Hostname: page-component-745bb68f8f-lrblm Total loading time: 0 Render date: 2025-01-22T17:02:48.372Z Has data issue: false hasContentIssue false
  • English
  • Français

Occult Fifth Nerve Dysfunction In Multiple Sclerosis

Published online by Cambridge University Press:  18 September 2015

Andrew Eisen ,
Donald Paty ,
Sherrill Purves  and
Maureen Hoirch
Andrew Eisen*
Affiliation:
Division of Neurology (Department of Medicine) of the Vancouver General Hospital and The University of British Columbia
Donald Paty
Affiliation:
Division of Neurology (Department of Medicine) of the Vancouver General Hospital and The University of British Columbia
Sherrill Purves
Affiliation:
Division of Neurology (Department of Medicine) of the Vancouver General Hospital and The University of British Columbia
Maureen Hoirch
Affiliation:
Division of Neurology (Department of Medicine) of the Vancouver General Hospital and The University of British Columbia
*
Diagnostic Neurophysiology (EMG), Vancouver General Hospital, 855 West 12th Avenue, Vancouver, B.C. V5Z 1M9
Rights & Permissions [Opens in a new window]

Summary:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Somatosensory evoked potentials (SEPs) were recorded following trigeminal nerve stimulation in 25 normal subjects. Mucosal stimulation of the lip resulted in a reduced stimulus artefact. The three initial peaks, N13, P19, and N30, measured respectively 12.8 ± 0.9 S−3, 19.3 ± 1.4 S−3 and 28.6 ± 1.7 S−3. Blink reflex studies were also performed in most of these subjects. In 41.4% of 29 patients with established or suspected multiple sclerosis, the trigeminal SEP was abnormal. Additional use of the blink reflex raised the overall incidence of trigeminal nerve dysfunction to 51.7%. None of the patients had clinical evidence of fifth nerve involvement either historically or on examination. Four of seven patients with progressive spinal MS and two patients whose only deficit was that of optic neuritis, had abnormal trigeminal SEPs. It is concluded that occult involvement of the pontine fifth nerve structures occurs frequently in MS despite the rarity of corresponding clinical findings. The trigeminal SEP is a useful additional neurophysiological method.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 8 , Issue 3 , August 1981 , pp. 221 - 225
Copyright
Copyright © Canadian Neurological Sciences Federation 1981

