Krbot Skorić Magdalena, Adamec Ivan, Crnošija Luka, Gabelić Tereza, Barun Barbara, Zadro Ivana, Butković Soldo Silva, Habek Mario
Mario Habek, Department of Neurology, University Hospital Center Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia,
Croat Med J. 2016 Dec 31;57(6):558-565. doi: 10.3325/cmj.2016.57.558.
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.
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.
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.
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.
为验证经颅磁刺激体感诱发电位（tSSEP）结果反映临床及磁共振成像（MRI）显示的多发性硬化（MS）病灶这一假说，本研究旨在调查临床孤立综合征（CIS）患者的tSSEP变化与临床及脑干MRI结果的关系。第二个目的是研究，相较于单独分析每个tSSEP参数，以tSSEP评分形式解读tSSEP结果是否能更好地评估三叉神经传入通路受累情况。
2014年8月1日至2016年3月1日期间，连续纳入115例CIS患者。分析面部感觉症状及脑干MRI（1.5T）病灶。根据原始tSSEP数据对每位患者进行tSSEP检测。分别计算左右两侧的tSSEP评分（根据主要成分P1无反应及潜伏期延长的临界值，0=正常反应，1=潜伏期延长，3=无反应），并将两个值相加。
tSSEP变量的绝对值在有无临床症状方面无差异。未发现tSSEP异常与临床症状之间存在关联（P=0.544）。脑干病灶（中脑和脑桥）与tSSEP无反应相关（分别为P=0.002和P=0.005）。脑干病灶患者的tSSEP评分显著更高（P=0.01），尤其是中脑（P=0.004）和脑桥（P=0.008）病灶。二元逻辑回归显示，tSSEP评分对患者出现中脑MR病灶的可能性有显著影响，χ²(1)=6.804，P=0.009；该模型对87%的病例分类正确。
本研究的一致发现是tSSEP与MRI显示的中脑病灶之间存在关联，表明tSSEP可评估面部本体感觉。本研究确立了tSSEP在早期多发性硬化中评估脑干功能的价值。
