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Publication Detail
Exploring brainstem function in multiple sclerosis by combining brainstem reflexes, evoked potentials, clinical and MRI investigations.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Journal Article
  • Authors:
    Magnano I, Pes GM, Pilurzi G, Cabboi MP, Ginatempo F, Giaconi E, Tolu E, Achene A, Salis A, Rothwell JC, Conti M, Deriu F
  • Publication date:
    11/2014
  • Pagination:
    2286, 2296
  • Journal:
    Clin Neurophysiol
  • Volume:
    125
  • Issue:
    11
  • Status:
    Published
  • Country:
    Netherlands
  • PII:
    S1388-2457(14)00166-7
  • Language:
    eng
  • Keywords:
    Acoustic-masseteric reflex (AMR), Multiple sclerosis, Trigemino-collic reflex (TCR), Vestibular-evoked myogenic potentials (VEMPs), Vestibulo-collic reflex (VCR), Vestibulo-masseteric reflex (VMR), Acoustic Stimulation, Adult, Brain Stem, Electric Stimulation, Evoked Potentials, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Relapsing-Remitting, Neck Muscles, Reflex, Young Adult
Abstract
OBJECTIVE: To investigate vestibulo-masseteric (VMR), acoustic-masseteric (AMR), vestibulo-collic (VCR) and trigemino-collic (TCR) reflexes in patients with multiple sclerosis (MS); to relate abnormalities of brainstem reflexes (BSRs) to multimodal evoked potentials (EPs), clinical and Magnetic Resonance Imaging (MRI) findings. METHODS: Click-evoked VMR, AMR and VCR were recorded from active masseter and sternocleidomastoid muscles, respectively; TCR was recorded from active sternocleidomastoid muscles, following electrical stimulation of the infraorbital nerve. EPs and MRI were performed with standard techniques. RESULTS: Frequencies of abnormal BSRs were: VMR 62.1%, AMR 55.1%, VCR 25.9%, TCR 58.6%. Brainstem dysfunction was identified by these tests, combined into a four-reflex battery, in 86.9% of cases, by EPs in 82.7%, MRI in 71.7% and clinical examination in 37.7% of cases. The sensitivity of paired BSRs/EPs (93.3%) was significantly higher than combined MRI/clinical testing (70%) in patients with disease duration ⩽6.4years. BSR alterations significantly correlated with clinical, EP and MRI findings. CONCLUSIONS: The four-BSR battery effectively increases the performance of standard EPs in early detection of brainstem impairment, otherwise undetected by clinical examination and neuroimaging. SIGNIFICANCE: Multiple BSR assessment usefully supplements conventional testing and monitoring of brainstem function in MS, especially in newly diagnosed patients.
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