Orientation-specific visual evoked potential deficits in multiple sclerosis

Effects of grating spatial orientation on visual evoked potentials and contrast sensitivity in multiple sclerosis

Previous studies suggest a delay of pattern visual evoked potentials (PVEPs) in multiple sclerosis (MS) depending on grating orientation. We examined a group of 14 patients with definite MS recording PVEPs to vertical and horizontal grating and analysing latency and amplitude of P60, N70 and P100 waves. We evaluated contrast sensitivity (CS) to dark and bright bars of several spatial frequencies (SF). The aim was to evaluate the diagnostic value of evoked responses and CS in revealing involvement of cortical structures. PVEPs to 1 degrees cycle/degree (c/d) vertical bars were abnormal in 25% for P60, in 32% for N70 and in 36%, for P100; in 25%, 36% and 42% respectively at 4 c/d; as regards horizontal bars at 1 c/d we found alterations of P60, N70 and P100 in 11%, 19% and 27% respectively; at 4 c/d in 19%, 27%) and 35%. CS resulted more abnormal for vertical grating, with a maximum impairment for 3.7 c/d SF. We may conclude that the use of vertical grating in clinical routine is more reliable both for PVEPs and CS testing; in addition CS can be abnormal even with normal PVEPs: this could mean an early impairment of CS and provide useful indications about a subclinical involvement of visual cortex.

Pattern visual evoked potential luminance and multiple sclerosis

Pattern visual evoked potentials (PVEPs) were recorded from 111 patients classified as having possible, probable or definite multiple sclerosis. Patients were stimulated with a checkerboard pattern using high and low luminances in order to test the hypothesis that an attenuated pattern luminance increases the detection rate of PVEP abnormalities. With increasing certainty of diagnosis, there was a concomitant increase in the incidence of PVEP abnormalities. However, there was no evidence that stimulating with a lower luminance pattern enhanced the sensitivity of the test. The same findings were also apparent when the patient data was analyzed according to the presence or absence of a history of optic neuritis or other visual symptoms. It is concluded that, within the luminance limits used in this study, the role of varied luminance in detecting demyelinating lesions in the optic nerves using the PVEP is minimal, although there was some limited evidence that a high level of luminance may be more appropriate than a low level.

Contrast sensitivity in multiple sclerosis measured by Cambridge Low Contrast Gratings: a useful clinical test?

The Cambridge Low Contrast Gratings (CLCG) were used to assess contrast sensitivity (CS) in 39 patients with clinically definite multiple sclerosis and 60 control subjects. CS was determined in both horizontal and vertical orientations and compared with visual evoked responses (VERs) in the same populations. Only 33% of patients had abnormal CS whereas 82% had abnormal VERs. There was no correlation between the degree of abnormalities in CS and VERs. There was no significant difference between CS determined in the vertical and horizontal orientation; however, examination in the vertical orientation increased the number of abnormalities detected by 2 (5%). We conclude that although CS, using the CLCG, is abnormal in a proportion of multiple sclerosis patients its detection is not clinically useful and is insensitive as a measure of subclinical optic neuropathy in multiple sclerosis.

The rapid assessment of visual dysfunction in multiple sclerosis

A consecutive series of patients with normal activity and a diagnosis of multiple sclerosis (10 male and 31 female) underwent extensive ophthalmological examination including visual evoked potentials (VEPs) and a new test of contrast sensitivity, which is described in detail. Seventy three per cent of patients had abnormal contrast sensitivity and 83% had abnormal VEPs. There was no association between abnormalities of the two types, but patients who had impaired contrast sensitivity and normal VEPs were younger than those whose contrast sensitivity was normal but whose VEPs were not. The test of contrast sensitivity (which took less than 5 minutes to administer) was the only examination to reveal visual abnormalities in all nine patients with a history of optic neuritis, and would be a useful supplementary test in the examination of patients with suspected multiple sclerosis.

