Leocani L, Rovaris M, Boneschi F M, Medaglini S, Rossi P, Martinelli V, Amadio S, Comi G
Department of Neurology, Clinical Neurophysiology and Neurorehabilitation, Scientific Institute Hospital San Raffaele, University Vita-Salute, Milan, Italy.
J Neurol Neurosurg Psychiatry. 2006 Sep;77(9):1030-5. doi: 10.1136/jnnp.2005.086280. Epub 2006 May 30.
Evoked potentials are used in the functional assessment of sensory and motor pathways. Their usefulness in monitoring the evolution of multiple sclerosis has not been fully clarified.
The aim of this longitudinal study was to examine the usefulness of multimodal evoked potential in predicting paraclinical outcomes of disease severity and as a prognostic marker in multiple sclerosis.
Eighty four patients with clinically definite multiple sclerosis underwent Expanded Disability Status Scale (EDSS) and functional system scoring at study entry and after a mean (standard deviation) follow-up of 30.5 (11.7) months. Sensory and motor evoked potentials were obtained in all patients at study entry and at follow-up in 64 of them, and quantified according to a conventional score.
Cross-sectionally, the severity of each evoked potential score significantly correlated with the corresponding functional system (0.32 < R < 0.60, p < 0.01, for all but follow-up visual evoked potential) and with EDSS (0.34 < R < 0.61; p < 0.001 for all but brain stem evoked potential). EDSS significantly correlated with global evoked potential score severity (baseline R = 0.60, follow-up R = 0.46, p < 0.001). Using longitudinal analysis, only changes in somatosensory evoked potential scores were significantly correlated with changes of sensory functional system (R = 0.34, p = 0.006). However, patients with multiple sclerosis with disability progression at follow-up had more severe baseline evoked potential scores than patients who remained stable. Patients with severe baseline global evoked potential score (higher than the median value) had a risk of 72.5% to progress on disability at follow-up, whereas patients with multiple sclerosis with lower scores had a risk of only 36.3%.
These results suggest that evoked potential is a good marker of the severity of nervous damage in multiple sclerosis and may have a predictive value regarding the evolution of disability.
诱发电位用于感觉和运动通路的功能评估。其在监测多发性硬化症病情进展中的作用尚未完全明确。
这项纵向研究的目的是检验多模式诱发电位在预测疾病严重程度的辅助临床结果以及作为多发性硬化症预后标志物方面的作用。
84例临床确诊的多发性硬化症患者在研究开始时以及平均（标准差）30.5（11.7）个月的随访后进行了扩展残疾状态量表（EDSS）和功能系统评分。所有患者在研究开始时均进行了感觉和运动诱发电位检测，其中64例在随访时再次检测，并根据传统评分进行量化。
横断面分析显示，每个诱发电位评分的严重程度与相应的功能系统显著相关（除随访视觉诱发电位外，所有相关系数R均满足0.32 < R < 0.60，p < 0.01），与EDSS也显著相关（除脑干诱发电位外，所有相关系数R均满足0.34 < R < 0.61；p < 0.001）。EDSS与整体诱发电位评分严重程度显著相关（基线时R = 0.60，随访时R = 0.46，p < 0.001）。采用纵向分析，只有体感诱发电位评分的变化与感觉功能系统的变化显著相关（R = 0.34，p = 0.006）。然而，随访时残疾进展的多发性硬化症患者基线诱发电位评分比病情稳定的患者更严重。基线整体诱发电位评分严重（高于中位数）的患者随访时残疾进展风险为72.5%，而评分较低的多发性硬化症患者风险仅为36.3%。
这些结果表明，诱发电位是多发性硬化症神经损伤严重程度的良好标志物，可能对残疾进展具有预测价值。
