Tongue somatosensory evoked potentials reflect midbrain involvement in patients with clinically isolated syndrome

Krbot Skorić, Magdalena and Adamec, Ivan and Crnošija, Luka and Gabelić, Tereza and Barun, Barbara and Zadro, Ivana and Butković Soldo, Silva and Habek, Mario (2016) Tongue somatosensory evoked potentials reflect midbrain involvement in patients with clinically isolated syndrome. Croatian Medical Journal, 57 (6). pp. 558-565. ISSN 0353-9504

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Abstract

AIM: To test the hypothesis that tSSEP findings reflect clinical and MRI MS lesions, the aim of this study was to investigate tSSEP changes in patients with clinically isolated syndrome (CIS) in relation to clinical and brainstem MRI findings. The second aim was to investigate whether the interpretation of the tSSEP results in the form of the tSSEP score enables better evaluation of the afferent trigeminal pathway involvement than analyzing each tSSEP parameter separately. ----- METHODS: 115 consecutive CIS patients were enrolled from August 1, 2014 until March 1, 2016. Facial sensory symptoms and brainstem MRI (1.5 T) lesions were analyzed. tSSEP testing was performed for each patient from the raw tSSEP data. The tSSEP score was calculated separately for the left and right side (according to the cut-off values for absent response and prolonged latency of the main component, P1 (0=normal response, 1=prolonged latency, 3=absent response) and the two values were summed. ----- RESULTS: There was no difference in the absolute values of the tSSEP variables regarding the presence of clinical symptoms. No association was found between tSSEP abnormalities and clinical symptoms (P=0.544). Brainstem lesions (midbrain and pons) were associated with the absent tSSEP responses (P=0.002 and P=0.005, respectively). tSSEP score was significantly higher in patients with brainstem lesions (P=0.01), especially midbrain (P=0.004) and pontine (P=0.008) lesions. Binary logistic regression showed that tSSEP score had a significant effect on the likelihood that patients have midbrain MR lesions, ?2(1)=6.804, P=0.009; and the model correctly classified 87% of cases. ----- CONCLUSIONS: The consistent finding of this study was the association between tSSEP and midbrain lesions on MRI, indicating that tSSEP evaluates proprioception of the face. This study establishes the value of tSSEP in assessing brainstem function in early multiple sclerosis.

Abstract in Croatian

Somatosenzorni evocirani potencijali jezika održavaju zahvaćenost srednjeg mozga kod pacijenata s klinički izoliranim sindromom ----- Cilj: Kako bismo testirali hipotezu da somatosenzorni evocirani potencijali jezika (prema engl, tongue somatosensory evoked potentials, tSSEP) odražavaju kliničke lezije i lezije vidljive magnetskom rezonancijom kod pacijenata s multiplom sklerozom, cilj ovog istraživanja bio je utvrditi promjene tSSEP-a kod pacijenata s klinički izoliranim sindromom u odnosu na kliničke nalaze i nalaze moždanog debla dobivene magnetskom rezonancijom. Drugi cilj bio je istražiti omogućuje li interpretacija tSSEP rezultata u obliku tSSEP izračuna bolju procjenu zahvaćenosti aferentnog trigeminalnog puta nego analiza svakog tSSEP parametra posebno. ----- Postupci: U razdoblju od 1. kolovoza 2014. do 1. ožujka 2016. godine u ispitivanje smo uključili 115 uzastopnih pacijenata s klinički izoliranim sindromom. Analizirali smo facijalne senzorne simptome i lezije moždanog debla vidljive magnetskom rezonancijom (1.5 T). tSSEP je izračunat za svakog ispitanika iz neobrađenih podataka, posebno za lijevu i desnu stranu (prema graničnim vrijednostima za odsutni odgovor i produženu latenciju glavne komponente, P1 [0=normalan odgovor, 1=produžena latencija, 3=odsutan odgovor]), te su te dvije vrijednosti zbrojene. ----- Rezultati: Nije bilo razlika u apsolutnim vrijednostima tSSEP varijabli prema prisutnosti kliničkih simptoma. Nije bilo povezanosti između abnormalnosti tSSEP-a i kliničkih simptoma (P=0,544). Lezije moždanog debla (srednji mozak i moždani most) bile su povezane s odsutnim tSSEP odgovorima (P =0,002 odnosno P =0,005). tSSEP izračun bio je značajno viši kod pacijenata s lezijama moždanog debla (P =0,01), posebice lezijama srednjeg mozga (P =0,004) i moždanog mosta (P =0,008). Binarna logistička regresija pokazala je da je tSSEP izračun imao značajan učinak na vjerojatnost da će pacijenti imati leziju u srednjem mozgu, χ2 (1)=6,804, P=0,009; a model je točno razvrstao 87% pacijenata. ----- Zaključak: Ovo ispitivanje opetovano je pokazalo povezanost između tSSEP-a i lezija u srednjem mozgu, ukazujući na to da tSSEP može služiti u procjeni propriocepcije lica. Potvrdili smo ulogu tSSEP-a u ocjeni funkcije moždanog debla u ranom stadiju multiple skleroze.

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