Leland Mylin

Pattern electroretinograms and visual-evoked potentials in glaucoma and multiple sclerosis.

Steady-state visual-evoked potentials and electroretinograms were simultaneously recorded in four patients with glaucoma and in five patients with multiple sclerosis. The stimuli included a homogenous field and a 2.3 cycles per degree sinusoidal grating that were counter-phase modulated at the rate of 7.5 Hz. We used narrow bandwidth spectral analysis to measure the response amplitudes and signal-to-noise ratios. Transient pattern visual-evoked potentials (1 Hz) were also measured for latency in each eye. We found abnormal pattern electroretinograms, based on the absence of a significant second harmonic component, in three of the four glaucomatous eyes although the homogenous field electroretinograms were normal. In the patients with multiple sclerosis, the pattern electroretinograms were abnormal in two eyes, but the transient visual-evoked potential latency had the highest diagnostic yield (seven of ten eyes).

A short latency cortical component of the foveal VEP is revealed by hemifield stimulation

Transient evoked potentials were recorded simultaneously over 5 electrodes placed in a horizontal row across the occiput. A range of spatial frequencies were presented as either full-field or hemifield stimuli. Subjects were 11 normal observers and 5 patients with lesions causing a homonymous hemianopic field defect. The shortest latency peak response was at approximately 70 msec, a negative potential (N70). For all spatial frequencies, full-field stimuli evoked a lower amplitude N70 at the midline than the sum of N70 amplitudes to two hemifield stimuli, suggesting partial cancellation. The latency and amplitude of N70 increased as spatial frequency increased. N70 and P100 differed in respect to their response to spatial frequency and field size, further suggesting that they may not be subsets of a unitary response. For hemifield stimulation, N70 had an ipsilateral maximum and attenuated or completely reversed in polarity across the midline. Consistent with the data of normals using hemifield stimuli, in 5 patients a full-field stimulus elicited an N70 lateralized contralaterally to the homonymous hemianopia, i.e., the ipsilateral N70 was absent. The absolute amplitude difference between the left and right electrodes was significant for hemifield stimulation in normals and full-field stimulation in the patients, but not for full-field stimulation in normals. Our results imply that the evaluation of N70 hemispheric distribution is useful for the evaluation of paramacular visual field defects.

N70 and P100 can be independently affected in multiple sclerosis

We have studied the relationship between N70 and P100 of the pattern visual evoked potential in 98 patients with multiple sclerosis and in 59 controls. In patients with multiple sclerosis, P100 was either absent or had prolonged latency in 121 eyes (61.7%), while N70 was absent or prolonged in 97 eyes (49.5%). The total number of eyes with either N70 and/or P100 abnormalities was 137 (69.9%). Eighty eyes (40.8%) had abnormal latency of both P100 and N70, while 41 eyes showed P100 delays without corresponding N70 changes. Seventeen eyes had abnormal N70, but normal P100 latency. N70 and P100 appear to be more often absent in the definite rather than in the possible multiple sclerosis group. These data show that N70 and P100 can be independently affected in patients with MS.

Binocular stimulation reveals cortical components of the human visual evoked potential

Dynamic random dot correlograms (RDCs) produced by a rear-projection television system elicited visual evoked potentials (VEPs) in a sample of 10 observers corrected to emmetropia. When the observers viewed the RDCs binocularly through stereo wave length filters, characteristic wave forms were recorded. Four components were reliably recorded at the onset and the offset of the correlated state of the RDCs. These components differ with statistical significance (P less than 0.05) from each other. These RDC VEPs provide a practical technique to evaluate the integrity of binocular and, by inference, cortical processes.

Delayed visual evoked potentials are independent of pattern orientation in macular disease

Visual evoked potentials (VEPs) and contrast sensitivity (CS) were studied in patients affected by maculopathy. VEP delays and CS reduction were demonstrated in each affected eye. In distinction to patients affected by multiple sclerosis (MS), in maculopathy patients VEP latency is independent of the orientation of the grating stimulus. It is proposed that stimulating with more than one pattern orientation is useful in the differential diagnostic use of VEPs.

Visual evoked potential latencies in papilledema and hydrocephalus

Visual evoked potentials (VEPs) obtained by using counterphase gratings were studied in adult patients with hydrocephalus and papilledema and in patients with papilledema due to brain tumor but without hydrocephalus. Transient VEPs were delayed only if hydrocephalic ventricular enlargement was present, while normal VEPs were recorded from patients with papilledema but without hydrocephalus. In three cases studied before and after treatment a reduction of the latency of the transient VEP corresponded to a reduction of ventricular size in patients with hydrocephalus. The steady-state VEPs similarly paralleled the recovery following therapy, but the response to specific spatial frequencies, the time of recovery, and measurements of interocular differences revealed that the two types of EP (i.e., recorded at slow and faster temporal rates) may tap different systems. The study of VEPs is proposed as a method of evaluating shunt patency in hydrocephalic patients.

Plasticity of monocular and binocular vision following cerebral blindness: evoked potential evidence.

Using monocular and dynamic random dot correlogram (DRDC) stimuli, sequential visual evoked potentials changes were demonstrated in 2 patients following cerebral blindness. The recovery of binocular vision was delayed in comparison to the recovery of monocular vision. The results are not due to simple acuity impairment or convergence deficiency, and thus provide evidence for the vulnerability of postsynaptic cortical mechanisms of human binocular vision.

Topographical analysis of the onset VEP in the detection of paracentral visual field defects.

Transient visual evoked potentials (VEP) were recorded simultaneously from 16 electrodes evenly placed over posterior scalp locations covering the occipital, posterior parietal and temporal areas. Interhemispheric amplitude difference of the N70 deflection was established across 6 homologous lateral electrode pairs in 15 normal controls and 32 patients with chiasmatic or retrochiasmatic cerebral lesions. Twenty-three of these had known homonymous or bitemporal field defects while 9 had normal fields on routine perimetry. Significant interhemispheric asymmetry of any single electrode pair occurred in 55% of the 32 patients with known pathology, while the cumulative yield of all electrode pairs was over 80 percent. The diagnostic yield of individual electrode pairs was significantly different: the electrode pair placed over the temporo-parietal junction detected the highest number of abnormalities. The cumulative abnormality taken over all lateral electrode pairs could be described with a curve well fitted with a probability summation function. It is inferred that the contribution of several independent generator sources is reflected in the N70 of the pattern onset VEP. The results suggest that multichannel recording of the interhemispheric amplitude distribution of the N70 of the onset VEP is useful for the evaluation of paracentral visual field defects.