.07). The CSF total protein concentrations were significantly higher in OS-MS (64.5 mg/dL) than in C-MS (46.6 mg/dL, P = 0.047). The mean annual relapse rate was 54.1%, and was significantly higher within the first year (59.7%, P < 0.001). The mean annual relapse rate in OS-MS (62.7%) was significantly higher than in C-MS (41.2%, P=0.01). The differences in the annual relapse rate and total protein concentration in CSF between OS-MS and C-MS suggest probably two distinct immunopathogenesis. The higher first year relapse rate of MS patients in Taiwan may address the importance of early intervention with immunomodulatory therapy.
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Affiliation(s)
- K H Chang
- Section of Neuromuscular Diseases, Department of Neurology, Chang Gung Memorial Hospital and University, Taipei, Taiwan 10591
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Gonzalez-Rosa JJ, Vazquez-Marrufo M, Vaquero E, Duque P, Borges M, Gamero MA, Gomez CM, Izquierdo G. Differential cognitive impairment for diverse forms of multiple sclerosis. BMC Neurosci 2006; 7:39. [PMID: 16712715 PMCID: PMC1481616 DOI: 10.1186/1471-2202-7-39] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 05/19/2006] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cognitive impairment is a common feature in multiple sclerosis (MS) patients and occurs in 60% of all cases. Unfortunately, neurological examination does not always agree with the neuropsychological evaluation in determining the cognitive profile of the patient. On the other hand, psychophysiological techniques such as event-related potentials (ERPs) can help in evaluating cognitive impairment in different pathologies. Behavioural responses and EEG signals were recorded during the experiment in three experimental groups: 1) a relapsing-remitting group (RRMS), 2) a benign multiple sclerosis group (BMS) and 3) a Control group. The paradigm employed was a spatial attention task with central cues (Posner experiment). The main aim was to observe the differences in the performance (behavioural variables) and in the latency and amplitude of the ERP components among these groups. RESULTS Our data indicate that both MS groups showed poorer task performance (longer reaction times and lower percentage of correct responses), a latency delay for the N1 and P300 component, and a different amplitude for the frontal N1. Moreover, the deficit in the BMS group, indexed by behavioural and pyschophysiological variables, was more pronounced compared to the RRMS group. CONCLUSION The present results suggest a cognitive impairment in the information processing in all of these patients. Comparing both pathological groups, cognitive impairment was more accentuated in the BMS group compared to the RMSS group. This suggests a silent deterioration of cognitive skills for the BMS that is not usually treated with pharmacological or neuropsychological therapy.
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Affiliation(s)
- Javier J Gonzalez-Rosa
- Multiple Sclerosis Unit, Virgen Macarena Hospital, Avda Dr Fedriani s/n, 41009 Seville, Spain
- Laboratory of Psychophysiology, Departament of Experimental Psychology, University of Seville, Camilo Jose Cela s/n, 41018 Seville, Spain
| | - Manuel Vazquez-Marrufo
- Laboratory of Psychophysiology, Departament of Experimental Psychology, University of Seville, Camilo Jose Cela s/n, 41018 Seville, Spain
| | - Encarnacion Vaquero
- Laboratory of Psychophysiology, Departament of Experimental Psychology, University of Seville, Camilo Jose Cela s/n, 41018 Seville, Spain
| | - Pablo Duque
- Multiple Sclerosis Unit, Virgen Macarena Hospital, Avda Dr Fedriani s/n, 41009 Seville, Spain
| | - Monica Borges
- Multiple Sclerosis Unit, Virgen Macarena Hospital, Avda Dr Fedriani s/n, 41009 Seville, Spain
| | - Miguel A Gamero
- Multiple Sclerosis Unit, Virgen Macarena Hospital, Avda Dr Fedriani s/n, 41009 Seville, Spain
| | - Carlos M Gomez
- Laboratory of Psychophysiology, Departament of Experimental Psychology, University of Seville, Camilo Jose Cela s/n, 41018 Seville, Spain
| | - Guillermo Izquierdo
- Multiple Sclerosis Unit, Virgen Macarena Hospital, Avda Dr Fedriani s/n, 41009 Seville, Spain
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Humm AM, Magistris MR, Truffert A, Hess CW, Rösler KM. Central motor conduction differs between acute relapsing–remitting and chronic progressive multiple sclerosis. Clin Neurophysiol 2003; 114:2196-203. [PMID: 14580619 DOI: 10.1016/s1388-2457(03)00231-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize central motor conduction in relation to the clinical deficits and to the disease duration in 90 patients with acute relapsing-remitting MS (RR-MS) and in 51 patients with chronic primary or secondary progressive MS (P-MS). METHODS The triple stimulation technique (TST) was used to quantify the central motor conduction failure (expressed by the TST amplitude ratio) and conventional motor evoked potentials (MEPs) were used to measure the central motor conduction time (CMCT). RESULTS The TST amplitude ratio was reduced in presence of a clinical motor deficit (p=0.02 for RR-MS, p<0.01 for P-MS), but did not significantly differ in RR-MS and P-MS (p>0.05) when patients with similar clinical motor deficit were compared. The CMCT was not related to the clinical motor deficit in both RR-MS and P-MS. However, the CMCT was markedly prolonged in P-MS, when patients with similar clinical motor deficit and with similar disease duration were compared (p<0.01). The differences were not attributable to differential involvement of the spinal cord, which was similar in RR-MS and P-MS. CONCLUSIONS Our results disclose differences between the central motor conduction in RR-MS and P-MS that are not related to disease severity, spinal cord involvement or disease duration.
