Evoked potentials and other guiding factors of conversion from radiologically isolated syndrome to definite multiple sclerosis

Main Article Content

Serkan Demir
Eyup Duzgun
Cahit Kafadar
Erdem Rifat Togrol
Guney Mehmet Senol
Akin Cakir

Abstract

Objective: Radiologically Isolated Syndrome (RIS) has become a popular subject recently with quite a number of follow-up and other clinical studies being done. A consensus on the approach to the patient with RIS is being tried to be established. The aim of our study was to assess the role of visual evoked potential (VEP) and somatosensory evoked potential (SEP) as a guiding factor for the conversion from Radiologically Isolated Syndrome (RIS) to definite Multiple Sclerosis (MS).


Material and methods: 49 RIS patients who were referred to GATA Haydarpasa Training Hospital Neurology Department between 2011-2015. All of the patients fullfillied the 2009 Okuda criteria for RIS and other differential diagnosis were excluded accordingly. VEP and SEP examinations made during the pre-MS RIS period were scanned retrospectively. For the VEP examination, the P100 latency and amplitudes, for the SEP examination, the P40 latency and amplitude was analysed.


Results: 49 patients were included in this study, the mean time of follow-up was 21,8 months. 63% of patients were female, while 37% were male. The mean age was 31,2 years. Among the four patients with abnormal SEPs, MS developed in three of them (75%) over time. This is statistically significant (p = 0.011). VEP and/or SEP was abnormal in 8 patients and MS developed in 4 (50%) of those (p=0.017). The following factors have a positive statistically significant correlation with conversion to MS: Presence of active plaques (r=0.461, p<0.001), presence of more than 9 plaques (r=0.287, p=0.046), VEP and/or SEP pathologies (r=0.402, p=0.004) and number of plaques (r=0.309, p=0.031). The most important factor for the transformation is the presence of active plaque which increases the risk 8.1-fold. The second important factor seems to be the presence of VEP and/or SEP abnormality, but this factor does not reach statistical significance. 


Conclusion: In the conversion to MS risk from RIS, VEP- SEP examinations are important and should take its place in the follow-up of these patients.

Downloads

Download data is not yet available.

Article Details

How to Cite
Demir, S. ., Duzgun, E. ., Kafadar, C. ., Togrol, E. R. ., Senol, G. M. ., & Cakir, A. . (2017). Evoked potentials and other guiding factors of conversion from radiologically isolated syndrome to definite multiple sclerosis. Medical Science and Discovery, 4(6), 44–50. Retrieved from https://medscidiscovery.com/index.php/msd/article/view/189
Section
Research Article

References

Lebrun C, Cohen M, Chaussenot A, Mondot L, Chanalet S. A prospective study of patients with brain MRI showing incidental t2 hyperintensities addressed as multiple sclerosis: a lot of work to do before treating. Neurol Ther. 2014 ;3(2):123-32.

Etemadifar M, Janghorbani M, Koushki MM, Etemadifar F, Esfahani MF. Conversion from radiologically isolated syndrome to multiple sclerosis. Int J Prev Med. 2014 ;5(11):1379-86.

Odom JV, Bach M, Brigell M, Holder GE, McCulloch DL, Tormene AP, Vaegan. ISCEV standard for clinical visual evoked potentials (2009 update). Doc Ophthalmol. 2010;120:111-9.

Togrol E, Gurtekin Y, Saracoğlu M, Akyatan N. Somatosensory Evoked Potentials & Correlations With Gender, Age And Height. 9th European Congress of Clinical Neurophysiology, Ljubliana Electroencephalography and Clinical Neurophysiology, 1998; 106:77

Granberg T, Martola J, Kristoffersen-Wiberg M, Aspelin P, Fredrikson S. Radiologically isolated syndrome--incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review. Mult Scler. 2013 ;19(3):271-80.

Okuda DT, Mowry EM, Beheshtian A, Waubant E, Baranzini SE, Goodin DS, Hauser SL, Pelletier D. Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome.Neurology. 2009 ;72(9):800-5.

De Stefano N, Siva A.The radiologically isolated syndrome dilemma: just an incidental radiological finding or presymptomatic multiple sclerosis? Mult Scler. 2013 ;19(3):257-8

Yamout B, Alroughani R, Al-Jumah M, Goueider R, Dahdaleh M, Inshasi J, et al. Consensus recommendations for the diagnosis and treatment of multiple sclerosis: the Middle East North Africa Committee for Treatment and Research In Multiple Sclerosis (MENACTRIMS).Curr Med Res Opin. 2015 ;31(7):1349-61

Tornatore C, Phillips JT, Khan O, Miller AE, Barnes CJ. Practice patterns of US neurologists in patients with CIS, RRMS, or RIS. Neurol Clin Pract. 2012 ;2(1): 48–57.

