Clinical evaluation of VEPs to interleaved checkerboard reversal stimulation of central, hemi- and peripheral fields

Abstract

The VEPs of 195 patients referred for supportive evidence of multiple sclerosis or optic neuritis were studied by a new method of interleaved checkerboard reversal stimulation of different areas of the visual field. In the first group of 95 patients checks of 40′ subtense reversed in the whole field (28° × 20°), alternately in the left and right hemifields and alternately in the central (5° radius) and peripheral fields. In the second group of 100 patients checks reversed in the whole field and in interleaved mode in 3 visual field areas, comprising the central (4° radius) and left and right hemisurround fields. In the first group abnormal responses were recorded from 52 eyes and there was partial disagreement among the stimulus conditions in 10 of the 52. Abnormalities were seen uniquely to central field stimulation in 3 eyes but never to whole field stimulation alone. In the second group abnormal responses were recorded in 58 eyes, again never uniquely to whole field stimulation, while abnormalities confined to one or two areas of the visual field were seen in 24, providing evidence of peripheral field involvement alone in 8 eyes. In the first group, waveforms created from the sum of the left and right hemifield and central and peripheral field responses showed quite close conformity to the whole field VEP, although amplitudes were significantly lower and latencies significantly shorter. In 7 eyes responses would have been differently classified (normal or abnormal) using the sum as compared with the whole fields. The sum of the 3 interleaved stimuli was less reliable, its morphology often not closely approximating whole field responses. It is suggested that interleaved stimulation of two or more areas of the visual field is a sensitive and reliable method which reduces the time necessary to perform the test and helps control the patients' concentration, fixation and alertness. Whole field stimulation is probably necessary only in patients with severely degraded responses.