Asuman ORHAN, Recep AYGÜL, Orhan DENİZ, Nuri KOÇAK, Hızır ULVİ

Multiple Sklerozis’li Olgularda BAEP ve MRI Bulgularının Karşılaştırılması+

Amaç: Multiple Sklerozis'de (MS) beyin sapı yapıları sıklıkla tutulmaktadır. Bu çalışmada beyin sapı tutuluşu olan ve olmayan kesin MS tanısı almış olgularda beyin sapı tutuluşunu belirlemede BAEP ve MRI'nin duyarlılıklarının karşılaştırılması amaçlandı. Yöntem: Öykü ve/veya klinik değerlendirmeyle kesin MS tanısı alan 50 olgu (35 kadın, 15 erkek) çalışmaya alındı (ortalama yaş: 33.9±9.59, yaş aralığı: 18-57 yıl). Olgular klinik olarak beyin sapı tutuluşu olan (grup 1) ve olmayan (grup 2) olmak üzere iki gruba ayrıldı. Çalışmaya alınan olgularda MRI ve BAEP kayıtlandı. BAEP parametreleri yaş olarak benzer 35 sağlıklı kontrolle karşılaştırıldı. I., III., ve V. dalga latansları ile I-III, III-V, I-V interpik latansları (IPL) belirlendi. Sonuçlar: Elli MS'li hastanın %26'sında MRI'de beyin sapında plak; %88'inde BAEP parametrelerinde anormallik belirlendi. BAEP anormallikleri %60 V. dalga latansı ve %74 III-V, %62 I-V IPL uzama şeklindeydi. Olgular ve kontrollerin karşılaştırılmasında V. dalga latansı ve III-V, I-V IPL'lar olgularda anlamlı şekilde uzamıştı (p < 0.001, her üçü için ). Grup 1'de olguların %33.3'ünde MRI'de beyin sapında plak bulundu ve %83.3'ünde BAEP'te anormallik kayıtlandı. Grup 2'deki MS'lilerin %100'ünün BAEP'lerinde anormallik belirlendi ve %7.1'i MRI'de beyin sapında plak gösterdi. Beyin sapı tutuluşunu olan ve olmayan MS'li olguların karşılaştırılmasında BAEP ve MRI bulguları arasında farklılıklar anlamlıydı (p < 0.001, her üçü için). Yorum: Sonuçlarımız, beyin sapı tutuluşu olan veya olmayan MS'li olgularda beyin sapı disfonksiyonunu belirlemede BAEP'in MRI'ya göre rölatif olarak daha duyarlı olduğunu göstermektedir. Anahtar kelimeler: Multiple sklerozis, Beyin sapı işitsel uyarılmış potansiyelleri, Manyetik rezonans inceleme

Anahtar Kelimeler:

Multiple sklerozis, Beyin sapı işitsel uyarılmış potansiyelleri, Manyetik rezonans inceleme

Comparison of BAEP and MRI Findings in Patients with Multiple Sclerosis

Purpose: Brainstem structure is frequently involved in multiple sclerosis (MS). In this study, we aimed to compare the sensitivities of BAEP and MRI in detecting the brainstem lesions in the cases diagnosed as definitive MS with and without brainstem involvement. Method: A total of 50 cases (35 females and 15 males) with definitive MS with their history and clinical evaluation (mean age: 33.9±9.59, range: 18-57 years) were included in this study. Patients with brainstem involvement as group 1 and cases without brainstem involvement as group 2 were separated into two groups. Thirty-five similarly age-matched healthy subjects were taken as the control group. MRI and BAEP were performed in the cases included in this study. I., III. and V. wave peak latencies, and I-III, I-V, and III-V inter peak latencies (IPLs) were determined. Results: Of the total 50 MS patients, 26% had plaques in brainstem in the MRI and 88% had abnormalities in BAEP evaluation. BAEP abnormalities were V. wave absolute latency in 60%, III-V IPL in 74% and in 62% I-V IPLs of patients. In the comparison of patients and controls, the V. wave absolute latency and III-V, I-V IPLs were significantly prolonged in the patients (p < 0.001 for all). Brainstem plaques in MRI were obtained in 33.3% and BAEP abnormalities were recorded in 83.3% patients in group 1. Abnormalities were determined in BAEP of the 100% MS cases in group 2; and additionally 7.1% cases showed a plaque in brainstem in MRI. In the comparison of MS patients with and without brainstem involvement, the differences were significant between in terms of BAEP and MRI findings (p < 0.001 for all). Conclusion: Our results indicated that BAEP is relatively more sensitive than MRI in the detection of brainstem dysfunction, with or without any clinical findings in MS cases. Key words: Multiple sclerosis, Brainstem auditory evoked potentials, Magnetic resonance imaging

