The choice of ABR click polarity and amplitude variables in multiple sclerosis patients

Evoked brainstem responses (ABR) to 75 dB nHL condensation (C), rarefaction (R), and alternating (A = C+R) clicks were investigated in healthy subjects and in patients with multiple sclerosis. A new wave IV-V 'shape ratio' (SR IV-V) was most sensitive. SR IV-V correlated most strongly with clinical MS classification, and seemed to be rather specific for retrocochlear dysfunction. Wave IV-V amplitude was also more sensitive than the common IV-V amplitude ratio. The variability of latencies and interpeak latencies was lower in ABR to A clicks than in ABR to either R or to C clicks. In patients, fewer subcomponents were found in ABR to A than in ABR to R and C clicks. ABR to A clicks were on the average slightly more sensitive than either C or R click ABR. Our results suggest that both A-mode ABR and the 'dispersion' variable SR IV-V can be used without significant problems in the diagnosis of brainstem demyelination. A test protocol which requires ABR to both C and R clicks to be abnormal, will, however, be less sensitive, though probably more specific.