From the Guidelines
VEP (Visual Evoked Potentials) testing is recommended for patients presenting with acute CNS demyelination of putative autoimmune etiology, particularly those with radiological or electrophysiological findings compatible with CNS demyelination, as stated in the 2018 study by the Journal of Neuroinflammation 1. The use of VEP testing is crucial in diagnosing and managing demyelinating diseases, as it provides valuable information about the functional integrity of the visual pathway.
- VEP testing can help identify patients with MOG-IgG-related disorders, which are characterized by acute optic neuritis, myelitis, and brainstem encephalitis.
- The 2018 study by the Journal of Neuroinflammation 1 recommends VEP testing for patients with monophasic or relapsing acute optic neuritis, myelitis, brainstem encephalitis, or any combination thereof.
- VEP testing can also be used to monitor disease activity and treatment response in patients with demyelinating diseases. In contrast to the 2001 study by the Annals of Neurology 1, which focuses on the diagnostic criteria for multiple sclerosis, the 2018 study by the Journal of Neuroinflammation 1 provides more specific guidance on the use of VEP testing in patients with acute CNS demyelination.
- The 2001 study by the Annals of Neurology 1 recommends the use of MRI, CSF analysis, and VEP testing in the diagnosis of multiple sclerosis, but does not provide specific guidance on the use of VEP testing in patients with acute CNS demyelination. Overall, VEP testing is a valuable tool in the diagnosis and management of demyelinating diseases, and should be used in conjunction with other diagnostic tests, such as MRI and CSF analysis, to provide a comprehensive evaluation of patients with acute CNS demyelination.
From the Research
Visual Evoked Potentials (VEP)
- VEP is a useful tool in assessing the extent of demyelination along the optic nerve in patients with multiple sclerosis (MS) and optic neuritis (ON) 2.
- VEP testing can be used to predict the extent of recovery after ON and capture disabling effects of clinical and subclinical demyelination events in the afferent visual pathway 2.
- Multifocal visual evoked potentials (mfVEP) are useful in detecting abnormality in patients with ON/MS and monitoring the progression of lesions (remyelination, atrophy) 3.
- mfVEP has good correlation with conventional visual evoked potential (VEP), standard automated perimetry, optical coherence tomography, and magnetic resonance imaging 3.
Diagnostic Value of VEP
- VEP may help distinguish resolved MS-related ON from resolved NMOSD-related ON 4.
- mfVEP is a sensitive and specific tool for detecting optic neuritis, with a sensitivity and specificity of 100% in detecting patients with ON due to MS when compared with normal patients 5.
- mfVEP provides direct topographical information of specific lesions and facilitates investigations on structural-functional correlations, thus providing new methods for exploring the interplay between demyelination, atrophy, and remyelination in MS 6.
Comparison of VEP in Different Conditions
- ON-MS eyes showed significantly delayed N75 and P100 latencies, while ON-NMOSD eyes showed significantly lower N75/P100 amplitudes and P100/N135 amplitudes 4.
- mfVEP latency z-scores had a significant difference among all ON groups, with a bimodal distribution in the possible MS group 5.
- Abnormal mfVEP responses in the fellow, non-ON afflicted eye may predict MS risk in ON patients 6.