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Affiliation(s)
- A M Humm
- Department of Neurology, University of Berne, Inselspital, CH-3010 Bern, Switzerland
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Spiegel J, Hansen C, Baumgärtner U, Hopf HC, Treede RD. Sensitivity of laser-evoked potentials versus somatosensory evoked potentials in patients with multiple sclerosis. Clin Neurophysiol 2003; 114:992-1002. [PMID: 12804667 DOI: 10.1016/s1388-2457(03)00069-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Somatosensory evoked potentials (SEPs) play a less important role in the diagnosis of multiple sclerosis (MS) than visually evoked potentials. Since standard SEPs only reflect the dorsal column function, we now investigated spinothalamic tract function in patients with MS using laser-evoked potentials (LEPs). METHODS LEPs to thulium laser stimuli (3ms, 540 mJ, 5mm diameter) were recorded from 3 midline positions (Fz, Cz, Pz) in 20 patients with MS, and 6 patients with possible but unconfirmed MS. Peak latencies and peak-to-peak amplitude of the vertex potential negativity (N2) and positivity (P2) were evaluated and compared with normative values from 22 healthy control subjects. Median and tibial nerve SEPs were recorded with standard methods. Depending on the results of sensory testing, two skin areas (both hands, both feet, or one hand and foot of the same body side) were assessed in each patient. RESULTS In group comparisons, LEPs in patients with MS were significantly delayed and reduced in amplitude compared with healthy subjects (P<0.001) or patients with suspected but unconfirmed MS (P<0.05). In intraindividual comparisons within the patients with MS, LEP amplitude was significantly lower (P<0.01) and latencies were significantly longer (N2: P<0.01; P2: P<0.05) for a clinically hypoalgesic skin area than an unaffected control area. On a single case basis, LEPs were abnormal in 12 (60%) and SEPs in 8 (40%) of the patients with MS; combined analysis of LEPs and SEPs raised sensitivity to 75% (15 patients). LEPs were also abnormal for 7 skin areas with clinically normal nociception and thermal sensitivity, indicating subclinical lesions. Standard SEPs detected subclinical lesions in 5 areas with normal tactile sensitivity. CONCLUSIONS In patients with multiple sclerosis, spinothalamic tract function and LEPs were impaired more often than dorsal column function and SEPs. LEPs also detected subclinical lesions. Combined assessment of LEPs and SEPs can help to document dissemination of demyelinating CNS lesions and thus contribute to the diagnosis of multiple sclerosis.
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Affiliation(s)
- Jörg Spiegel
- Institute of Physiology and Pathophysiology, Johannes Gutenberg-University, Saarstrasse 21, D-55099, Mainz, Germany
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Anlar O, Kisli M, Tombul T, Ozbek H. Visual evoked potentials in multiple sclerosis before and after two years of interferon therapy. Int J Neurosci 2003; 113:483-9. [PMID: 12856477 DOI: 10.1080/00207450390162236] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Magnetic resonance imaging (MRI) is important in the diagnosis of and follow-up for the treatment of multiple sclerosis (MS); evoked potentials may be important if MRI is normal or cannot be performed. We assessed serial visual evoked potentials (VEPs) and cranial MRI in a group of clinically relapsing-remitting multiple sclerosis (N = 15) treated with interferon beta-lb (INFB-1b) and in normal subjects (N = 15). The investigations were done 1 week before INFB-lb therapy, 1 year later (N = 15), and 2 years later (N = 10). VEPs were abnormal in most of the patients; MRIs were abnormal in all patients. We used P100 latency as an electrophysiological index for the progress of illness. There were significant differences in VEPs between the beginning and ending of the interferon treatment. We concluded that VEPs would be a reliable index for following up the progress of MS under interferon therapy.
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Affiliation(s)
- Omer Anlar
- Department of Neurology, University of Yuzuncu Yil, Van, Turkey.
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