Contributions
Abstract: P385
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Introduction: Evoked potentials (EPs) have been part of the routine diagnostic workup in suspected MS for decades. However, with the broad availability of brain MRI, the role of EPs in clinical practice is under debate. We related EP and brain MRI results to disability (Expanded Disability Status Scale, EDSS) at the time of diagnosis to elucidate the differential contribution of both methods to objectify disease severity.
Methods: We studied 543 newly diagnosed MS and CIS patients (EDSS 1.6 ± 1.5) with both EP data and brain MRI available. Brain MRI followed a standardized protocol (3D FLAIR, 3D T1w, 3 Tesla). EPs comprised visually evoked potentials (VEPs) and somatosensory EPs (SSEPs) of the median and tibial nerve. Tibial nerve SSEP latencies were corrected for body height. Latencies of all VEPs and SSEPs were combined with amplitudes to one score. White matter lesion volume (WMLV) was derived from brain MRI by an automated tool (Lesion Segmentation Tool). EP results and WMLV were correlated with EDSS at the time of diagnosis by linear regression models.
Results: EDSS correlated with tibial nerve SSEPs (R=0.495, p< 0.001) and, to a lesser extent, with median nerve SSEPs (R=0.356, p< 0.001) and VEPs (R=0.169, p< 0.001). EDSS also correlated with WMLV (R=0.345, p< 0.001). Of 268 cases with normal tibial nerve SSEPs, only two showed abnormalities of median nerve SSEPs. Including all three EP measures and WMLV in a multiple linear regression model with EDSS as response variable, tibial nerve SSEPs and WMLV were the only significant explanatory variables.
Conclusions: With regard to EDSS, only tibial nerve SSEPs add information to brain MRI. Compared to tibial nerve SSEP, the value of median nerve SSEP seems to be low, if not negligible.
Disclosure: A. Wuschek has received intramural funding from the Technical University of Munich (KKF grant).
V. Pongratz has received research support from Novartis (Oppenheim Förderpreis) and intramural funding from the Technical University of Munich (KKF grant).
M. Bussas has nothing to disclose.
S. Grahl has nothing to disclose.
C. Gasperi has nothing to disclose.
M. Hoshi has nothing to disclose.
A. Berthele reports personal fees from Biogen, Merck Serono, Mylan, Novartis, Roche, Sanofi Genzyme, and Teva, and compensations for clinical trials from Alexion Pharmaceuticals, Biogen, Novartis, Genzyme, Roche, and Teva.
J. Kirschke has nothing to disclose.
C. Zimmer has nothing to disclose.
B. Hemmer has served on scientific advisory boards for F. Hoffmann-La Roche Ltd, Novartis, Bayer AG, and Genentech; he has served as DMSC member for AllergyCare and TG Therapeutics; he or his institution have received speaker honoraria from Biogen Idec, Teva Neuroscience, Merck Serono, Medimmune, Novartis, Desitin, and F. Hoffmann-La Roche Ltd; his institution has received research support from Chugai Pharmaceuticals and Hoffmann-La-Roche; holds part of two patents; one for the detection of antibodies and T cells against KIR4.1 in a subpopulation of MS patients and one for genetic determinants of neutralizing antibodies to interferon β.
M. Mühlau received research support from Merck Serono and Novartis as well as travel support from Bayer and Merck Serono.
Abstract: P385
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Introduction: Evoked potentials (EPs) have been part of the routine diagnostic workup in suspected MS for decades. However, with the broad availability of brain MRI, the role of EPs in clinical practice is under debate. We related EP and brain MRI results to disability (Expanded Disability Status Scale, EDSS) at the time of diagnosis to elucidate the differential contribution of both methods to objectify disease severity.
Methods: We studied 543 newly diagnosed MS and CIS patients (EDSS 1.6 ± 1.5) with both EP data and brain MRI available. Brain MRI followed a standardized protocol (3D FLAIR, 3D T1w, 3 Tesla). EPs comprised visually evoked potentials (VEPs) and somatosensory EPs (SSEPs) of the median and tibial nerve. Tibial nerve SSEP latencies were corrected for body height. Latencies of all VEPs and SSEPs were combined with amplitudes to one score. White matter lesion volume (WMLV) was derived from brain MRI by an automated tool (Lesion Segmentation Tool). EP results and WMLV were correlated with EDSS at the time of diagnosis by linear regression models.
Results: EDSS correlated with tibial nerve SSEPs (R=0.495, p< 0.001) and, to a lesser extent, with median nerve SSEPs (R=0.356, p< 0.001) and VEPs (R=0.169, p< 0.001). EDSS also correlated with WMLV (R=0.345, p< 0.001). Of 268 cases with normal tibial nerve SSEPs, only two showed abnormalities of median nerve SSEPs. Including all three EP measures and WMLV in a multiple linear regression model with EDSS as response variable, tibial nerve SSEPs and WMLV were the only significant explanatory variables.
Conclusions: With regard to EDSS, only tibial nerve SSEPs add information to brain MRI. Compared to tibial nerve SSEP, the value of median nerve SSEP seems to be low, if not negligible.
Disclosure: A. Wuschek has received intramural funding from the Technical University of Munich (KKF grant).
V. Pongratz has received research support from Novartis (Oppenheim Förderpreis) and intramural funding from the Technical University of Munich (KKF grant).
M. Bussas has nothing to disclose.
S. Grahl has nothing to disclose.
C. Gasperi has nothing to disclose.
M. Hoshi has nothing to disclose.
A. Berthele reports personal fees from Biogen, Merck Serono, Mylan, Novartis, Roche, Sanofi Genzyme, and Teva, and compensations for clinical trials from Alexion Pharmaceuticals, Biogen, Novartis, Genzyme, Roche, and Teva.
J. Kirschke has nothing to disclose.
C. Zimmer has nothing to disclose.
B. Hemmer has served on scientific advisory boards for F. Hoffmann-La Roche Ltd, Novartis, Bayer AG, and Genentech; he has served as DMSC member for AllergyCare and TG Therapeutics; he or his institution have received speaker honoraria from Biogen Idec, Teva Neuroscience, Merck Serono, Medimmune, Novartis, Desitin, and F. Hoffmann-La Roche Ltd; his institution has received research support from Chugai Pharmaceuticals and Hoffmann-La-Roche; holds part of two patents; one for the detection of antibodies and T cells against KIR4.1 in a subpopulation of MS patients and one for genetic determinants of neutralizing antibodies to interferon β.
M. Mühlau received research support from Merck Serono and Novartis as well as travel support from Bayer and Merck Serono.