Multimodal evoked potentials in patients with multiple sclerosis in assessment of the course of the disease.

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory, demyelinating disease of the central nervous system with a multifocal damage. THE AIM: The assessment of the MS course by multimodal evoked potentials (EP). MATERIAL AND METHODS: We evaluated 95 patients (63 female, 32 male) with relapsing-remitting MS in the average age of 36.4±10.4. The average disease duration was 4.6±7.4 year. Among them, 48 patients (50.5%) were treated with immunomodulatory drugs. All patients underwent neurological examination and EP testing: VEP (visual evoked potentials), SEP (somatosensory evoked potentials), endogenous potential P300. The latencies of following waves were evaluated: P100 (VEP), N4 , N9 , N13, N20, P22 (SEP) and P300, with the reference values of the Neurophysiological Research Laboratory of the Department of Neurology in Zabrze. RESULTS: Abnormal VEP(I) was found in 80 patients (84.2%), SEP(I) in 9 patients (9.5%), P300(I) in 15 patients (15.8%). Abnormal result of the control research VEP (II) was found in 23 patients (82.1%), SEP(II) in 1 patient (3.6%), P300(II) in 4 patients (14.3%). The average values of the waves latencies in the control study were higher, however the statistical significance was not found. The correlation was observed between EDSS, and N20 and P22. No relationship was found between EP and age, disease duration, number of relapses and treatment. CONCLUSIONS: In the era of neuroimaging, usage of EP in the diagnosis and assessment of MS is limited. Electrophysiological studies may be used in addition to the clinical examination to confirm the multifocal damage.

In diabetic Charcot neuroarthropathy impaired microvascular function is related to long lasting metabolic control and low grade inflammatory process.

AIMS: The aim of this study was to assess microvascular function associated with the occurrence of Charcot neuroarthropathy (CN) in patients with diabetes. METHODS: We evaluated 70 diabetic patients (54 men) with Charcot neuroarthropathy (CN-DM), median age 59 (IQR: 51-62), mean disease duration 16±8years. The control group were 70 subjects with diabetes and without Charcot neuroarthropathy (DM), 54 men, median age 60 (54-62), mean diabetes duration 15±7years. We assessed metabolic control of diabetes, serum C-reactive protein concentration (CRP) and cardiovascular autonomic neuropathy (CAN). We used AGE-Reader to measure skin autofluorescence (AF) associated with accumulation of advanced glycation end products that reflects long lasting metabolic control. Microvascular function was examined by laser Doppler flowmetry (PERIFLUX 5000) with thermal hyperemia (TH) and postocclusive reactive hyperemia (PORH). RESULTS: CN-DM patients as compared to DM subjects had lower HbA1c level [7.6 (6.6-8.4) vs 8.4 (7.3-9.7)%, p<0.001], lower eGFR [75.9±24.1 vs 86.6±17.8ml/min/1.73m(2), p=0.003], higher CRP serum concentration [3.8 (2.3-10.1) vs 1.9 (0.8-4.4)mg/l, p<0.001] and higher skin autofluorescence [2.8 (2.5-3.1) vs 2.6 (2.3-2.9)AU, p=0.03]. The cardiovascular autonomic neuropathy (CAN) was more frequently diagnosed in CN-DM subjects [59 vs 27%, p<0.001]. The peak flow during thermal hyperemia (THmax) was lower in CN-DM subjects as compared to DM group [156 (93-240) vs 235 (155-300)PU, p=0.001]. We found negative correlation between THmax and CRP concentration (Rs=-0.34, p=0.003), TG concentration (Rs=-0.37, p=0.002) and skin AF (Rs=-0.32, p=0.04) and positive correlation between THmax and HDL cholesterol level (Rs=0.42, p<0.001) in CN-DM patients. There was also a positive correlation between PORHpeak and HDL cholesterol level (Rs=-0.23, p=0.04). CONCLUSION: Deterioration of microvascular function and autonomic system dysfunction are present in Charcot neuroarthropathy. Impaired microvascular reactivity is associated with worse long lasting metabolic control of diabetes and low grade inflammatory process.