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

Gabelić, Tereza (2014) Procjena oštećenja moždanoga debla vestibularnim evociranim miogenim potencijalima (VEMP) u relapsno-remitirajućoj multiploj sklerozi. PhD thesis, Sveučilište u Zagrebu.

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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.

Abstract in Croatian

Uvod: Cilj ovog istraživanja bio je pomoću VEMP-a odrediti udio bolesnika s RRMS-om koji imaju subkliničko oštećenje moždanoga debla te utvrditi razlike u oVEMP-u i cVEMP-u između različitih kliničkih prezentacija bolesti, kao i utvrditi ulogu latencija, korigiranih amplituda i novih VEMP varijabli u procjeni oštećenja moždanoga debla u bolesnika sa MS-om. Ispitanici i metode: U istraživanje je uključeno 100 bolesnika s RRMS-om koji su podjeljeni u dvije skupine – bolesnici bez i s kliničkom lezijom moždanoga debla. Kontrolna skupina sastojala se od 50 zdravih dobrovoljaca. Bolesnicima s MS-om izračunati su EDSS i BSFS, te uzeti podaci vezani uz tijek bolesti, kao i podaci vezani uz neuroanatomsku lokalizaciju lezija na MR-u moždanoga debla. Svim ispitanicima učinjen je VEMP te provedena analiza varijabli. Rezultati: Svi bolesnici s MS-om bez obzira na kliničku prisutnost lezije moždanoga debla pokazali su statistički značajnu razliku u latencijama oVEMP varijabli u odnosu na zdrave kontrole. U blokovima provođenja značajna razlika dobivena je između bolesnika s MS-om i zdravih kontrola dok je statistički značajna razlika dobivena za sve ispitivane blokove u bolesnika s MS i kliničkom lezijom debla u odnosu na bolesnike s MS-om bez kliničke lezije moždanoga debla. Patološki odgovor VEMP-a u bolesnika s MS-om bez kliničke lezije moždanoga debla detektiran je u 94%, dok je kod bolesnika s MS-om i prisutnim kliničkim znakovima lezije moždanoga debla patološki odgovor VEMP-a detektiran u 90% bolesnika. VEMP score analiza pokazala je pokazala je statistički značajnu razliku za varijablu VEMP SCM te ukupni VEMP score u grupi bolesnika sa kliničkim znakovima lezije moždanoga debla u odnosu na bolesnike s MS-om bez lezije debla. U obje skupine bolesnika s MS-om, za varijable OM i VEMP ukupni, metoda VEMP otkrila je više patoloških nalaza od MR-a, odnosno pokazala patološki nalaz VEMP-a u bolesnika sa urednim MR-om moždanoga debla što može implicirati postojanje lezije moždanoga debla. Zaključak: Dijagnostička pretraga VEMP-a uz korištenje novih VEMP varijabli osjetljiva je metoda u verifikaciji postojećih i identifikaciji asimptomatskih lezija moždanoga debla.

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