Keywords:

Multiple sclerosis, Brainstem auditory evoked potentials, Magnetic resonance imaging,

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Matthews BW. Mc Alpines multiple sclerosis. Pathology. Longman Group Limited, New York, USA. 1991: 343-345.
McDonald WI, Halliday AM. Diagnosis and classification of multiple sclerosis. Br Med Bull 1977; 34:4-9.
Gebarski SS, Gabrielsen TO, Gilman S, et al. The initial diagnosis of multiple sclerosis: Clinical impact of magnetic resonance imaging. Ann Neurol 1985; 17: 469- 474.
Cutler JR, Amioff MJ, Brant-Zawadzki M. Evaluation of patients with multiple sclerosis by evoked potentials and magnetic resonance imaging: A comparative study. Ann Neurol 1986; 20: 645-648.
Baum K, Scheuler W, Hegerl U. Detection of brainstem lesions in multiple sclerosis: Comparison of brainstem auditory evoked potentials with nuclear magnetic resonance imaging. Acta Neurol Scand 1988; 77: 283-288.
Poel JC, Jones SJ, Miller DH. Sound lateralization, brainstem auditory evoked potentials and magnetic imaging in multiple sclerosis. Brain 1988; 111(6): 1453-74.
Capra R, Mattioli F, Vignolo LA: Lesion detection in MS patients with and without clinical brainstem disorders: Magnetic resonance imaging and brainstem auiditory evoked potentials compared. Euro Neurology 1989; 29 (6): 317-32.
Fazekas F, Offenbacher H, Fuchs S, et al: Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis. Neurology 1988; 38(12): 1822-25.
Bartel DR, Mark ON, Kolar OJ. The diagnosis and classification of multiple sclerosis: Evoked responses and spinal fluid electrophoresis. Neurology 1983; 33: 611-617.
Giessen BG, Kurtzberg D, Vaughan HG, et al. Trimodal evoked potentials compared with magnetic resonance imaging in the diagnosis of multiple sclerosis. Arch Neurol 1987; 44: 281-284.
Rose AS. Criteria for the clinical diagnosis of multiple sclerosis. Neurology 1976; 26: 20-22.
Antonelli AR, Bellotto R, Bertazolli M. Auditory brainstem response test battery for multiple sclerosis patients: Evaluation of test findings and assesment of diagnostic criteria. Audiology 1986; 25: 227-238.
Muş N, Gülhan M. Multipl skleroziste işitsel beyinsapı cevapları. In: ÖzdamarÖ, Muş N, ed(s). İşitsel beyin sapı cevapları. Ankara. 1996: 195-196.
Stockard JJ, Stockard EJ, Sharbrough WF. Detection and localization of occult lesions with brainstem auditory responses. Mayo Clin Proc 1977; 52: 761-769.
La Mantia L, Milanese C, Corridori F. Brainstem auditory evoked potentials in the diagnosis of multiple sclerosis. Ital J Neurol 1982; 4: 289-293.
Chiappa KH. Pattern-shift visual, brainstem auditory and short-latency somatosensory evoked potentials in multiple sclerosis. Ann NY Acad Sci 1984; 436: 315-327.
Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: Guidelines for resarch protocols. Ann Neurol 1983; 13: 227-231.
Barbara S, Giesser MD, Kurtzberg D. Trimodal evoked potentails compared with magnetic resonance ımaging in the diagnosis of multiple sclerosis. Arch Neurol 1987; 44: 281-284.
Akyatan N, Siva A, Yardım M. Multiple sklerozda multimodal uyandırılmış yanıtlar. Klinik Gelişim 1991; 4: 1297-1303.
Akyatan N, Gürsoy M, Gürtekin Y. Brainstem auditory evoked responses and their value in the diagnosis of brain stem lesions. European Congress of Clinical Neurophysiology, Linon–Portugal, 1992.
Pakalnis A, Drake ME, Dadmehr N, Weiss K. Evoked potentials and EEG in multiple sclerosis. Electroencephalogr Clin Neurophysiol 1987; 67: 333-336.
Fischer C, Blanc A, Mauguiere F. Diagnostic value of brainstem auditory evoked potentials. Rev Neurology 1981; 137(4): 229-240.
Antonelli AR, Bellotto R, Bertazolli M. Auditory brainstem response test battery for multiple sclerosis patients: Evaluation of test findings and assesment of diagnostic criteria. Audiology 1986; 25: 227-238.