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A Method to Separate Demyelination From Axonal Damage to the Optic Nerve

Gastone G. Celesia, MD; David Kaufman, DO; Sandra B. Cone, MS

Arch Neurol. 1986;43(12):1247-1252.

Abstract
• Pattern electroretinograms (P-ERGs) and visual evoked potentials (VEPs) were recorded in 35 patients with multiple sclerosis and in 35 age-matched normal subjects. Four patterns of abnormalities were noted in the group with multiple sclerosis. The most frequent abnormality consisted of the following: normal P-ERG, delayed P100, and prolonged interpeak interval between the b-wave of the P-ERG and P100 (retinocortical time). This pattern indicates demyelination of the optic nerve. A second pattern consisted of absent P-ERG and absent VEP. This pattern was associated with optic atrophy and/or central scotoma, indicating severe optic nerve axonopathy with retrograde degeneration of ganglion cells. A third pattern consisted of normal P-ERG and absent VEP, suggesting a total block of transmission at the optic nerve. A fourth pattern consisted of present but low-amplitude P-ERG, delayed VEP, and prolonged retinocortical time, indicating a demyelinating process with partial axonal involvement. The concomitant use of P-ERG and VEP results in a better classification of the type and severity of dysfunction affecting the optic nerve. The prognostic value of the four patterns for recovery of visual function is discussed.

Author Affiliations
From the Department of Neurology, Loyola University School of Medicine, Maywood, Ill (Dr Celesia and Ms Cone); the Department of Neurology, Veterans Administration Medical Center, Hines, Ill (Dr Celesia and Ms Cone); and the Department of Neurology, Michigan State University, East Lansing (Dr Kaufman).

Footnotes
Accepted for publication Aug 25, 1986.

Reprint requests to the Department of Neurology, Loyola University School of Medicine, 2160 S First Ave, Maywood, IL 60153 (Dr Celesia).

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