Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-19T23:11:03.753Z Has data issue: false hasContentIssue false
  • English
  • Français

Motor Evoked Potentials and Disability in Secondary Progressive Multiple Sclerosis

Published online by Cambridge University Press:  18 September 2015

D. Facchetti ,
R. Mai ,
A. Micheli ,
N. Marcianó ,
R. Capra ,
R. Gasparotti  and
M. Poloni
D. Facchetti*
Affiliation:
Neurophysiology Service, Salvatore Maugeri Foundation, IRCCS, Gussago (Bs)
R. Mai
Affiliation:
Neurophysiology Service, Salvatore Maugeri Foundation, IRCCS, Gussago (Bs)
A. Micheli
Affiliation:
Neurophysiology Service, Salvatore Maugeri Foundation, IRCCS, Gussago (Bs)
N. Marcianó
Affiliation:
Neurophysiology Service, Salvatore Maugeri Foundation, IRCCS, Gussago (Bs) Neurologic Clinic, Dept. of Radiology, University of Brescia, (Bs)
R. Capra
Affiliation:
Neurophysiology Service, Salvatore Maugeri Foundation, IRCCS, Gussago (Bs) Neurologic Clinic, Dept. of Radiology, University of Brescia, (Bs)
R. Gasparotti
Affiliation:
Neurophysiology Service, Salvatore Maugeri Foundation, IRCCS, Gussago (Bs) Section of Neuroradiology, Dept. of Radiology, University of Brescia, (Bs)
M. Poloni
Affiliation:
Neurophysiology Service, Salvatore Maugeri Foundation, IRCCS, Gussago (Bs) III Neurologic Clinic, University of Milan, San Paolo Hospital, Milan, Italy
*
Servizio di Neurofisiologia, Centro Medico di Gussago, via Pinidolo 23, 25064 Gussago (BS), Italy
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

To investigate the mechanisms underlying disability in multiple sclerosis (MS), 40 patients with the relapsing-remitting form of the disease and 13 patients with secondary progressive MS underwent multimodal evoked potential (EP), motor evoked potential (MEP), and spinal motor conduction time evaluation. Clinical disability was evaluated by the expanded disability status scale (EDSS) and functional system scales. In secondary progressive MS patients, magnetic resonance imaging (MRI) was used to obtain a semiquantitative estimate of the total lesion load of the brain.

Results:

Spinal motor conduction time was significantly longer in secondary progressive MS patients than controls (p < 0.001) and relapsing-remitting MS patients (p < 0.05), but did not differ between relapsing-remitting patients and controls. Spinal motor conduction times also correlated directly with EDSS scores (p < 0.001) and pyramidal functional system scores (p < 0.001). Brain lesion load (4960.3 ± 3719.0 mm2) and the total number of lesions (67.7 ± 37.0) in secondary progressive MS did not correlate with disability scores. For the following EPs, the frequencies of abnormalities were significantly higher in secondary progressive MS patients than relapsing-remitting patients: visual evoked potentials (p < 0.05), somatosensory evoked potentials and upper limb motor evoked potentials (p < 0.01), and brainstem auditory evoked potentials, lower limb somatosensory evoked potentials and lower limb motor evoked potentials (p < 0.001).

Conclusions:

These findings suggest that disability in secondary progressive MS patients is mainly due to progressive involvement of corticospinal tract in the spinal cord.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 4 , November 1997 , pp. 332 - 337
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

