Evaluation of brainstem involvement in multiple sclerosis

Evidence suggests that brainstem involvement in multiple sclerosis (MS) is one of the major predictive factors for future disability. Recent work demonstrates that brainstem pathology is more frequent than can be depicted either clinically or with the use of MRI. Evoked potentials have been shown to reliably predict disability in MS patients. This review will consider the main clinical and neuroradiological aspects together with the role of different neurophysiological tests, as ancillary tools to conventional studies, in evaluation of brainstem pathology in MS patients. Specifically, the role of vestibular evoked myogenic potentials, trigeminal somatosensory evoked potentials, autonomic nervous system testing and sleep testing in MS, as correlates of brainstem damage, will be explored.