Visual evoked responses and visual symptoms in multiple sclerosis

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Abstract
Absolute latency, interocular difference in latency, and waveform of visual evoked responses (VER) to checkerboard reversal stimuli recorded from the midline of the skull were studied in 104 multiple sclerosis patients, 25-50 yr of age, classified according to visual symptomatology. Group 1 had strong evidence of past or present optic neuritis. Patients with blurring of vision, diplopia, and undefined visual complaints were assigned to group 2, while group 3 contained patients with no visual symptoms but suspected diagnosis of multiple sclerosis on other grounds. The 3 parameters explored showed consistent association with the degree of visual involvement, as assessed by clinical impression, but their discriminatory power was diverse. Absolute latency was significantly longer in group 1 patients compared with groups 2 and 3, but it did not discriminate between the last 2, whereas interocular difference in latency was sensitive to differences between symptomatic (diplopia, blurring) and asymptomatic groups (2 and 3). Waveshapes were grouped into 3 categories based upon degree of distortion of the major positive peak, and their relative distribution among the 3 patient groups was associated with symptomatology. In the production of symptoms such as diplopia, a temporal disparity of afferent impulses might be involved in much the same way that spatial incongruities between both eyes lead to impaired function. Interocular difference in latency rather than absolute latency would be a more accurate predictor of symptom development. The analysis of VER waveshape also suggests the importance of inhomogeneous involvement of the visual pathways in the production of symptoms during the evolution of multiple sclerosis.