References

REFERENCES

1.Barker, AT, Jalinous, R, Freeston, IL. Non-invasive magnetic stimulation of human motor cortex. Lancet 1985; 1: 1106–1107.CrossRefGoogle ScholarPubMed
2.Hess, CW, Mills, KR, Murray, NMF. Measurement of central motor conduction in multiple sclerosis by magnetic brain stimulation. Lancet 1986; 16: 355–358.CrossRefGoogle Scholar
3.Booth, KR, Streletz, LJ, Raab, VE, et al. Motor evoked potentials and central motor conduction: studies of transcranial magnetic stimulation with recording from the leg. Electroencephalogr Clin Neurophysiol 1990; 81: 57–62.CrossRefGoogle Scholar
4.Murray, NMF. The clinical usefulness of magnetic cortical stimulation. Electroencephalogr Clin Neurophysiol 1992; 85: 81–85.CrossRefGoogle ScholarPubMed
5.Kidd, D, Thompson, AJ, Kendall, BE, Miller, DH, Mcdonald, WI. Benign form of multiple sclerosis: MRI evidence for less frequent and less inflammatory disease activity. J Neurol Neurosurg Psychiatry 1994; 57: 1070–1072.CrossRefGoogle ScholarPubMed
6.Wiebe, S, Lee, DH, Karlik, SJ, et al. Serial cranial and spinal cord magnetic resonance imaging in multiple sclerosis. Ann Neurol 1992; 32: 643–646.CrossRefGoogle ScholarPubMed
7.Thompson, AJ, Miller, D, Youl, B, et al. Serial gadoliniumenhanced MRI in relapsing-remitting multiple sclerosis of varying disease duration. Neurology 1992; 42: 60–63.CrossRefGoogle ScholarPubMed
8.Tartaglino, LM, Friedman, DP, Flanders, AE, et al. Multiple sclerosis in the spinal cord: MR appearance and correlation with clinical parameter. Radiology 1995; 195: 725–732.CrossRefGoogle Scholar
9.Kidd, D, Thorpe, JW, Thompson, AJ, et al. Spinal cord MRI using multi-array coils and fast spin echo. II. Findings in multiple sclerosis. Neurology 1993; 43: 2632–2637.CrossRefGoogle ScholarPubMed
10.Koopmans, RA, Li, DKB, Grochowski, E, Curler, PJ, Pary, DW. Benign versus chronic progressive multiple sclerosis: magnetic resonance imaging features. Ann Neurol 1989; 25: 74–81.CrossRefGoogle ScholarPubMed
11.Poser, CM, Paty, DW, Sheinberg, L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983, 12: 227–231.CrossRefGoogle Scholar
12.Eisen, AA, Shtybel, W. AAEM minimonograph #35; clinical experience with transcranial magnetic stimulation. Muscle and Nerve 1990; 13: 995–1011.CrossRefGoogle Scholar
13.Eisen, AA. Noninvasive measurement of spinal cord conduction: review of presently available methods. Muscle and Nerve 1986; 9: 95–103.CrossRefGoogle ScholarPubMed
14.Snooks, SJ, Swash, M. Motor conduction velocity in the human spinal cord: slowed conduction in multiple sclerosis and radiation myelopathy. J Neurol Neurosurg Psychiatry 1985; 48: 1135–1139.CrossRefGoogle ScholarPubMed
15.Fujiki, M, Isono, M, Hori, S, Ueno, S. Corticospinal direct response to transcranial magnetic stimulation in humans. Electroencephologr Clin Neurophysiol 1996; 10: 48–57.CrossRefGoogle Scholar
16.Kutzke, JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale. Neurology 1983; 33: 1444–1452.CrossRefGoogle Scholar
17.Ravnborg, M, Liguori, R, Christiansen, P, Larsson, H, Soelberg-Sørensen, P. The diagnostic reliability of magnetically evoked motor potentials in multiple sclerosis. Neurology 1992; 42: 1296–1301.CrossRefGoogle ScholarPubMed
18.Berardelli, A, Inghilleri, M, Cruccu, G, et al. Stimulation of motor tracts in multiple sclerosis. J Neurol Neurosurg Psychiatry 1988; 51: 677–683.Google Scholar
