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Auditory evoked potentials and vestibular evoked myogenic potentials in evaluation of brainstem lesions in multiple
Anita Ivanković1, Vesna Nesek Mađarić, Katarina Starčević
1University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia.
Objective:
The aim of this study was to determine the roles of magnetic resonance imaging (MRI), auditory evoked potentials (AEP) and vestibular evoked myogenic potentials (VEMP) in the evaluation of brainstem involvement in multiple sclerosis (MS).
Patients And Methods:
Altogether 32 patients with the diagnosis of MS participated in the study. The following data was collected from all patients: age, gender, Expanded Disability Status Scale (EDSS) score, brainstem functional system score (BSFS) (part of the EDSS evaluating brainstem symptomatology), and involvement of the brainstem on the brain MRI. AEP and ocular VEMP (oVEMP) and cervical VEMP (cVEMP) were studied in all patients.
Results:
BSFS, MRI, AEP, oVEMP and cVEMP involvement of the brainstem was evident in 9 (28.1%), 14 (43.8%), 7 (21.9%), 12 (37.5%) and 10 (31.0%) patients, respectively. None of the tests used showed statistically significant advantage in the detection of brainstem lesions. When combining oVEMP and cVEMP 18 (56.3%) patients showed brainstem involvement. This combination showed brainstem involvement in greater percentage than BSFS or AEP, with statistical significance (p=0.035 and p=0.007, respectively).
Conclusion:
VEMP is a reliable method in detection of brainstem involvement in MS. It is comparable with MRI, but superior to clinical examination or AEP.
Insights
Vestibular evoked myogenic potentials (VEMP) effectively detect brainstem involvement in multiple sclerosis (MS), proving more reliable than clinical assessment or auditory evoked potentials (AEP). VEMP, combined with MRI, offers a comprehensive evaluation for MS patients.
Area of Science:
- Neuroscience
- Neurology
- Medical Imaging
Background:
- Multiple Sclerosis (MS) is a chronic neurological disease.
- Brainstem involvement is a significant factor in MS progression and symptomatology.
- Accurate assessment of brainstem lesions is crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic roles of Magnetic Resonance Imaging (MRI), Auditory Evoked Potentials (AEP), and Vestibular Evoked Myogenic Potentials (VEMP) in detecting brainstem involvement in MS.
- To compare the efficacy of these neurophysiological and imaging techniques.
Main Methods:
- 32 patients diagnosed with MS were included in the study.
- Data collected included clinical scores (EDSS, BSFS), brain MRI, AEP, and both ocular (oVEMP) and cervical (cVEMP) VEMP.
- Statistical analysis was performed to compare the detection rates of brainstem lesions.
Main Results:
- Brainstem involvement was detected by MRI in 43.8%, AEP in 21.9%, oVEMP in 37.5%, and cVEMP in 31.0% of patients.
- Combining oVEMP and cVEMP identified brainstem involvement in 56.3% of patients, significantly higher than BSFS or AEP.
- No single test demonstrated a statistically significant advantage in detecting brainstem lesions individually.
Conclusions:
- Vestibular Evoked Myogenic Potentials (VEMP) are a reliable method for detecting brainstem involvement in MS.
- VEMP demonstrates comparable efficacy to MRI and is superior to clinical examination (BSFS) and AEP.
- Combined VEMP testing offers enhanced sensitivity for identifying brainstem lesions in MS patients.