References

REFERENCES

Allison, T., Goff, W.R., Williamson, P.D. and Van Gilder, J.C. (1979). On the neural origin of early components of the human somatosensory evoked response. In: Progress in Clinical Neurophysiology, vol. 7, pp. 51–68, edited by Desmedt, J.E.Karger: Basel.Google Scholar
Asselman, P., Chadwick, D.W., Marsden, C.D. (1975). Visual evoked responses in the diagnosis and management of patients suspected of multiple sclerosis. Brain, 98, 261–282.CrossRefGoogle ScholarPubMed
Bennett, M.H. and Jannetta, P.J. (1980). Trigeminal evoked potentials in humans. Electroencephalography and Clinical Neurophysiology, 48, 517–526.CrossRefGoogle ScholarPubMed
Chiappa, K.H. (1980). Pattern shift visual, brainstem auditory, and short-latency somatosensory evoked potentials in multiple sclerosis. Neurology, 30(2), 110–123.Google ScholarPubMed
Donchin, E., Callaway, E., Cooper, R., Desmedt, J.E., Goff, W.R., Hillyard, S.A., and Sutton, S. (1977). Publication criteria for studies of evoked potentials (EP) in man. Report of a committee. In: Progress in Clinical Neurophysiology, vol., 1, edited by Desmedt, J.E.Karger: Basel, pp. 1–11.Google Scholar
Eisen, A. and Elleker, G. (1980). Sensory nerve stimulation and evoked cerebral potentials. Neurology, 30, 1097–1105.Google ScholarPubMed
Eisen, A., and Odusote, K. (1980). Central and peripheral conduction times in multiple sclerosis. Electroencephalography and Clinical Neurophysiology, 48, 253–265.CrossRefGoogle ScholarPubMed
Ghatak, N.R., Hirano, A., Lutmaer, H., and Zimmerman, H.M. (1974). Asymptomatic demyelinated plaque in the spinal cord. Archives of Neurology, 30, 484–486.CrossRefGoogle ScholarPubMed
Halliday, A.M., McDonald, W.I., and Mushin, J. (1973). Visual evoked potentials in the diagnosis of multiple sclerosis. British Medical Journal, 4, 661–664.CrossRefGoogle ScholarPubMed
Hennerici, M., Wenzel, D., and Freund, H.J. (1977). The comparison of small size rectangle and chequer-board stimulation for the evaluation of delayed visual evoked responses in patients suspected of multiple sclerosis. Brain, 100, 119–136.CrossRefGoogle Scholar
Kimura, J. (1970). Alteration of the orbicularis oculi reflex in pontine lesions: study in multiple sclerosis. Archives of Neurology, 22, 156–161.CrossRefGoogle ScholarPubMed
Kimura, J. (1973). The blink reflex as a test for brainstem and higher central nervous system function. In: New Developments in Electromyography and Clinical Neurophysiology. vol. 3, pp. 682–691, edited by Desmedt, J.E.Karger: Basel.Google Scholar
Kimura, J. (1975). Electrically elicited blink reflex in diagnosis of multiple sclerosis-review of 260 patients over a seven-year period. Brain, 98, 413–426.CrossRefGoogle Scholar
Kugelberg, E. (1952). Facial reflexes. Brain. 75, 385–396.Google ScholarPubMed
Matthews, W.B., Small, D.G., Small, M. and Poutney, E. (1977). Pattern reversal evoked visual potential in the diagnosis of multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry, 40: 1009–1114.CrossRefGoogle ScholarPubMed
McAlplne, D., Lumsden, C.E., and Acheson, E.D. (1965). Multiple Sclerosis: A Reappraisal. E. and S. Livingstone, Edinburgh and London.Google Scholar
McDonald, W.I. (1980). The role of evoked potential in the diagnosis of multiple sclerosis. In: Progress in Multiple Sclerosis Research, pp. 564–568, edited by Bauer, H.J., Poser, S. and Ritter, G.Springer-Verlag, Berlin.Google Scholar
McDonald, W.I. and Halliday, A.M. (1977). Diagnosis and classification of multiple sclerosis. British Medical Bulletin, 33, 4–8.CrossRefGoogle ScholarPubMed
Paty, D.W., Blume, W.T., Brown, W.F., Jaatoul, N., Kertesz, A., and McInnis, W. (1979). Chronic progressive myelopathy: Investigation with CSF electrophoresis, evoked potentials, and CT scan. Annals of Neurology, 6, 419–424.CrossRefGoogle ScholarPubMed
Poser, C.M. (1980). Diagnostic techniques in multiple sclerosis. Survey of Ophthalmology 25(2), 91–101.CrossRefGoogle ScholarPubMed
Poser, S., Bauer, H.J. and Ehlers, C. Th. (1980). Clinicopathological and epidemiological documentation of patients with multiple sclerosis. In: Progress in Multiple Sclerosis Research, pp. 626–628, edited by Bauer, H.J., Poser, S. and Ritter, G., Springer-Verlag, Berlin, Heidelberg. New York.CrossRefGoogle Scholar
Purves, S.J.Low, M.D., Galloway, J. and Reeves, B. (1981). A comparison of visual, brainstem auditory and somatosensory evoked potentials in multiple sclerosis. The Canadian Journal of Neurological Sciences, vol. 8, No. 1, 15–19.CrossRefGoogle ScholarPubMed
Ritchie, J.M. and Rogart, R.B. (1977). The density of sodium channels in mammalian myelinated nerve fibers and the nature of the axonal membrane under the myelin sheath. Proceedings of the National Academy of Science. U.S.A., 74: 211–215.CrossRefGoogle ScholarPubMed
Shahani, B.T., and Young, R.R. (1972). Human orbicularis oculi reflexes. Neurology 22, 149–154.Google ScholarPubMed
Stöhr, M., and Petruch, F., (1979). Somatosensory evoked potentials following stimulation of the trigeminal nerve in man. Journal of Neurology. 220. 95–98.CrossRefGoogle ScholarPubMed
Stöhr, M., Petruch, F., and Scheglmann, K. (1981). Somatosensory evoked potentials following trigeminal nerve stimulation in trigeminal neuralgia. Annals of Neurology. 9. 63–66.CrossRefGoogle ScholarPubMed
Waxman, S.G. (1977). Conduction in myelinated. unmyelinated and demyelinated fibers. Archives of Neurology. 34, 585–589.CrossRefGoogle ScholarPubMed
Wisniewski, H., Oppenheimer, D., and McDonald, W.I. (1976). Relation between myelination and function in MS and EAE. Journal of Neuropathology and Experimental Neurology, 35, 327.CrossRefGoogle Scholar