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Occult fifth nerve dysfunction in multiple sclerosis

A Eisen, D Paty, S Purves

    The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
    |August 1, 1981
    PubMed
    Summary
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    Trigeminal somatosensory evoked potentials (SEPs) reveal frequent, undetected brainstem nerve damage in multiple sclerosis (MS) patients. This neurophysiological test, alongside blink reflex studies, aids in diagnosing occult trigeminal nerve dysfunction in MS.

    Area of Science:

    • Neuroscience
    • Clinical Neurophysiology
    • Neurology

    Background:

    • Multiple sclerosis (MS) can affect cranial nerves, but clinical signs of trigeminal nerve involvement are rare.
    • Occult neurological deficits are common in MS, necessitating sensitive diagnostic tools.
    • Somatosensory evoked potentials (SEPs) offer a method to assess sensory pathway integrity.

    Purpose of the Study:

    • To investigate the utility of trigeminal nerve somatosensory evoked potentials (SEPs) in detecting subclinical trigeminal nerve dysfunction in multiple sclerosis (MS).
    • To determine the incidence of trigeminal nerve involvement in MS patients, particularly those without overt clinical signs.
    • To evaluate the combined diagnostic yield of trigeminal SEPs and blink reflex studies in MS.

    Main Methods:

    Related Experiment Videos

  • Recorded trigeminal somatosensory evoked potentials (SEPs) following mucosal lip stimulation in 25 healthy subjects.
  • Performed blink reflex studies in conjunction with SEPs in a cohort of 29 patients with established or suspected MS.
  • Analyzed the incidence of abnormal trigeminal SEPs and blink reflexes in MS patients, correlating findings with clinical presentation.

    • Main Results:

    • Trigeminal SEPs showed characteristic peaks (N13, P19, N30) in normal subjects.
    • Abnormal trigeminal SEPs were detected in 41.4% of MS patients.
    • Combining trigeminal SEPs with blink reflex studies increased the detection rate of trigeminal nerve dysfunction to 51.7% in MS patients, many lacking clinical fifth nerve signs.

    Conclusions:

    • Occult involvement of pontine trigeminal nerve pathways is frequent in MS, often preceding or occurring without clinical manifestations.
    • Trigeminal somatosensory evoked potentials (SEPs) serve as a valuable neurophysiological tool for identifying subclinical trigeminal nerve dysfunction in MS.
    • The combined use of trigeminal SEPs and blink reflex testing enhances diagnostic sensitivity for cranial nerve involvement in MS.