Evaluation of brainstem involvement in multiple sclerosis

Abstract

Evidence suggests that brainstem involvement in multiple sclerosis (MS) is one of the major predictive factors for future disability. Recent work demonstrates that brainstem pathology is more frequent than can be depicted either clinically or with the use of MRI. Evoked potentials have been shown to reliably predict disability in MS patients. This review will consider the main clinical and neuroradiological aspects together with the role of different neurophysiological tests, as ancillary tools to conventional studies, in evaluation of brainstem pathology in MS patients. Specifically, the role of vestibular evoked myogenic potentials, trigeminal somatosensory evoked potentials, autonomic nervous system testing and sleep testing in MS, as correlates of brainstem damage, will be explored.

Keywords::

• autonomic nervous system
• brainstem
• evoked potentials
• MRI
• multiple sclerosis
• sleep
• symptoms
• trigeminal somatosensory evoked potentials
• vestibular myogenic evoked potentials

Acknowledgements

The author would like to thank his colleagues Antonija Mišmaš and Ivan Adamec from the Laboratory for Autonomic Nervous System Testing; Tereza Gabelić and Magdalena Krbot Skorić from the Laboratory for Experimental Evoked Potentials; Barbara Barun from the Laboratory for Sleep Disorders; and medical students Anabella Karla Barušić and Ivo Bach for all their help and constructive comments in preparing of this manuscript.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.