Azevedo CJ, Overton E, Khadka S, Buckley J, Liu S, Sampat M, et al. Early CNS neurodegeneration in radiologically isolated syndrome. Neurol Neuroimmunol Neuroinflamm. 2015 ;2(3):e102

Keegan M., Guo Y., Okuda D., Siva A., Pelletier D., Kantarci O., Lucchinetti C., Lebrun Frenay C.: Radiologically Isolated Syndrome: Pathologically Defined as Demyelinating Disease; Poster presented in the Annual meeting of AAN, P1.391, April 16, 2016

Lyoo IK, Seol HY, Byun HS, Renshaw PF. Unsuspected multiple sclerosis in patients with psychiatric disorders: a magnetic resonance imaging study. J Neuropsychiatry Clin Neurosci 1996;8(1):54–9

Katzman GL, Dagher AP, Patronas NJ. Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 1999;282(1):36–9

Weber F, Knopf H. Incidental findings in magnetic resonance imaging of the brains of healthy young men. J Neurol Sci 2006;240(1-2):81–4

Hartwigsen G, Siebner HR, Deuschl G, Jansen O, Ulmer S. Incidental findings are frequent in young healthy individuals undergoing magnetic resonance imaging in brain research imaging studies. J Comput Assist Tomo 2010;34(4):596–600

Gabelic T, Ramasamy DP, Weinstock-Guttman B, Hagemeier J, Kennedy C, Melia R, et al. Prevalence of Radiologically Isolated Syndrome and White Matter Signal Abnormalities in Healthy Relatives of Patients with Multiple Sclerosis. AJNR Am J Neuroradiol. 2014 Jan;35(1):106-12.

Brex PA, Ciccarelli O, O'Riordan JI, Sailer M, Thompson AJ, Miller DH. A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. N Engl J Med. 2002 ;346(3):158-64.

Lana-Peixoto MA. How much radiologically isolated syndrome suggestive of multiple sclerosis is multiple sclerosis? Arq Neuropsiquiatr. 2012 ;70(1):2-4

Okuda DT, Siva A, Kantarci O, Inglese M, Katz I, Tutuncu M, et al. Radiologically isolated syndrome: 5-year risk for an initial clinical event. PLoS One. 2014;9(3):e90509.

Fischer C, André-Obadia N, Mauguière F. Diagnostic criteria of multiple sclerosis: electrophysiological criteria. Rev Neurol (Paris). 2001 ;157(8-9 Pt 2):974-80.

Kjaer M. Evoked potentials. With special reference to the diagnostic value in multiple sclerosis.Acta Neurol Scand. 1983;67(2):67-89.

Kjaer M. Brain stem auditory and visual evoked potentials in multiple sclerosis. Acta Neurol Scand. 1980 ;62(1):14-9.

Leocani L, Comi G. Clinical neurophysiology of multiple sclerosis. Handb Clin Neurol. 2014;122:671-9.

Comi G, Leocani L, Medaglini S, Locatelli T, Martinelli V, Santuccio G, Rossi P. Measuring evoked responses in multiple sclerosis. Mult Scler. 1999;5(4):263-7.

Sand T, Kvalay MB, Wader T, Hovdal H. Evoked potential tests in clinical diagnosis. Tidsskr Nor Laegeforen nr. 9, 2013; 133(9): 960 – 5

Loncarević N, Tirić-Campara M, Mulabegović N. Somatosensory evoked cerebral potentials (SSEP) in multiple sclerosis. Med Arh. 2008 ;62(2):80-1.

Slimp JC, Janczakowski J, Seed LJ, Kraft GH. Comparison of median and posterior tibial nerve somatosensory evoked potentials in ambulatory patients with definite multiple sclerosis. Am J Phys Med Rehabil. 1990 ;69(6):293-6.

Tsao WC, Lyu RK, Ro LS, Lao MF, Chen CM, Wu YR, et al. Clinical Correlations of Motor and Somatosensory Evoked Potentials in Neuromyelitis Optica. PLoS One. 2014; 9(11): e113631.

Lebrun C, Bensa C, Debouverie M, Wiertlevski S, Brassat D, de Seze J, et al. Association between clinical conversion to multiple sclerosis in radiologically isolated syndrome and magnetic resonance imaging, cerebrospinal fluid, and visual evoked potential: follow-up of 70 patients. Arch Neurol. 2009 ;66(7): 841-6

Gronseth GS., Ashman EJ. Practice parameter: The usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000; 54(9); 1720-5

Most read articles by the same author(s)