Reappraisal of neurophysiological examinations and therapeutic neuromodulation

      Multiple Sclerosis is characterized by a dynamic combination of demyelination, remyelination and axonal degeneration. Magnetic Resonance Imaging have provided important information on these pathological processes, however even the more recent technical developments lack pathological specificity. Evoked Potentials (EPs) may provide useful information because of the high temporal resolution of the techniques allowing to accurately capture the dynamic process of demyelination/remyelination and at the same time they may also inform about axonal loss. The diagnostic value of EPs is limited because of the clear superiority of MRI in revealing subclinical involvement of the central nervous system, with the exception of the involvement of the optic nerve. For this area the recently developed technique of multifocal visual evoked potentials (mVEP) is able to reveal even small focal lesions. Moreover, EPs may also provide information on the pathological damage affecting the nervous pathways. Conventional scores derived from multimodal EPs have shown good correlation with clinical measures of disease severity, with a major contribution coming from motor and somatosensory potentials. These global measures of nervous pathways involvement may also provide some prognostic information. The use of EPs as biomarkers in clinical trials is limited, however VEP have been succesfully used in phase II clinical trials exploring the efficacy of remyelination strategies. Brain Magnetic Stimulation has been initially used as a diagnostic tool to test motor pathways. More recently the technique has been applied to modulate brain plasticity and some preliminary studies in multiple sclerosis have revealed positive effects on spasticity, gait, pain, bladder dysfunction and cognitive deficits.
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