Delayed visual evoked potentials are independent of pattern orientation in macular disease

Visual evoked potentials (VEPs) and contrast sensitivity (CS) were studied in patients affected by maculopathy. VEP delays and CS reduction were demonstrated in each affected eye. In distinction to patients affected by multiple sclerosis (MS), in maculopathy patients VEP latency is independent of the orientation of the grating stimulus. It is proposed that stimulating with more than one pattern orientation is useful in the differential diagnostic use of VEPs.

A modified mirror projection visual evoked potential stimulator for presenting patterns in different orientations

Modifications to a standard mirror projection visual evoked potential stimulator are described to enable projection of patterns in varying orientations. The galvanometer-mirror assembly is mounted on an arm which can be rotated through 90 degrees. This enables patterns in any orientation to be deflected perpendicular to their axes.

Apperceptive agnosia due to carbon monoxide poisoning. An interpretation based on critical band masking from disseminated lesions

Apperceptive visual agnosia is normally held to be a specific deficit in 'apperception' - a hypothetical postsensory stage in visual processing. This paper describes the investigation of a patient diagnosed as suffering from a classical apperceptive agnosia resulting from carbon monoxide poisoning. Controlled behavioural testing confirmed the apparent agnosia but revealed that he could be trained to make a number of visual discriminations which had not been apparent from routine clinical examination and that he suffered a number of subtle sensory impairments which likewise had not hitherto been apparent. Evoked potential recording to grating patterns showed a complex pattern of brain responses involving interactions between spatial frequency, orientation and hemisphere recorded from. The data suggested that the agnosia was caused by sensory impairments rather than a deficit in apperception. We proposed that the impairments were caused by loss of certain spatial frequency and orientation information but rejected an interpretation based on the concept of processing channels in favour of one based on object contour masking by a peppery field defect caused by disseminated lesions. This interpretation received some support from fine grain static perimetry, contrast sensitivity function measurement and orientation discrimination in the two hemifields. Qualitatively similar results were obtained in normal subjects whose field was artificially masked. The results have implications for theories of visual agnosia and for theories of vision based on the concept of processing channels.

Transient visually evoked potentials to sinusoidal gratings in optic neuritis

Transient visually evoked potentials (VEPs) to sinusoidal gratings over a range of spatial frequencies have been recorded in cases of optic neuritis. The use of the response to pattern onset in addition to the response to pattern reversal extended the range to higher spatial frequencies by up to two octaves. There was an increase in VEP delay and a greater degree of discrimination from a control group at higher spatial frequencies. This finding is discussed in the light of previous reports of luminance and checkerboard VEPs in demyelinating optic nerve disease. An attempt is made to relate amplitude changes in various VEP components to contrast sensitivity measurements in this group of patients.

Flash electroretinogram abnormalities in patients with clinically definite multiple sclerosis

We studied the flash electroretinograms (ERGs) of 105 patients with multiple sclerosis who were divided into four groups. The first group had no history or clinical evidence of optic nerve dysfunction, the second and third groups had either left or right optic nerve disease respectively, and the fourth group had historical or clinical evidence of bilateral optic nerve disease. Statistical analysis of the data using analysis of variance (ANOVA) showed that the group of patients with no history or clinical evidence of optic nerve disease had no significant difference from the control group for their peak b-wave implicit times but the other three groups were significantly delayed on the affected side(s). Using the Mann-Whitney U-test we found all four patient groups had significantly greater absolute interocular latency differences from the control group. The electroretinal contribution to flash VEP delay was also investigated. In those patients with unilateral or bilateral optic nerve disease we found that in 14-31% of those patients with flash VEP delay there was also abnormal prolongation of the ERG b-wave. These results confirm a high incidence of retinal dysfunction in multiple sclerosis patients and may suggest that transynaptic degeneration of retinal structures occurs in optic nerve demyelination. The significant absolute interocular latency difference in particular may provide another electrophysiological parameter to establish a diagnosis of multiple sclerosis in suspect cases.