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Stimulus-specific Cortical Visual Evoked Potential Morphological Patterns
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Multifocal visual evoked potentials are influenced by variable contrast stimulation in MS.

Audrey R Frohman1, Zane Schnurman, Amy Conger

  • 1Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, USA.

Neurology
|July 21, 2012
PubMed
Summary

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Reduced contrast in pattern reversal multifocal visual evoked potentials (mfVEP) testing reveals abnormalities in multiple sclerosis (MS) patients, even in seemingly unaffected eyes, highlighting subclinical optic nerve damage.

Area of Science:

  • Ophthalmology
  • Neuroscience
  • Clinical Electrophysiology

Background:

  • Multiple sclerosis (MS) can cause optic nerve damage, leading to visual impairment.
  • Intereye asymmetry in visual function and retinal nerve fiber layer (RNFL) thickness are common in MS patients, particularly those with a history of acute optic neuritis (MS-AON).
  • Pattern reversal multifocal visual evoked potentials (mfVEP) are used to assess visual pathway function.

Purpose of the Study:

  • To investigate if mfVEP abnormalities in timing and amplitude correlate with intereye asymmetry in low contrast letter acuity and RNFL thickness in MS patients.
  • To determine the effect of varying stimulus contrast levels on mfVEP responses in MS patients.

Main Methods:

  • A cross-sectional study involving 11 normal subjects and 40 MS patients (21 with MS-AON) was conducted.

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  • Low contrast letter acuity and RNFL thickness were assessed for intereye asymmetry.
  • Pattern reversal mfVEP was performed at high (100%), low (33.3%), and very low (14.2%) contrast levels.

    • Main Results:

    • mfVEP amplitude was significantly reduced in MS-AON eyes at lower contrast levels compared to 100% contrast (p < 0.0001).
    • Intereye asymmetry in mfVEP timing responses increased significantly at lower contrast levels in MS-AON patients (p < 0.0001 for 33.3% and p < 0.001 for 14.2%).
    • Occult visual pathway damage was unmasked in the fellow eyes of 57% of MS-AON patients at low contrast stimulation (p < 0.001).

    Conclusions:

    • mfVEP abnormalities are contrast-dependent, supporting the hypothesis that reduced contrast reveals functional deficits in MS.
    • The mfVEP paradigm at reduced contrast is effective in detecting subclinical visual pathway damage in apparently unaffected eyes of MS patients.