Procjena oštećenja moždanoga debla vestibularnim evociranim miogenim potencijalima (VEMP) u relapsno-remitirajućoj multiploj sklerozi

Abstract

Background: The aim of this study was by using VEMP method to determine the proportion of patients with RRMS who have subclinical damage of the brainstem and to determine differences in oVEMP and cVEMP between the different clinical presentation of the disease, as well as to determine the role of latencies, corrected amplitudes and new VEMP variables in the evaluation of brainstem involvement in patients with MS. Patients and methods : The study included 100 patients with RRMS who were divided into two groups - patients with and without clinically detectable lesions of the brainstem. The control group consisted of 50 healthy volunteers. For patients with MS EDSS and BSFS were calculated and data related to the disease course, as well as data related to the neuroanatomical localization of lesions on MRI in the brainstem were taken. All study subjects underwent VEMP and the analysis of variables were done. Results: All patients with MS regardless of the clinical presence of lesions of the brainstem showed statistically significant differences in oVEMP latencies variables compared to healthy controls. Significant difference was obtained between patients with MS and healthy controls regarding analysis of conduction blocks, whereas statistically significant difference was reached for all explored blocks in MS patients with clinical brainstem lesion compared to patients with MS without clinical lesions of the brainstem. In patients with MS without clinical lesions of the brainstem pathological VEMP response was detected in 94%, while in patients with MS and present clinical signs of brainstem lesion pathological VEMP response was detected in 90% of patients. VEMP score analysis showed a statistically significant difference for the variables VEMP SCM and VEMP total scores in the group of patients with clinical signs of brainstem lesions in comparison with patients with MS without clinical lesions of the brainstem. In both groups of patients with MS, the variable OM and VEMP total revealed more pathological findings than MRI and demonstrated abnormal VEMP findings in patients with normal MRI of the brainstem which could imply the existence of brainstem lesion. Conclusion : VEMP enhanced by using new VEMP variables is sensitive method in the verification of existing and identification of asymptomatic lesions of the brainstem