19.Caramia, MD, Bernardi, G, Zarola, F, Rossini, PM. Neurophysiological evaluation of the central nervous impulse propagation in patients with sensorimotor disturbances. Electroencephalogr Clin Neurophysiol 1988; 70: 16–25.CrossRefGoogle ScholarPubMed
20.Filippi, M, Campi, A, Mammi, S, et al. Brain magnetic resonance imaging and multimodal evoked potentials in benign and secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 1995; 58: 31–37.CrossRefGoogle ScholarPubMed
21.Hess, CW, Mills, KR, Murray, NMF, Schriefer, TN. Magnetic brain stimulation: central motor conduction studies in multiple sclerosis. Ann Neurol 1987; 22: 744–752.CrossRefGoogle ScholarPubMed
22.Jones, SM, Streletz, LJ, Raab, VE, Knobler, RL, Lublin, FD. Lower extremity motor evoked potentials in multiple sclerosis. Arch Neurol 1991; 48: 944–948.CrossRefGoogle ScholarPubMed
23.Chiappa, KH. Evoked Potentials in Clinical Medicine. Second edition. 1990. Raven Press. New York.Google Scholar
24.Khoshbin, S, Hallett, M. Multimodality evoked potentials and blink reflex in multiple sclerosis. Neurology 1981; 31: 138–144.CrossRefGoogle ScholarPubMed
25.Mills, KR, Murray, NMF. Corticospinal tract conduction time in multiple sclerosis. Ann Neurol 1985; 18: 601–605.CrossRefGoogle ScholarPubMed
26.Smith, SJM, Claus, D, Hess, CW, et al. F responses and central motor conduction in multiple sclerosis. Electroencephalogr Clin Neurophysiol 1989; 74: 438–443.CrossRefGoogle ScholarPubMed
27.Kandler, RH, Jarrat, JA, Davies-Jones, GAB, et al. The role of magnetic stimulation as a quantifier of motor disability in patients with multiple sclerosis. J Neurol Sci 1991; 106: 31–34.CrossRefGoogle ScholarPubMed
28.Berger, AR, Shahani, BT. Electrophysiologic evaluation of spinal cord motor conduction. Muscle Nerve 1989; 12: 976–980.CrossRefGoogle ScholarPubMed
29.Beer, S, Rosier, KM, Hess, CW. Diagnostic value of paraclinical tests in multiple sclerosis: relative sensitivities and specificities for reclassification according to the Poser committee criteria. J Neurol Neurosurg Psychiatry 1995; 59: 152–159.CrossRefGoogle Scholar
30.Mayr, N, Baumgartner, C, Zeitlhofer, J, Deecke, L. The sensitivity of transcranial cortical magnetic stimulation in detecting pyramidal tract lesions in clinically definite multiple sclerosis. Neurology 1991; 41: 566–569.CrossRefGoogle ScholarPubMed
31.Ingram, DA, Thompson, AJ, Swash, M. Central motor conduction in multiple sclerosis: evaluation of abnormalities revealed by transcutaneous magnetic stimulation of the brain. J Neurol Neurosurg Psychiatry 1988; 51: 487–494.Google Scholar
32.Kandler, RH, Jarrat, JA, Gumpert, EJW, et al. The role of magnetic stimulation in the diagnosis of multiple sclerosis. J Neurol Sci 1991; 106: 25–30.CrossRefGoogle ScholarPubMed
33.Smith, ME, Stone, LA, Albert, PS, et al. Clinical worsening in multiple sclerosis is associated with increased frequency and area of gadopentetate dimeglumin-enhancing magnetic resonance imaging lesions. Ann Neurol 1993; 33: 480–489.CrossRefGoogle ScholarPubMed
34.Miller, DH, Barkhof, F, Nauta, JP. Gadolinium enhancement increases the sensitivity of MRI in detecting disease activity in multiple sclerosis. Brain 1993; 116: 1077–1079.CrossRefGoogle ScholarPubMed
35.Baumhefner, RW, Tourtellotte, WW, Syndulko, K, et al. Quantitative multiple sclerosis plaque assessment with magnetic resonance imaging. Its correlation with clinical parameters, evoked potentials and intra-blood-brain barrier IgG synthesis. Arch Neurol 1990; 47: 19–26.CrossRefGoogle ScholarPubMed
36.Cutler, JR, Aminoff, MJ, Brant-Zavadazki, M. Evaluation of patients with multiple sclerosis by evoked potentials and magnetic resonance imaging: a comparative study. Ann Neurol 1986; 20: 645–648.CrossRefGoogle ScholarPubMed
37.Miller, DH. Magnetic resonance in monitoring the treatment of multiple sclerosis. Ann Neurol 1994; 36: S91-S94.CrossRefGoogle ScholarPubMed
38.Paty, DW, Li, DK, Oger, JF, et al. Magnetic resonance imaging in the evaluation of clinical trials in multiple sclerosis. Ann Neurol 1994; 36: S95-S96.CrossRefGoogle ScholarPubMed
39.Capra, R, Marciano’, N, Vignolo, L, Chiesa, A, Gasparotti, R. Gadolinium-pentetic acid magnetic resonance imaging in patients with relapsing-remitting multiple sclerosis. Arch Neurol 1992; 49: 687–689.CrossRefGoogle ScholarPubMed
40.Stone, LA, Albert, PS, Smith, ME, et al. Changes in the amount of diseased white matter over time in patients with relapsing remitting multiple sclerosis. Neurology 1995; 45: 1808–1814.CrossRefGoogle ScholarPubMed
41.The IFNβ multiple sclerosis study group. Interferon β-lb is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicentre, randomized, double blind placebo controlled trial. Neurology 1993; 43: 655–661.CrossRefGoogle Scholar
42.Paty, DW, Oger, JF, Kastruokoff, LF, et al. MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding and CT. Neurology 1988; 38: 180–185.CrossRefGoogle Scholar
43.Mcdonald, WI, Miller, DH, Thompson, AJ. Are magnetic resonance findings predictive of clinical outcome in therapeutic trials in multiple sclerosis? The dilemma of interferon-β. Ann Neurol 1994; 36: 14–18.CrossRefGoogle ScholarPubMed
44.Khoury, SJ, Guttman, CRG, Oraw, EJ, et al. Longitudinal MRI in multiple sclerosis: correlation between disability and lesion burden. Neurology 1994; 44: 2120–2124.CrossRefGoogle ScholarPubMed
45.Paty, DW, Li, DKB, the UBC MS/MRI study group and the INFβ multiple sclerosis study group. Interferon β-lb is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a multicentre, randomized, double blind, placebo controlled, trial. Neurology 1993; 43: 662–667.CrossRefGoogle Scholar
46.Grossman, RI. Magnetization transfer in multiple sclerosis. Ann Neurol 1994; 36: S97-S99.CrossRefGoogle ScholarPubMed
47.Filippi, M, Capra, R, Campi, A, et al. Triple dose of gadolinium-DTPA and delayed MRI in patients with benign multiple sclerosis. J Neurol Neurosurg Psychiatry 1996; 60: 526–530.CrossRefGoogle ScholarPubMed
48.Evans, AC, Frank, JA, Antel, J, Miller, DH. The role of MRI in clinical trials: comparison of image processing tecnique. Ann Neurol 1997; 41: 125–132.CrossRefGoogle Scholar
49.IFNβ Multiple Sclerosis Study Group and the University of British Columbia MS/MRI Analysis Group. Interferon β-lb in the treatment of multiple sclerosis: final outcome of the randomized contolled trial. Neurology 1995; 45: 1277–1285.CrossRefGoogle Scholar
50.Kidd, D, Thorphe, JW, Kendal, BE, et al. MRI dynamics of spinal cord in progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 1996; 60: 15–19.CrossRefGoogle ScholarPubMed