Pattern-onset Visual Evoked Potentials Research Articles

Distinct Patterns of P1 and C2 VEP Potentiation and Attenuation in Visual Snow: A Case Report.

Visual snow syndrome, characterized by persistent flickering dots throughout the visual field, has been hypothesized to arise from abnormal neuronal responsiveness in visual processing regions. Previous research has reported a lack of typical VEP habituation to repeated stimulus presentation in patients with visual snow. Yet these studies generally used pattern-reversal paradigms, which are suboptimal for measuring cortical responses to the onset of foveal stimulation. Instead, these responses are better indexed by the C2, a pattern-onset VEP peaking 100–120 ms after stimulus onset. In this case study, we analyzed the C2 and its adaptation profile in data previously collected from a single patient with visual snow using a “double-pulse” presentation paradigm. In controls, shorter intervals between stimulus pairs were associated with greater attenuation of the C2 VEP, with recovery from adaptation at longer stimulus onset asynchronies (SOAs). However, the visual snow patient showed the opposite pattern, with reduced C2 amplitude at longer SOAs despite distinct C2 peaks at the shortest SOAs. These results stand in contrast not only to the pattern of C2 VEP attenuation in controls, but also to a lack of adaptation previously reported for the pattern-onset P1 VEP in this patient. Exploratory source localization using equivalent current dipole fitting further suggested that P1 and C2 VEPs in the visual snow patient arose from distinct sources in extrastriate visual cortex. While preliminary, these results support differential patterns of VEP attenuation and potentiation within the same individual, potentially pointing toward multiple mechanisms of abnormal neuronal responsiveness in visual snow syndrome.

Characterising the orientation-specific pattern-onset visual evoked potentials in children with bilateral refractive amblyopia and non-amblyopic controls.

An orientation-specific visual evoked potential (osVEP) protocol was developed to probe meridional anisotropies in children with refractive amblyopia. The aim was to characterise the osVEP response in children with bilateral refractive amblyopia, evaluate the intra-session repeatability of the main osVEP components (C1, C2 and C3), coefficient of repeatability (CoR) of the response to gratings in different meridians and determine if refractive amblyopes have poorer repeatability as compared with non-amblyopic controls. Children aged 4-7years with newly diagnosed and untreated bilateral refractive amblyopia and non-amblyopic controls were recruited. Orientation-specific pattern-onset VEPs were recorded in response to an achromatic sinewave grating stimulus of 4 cycles per degree under monocular and binocular stimulation. The grating lines used for monocular stimulation were parallel with the subjects' most positive and negative astigmatic meridians when considered in sphero-minus cylinder form (Meridians 1 and 2, respectively). In subjects without astigmatism, meridians 1 and 2 were designated horizontal and vertical gratings, respectively. Binocular stimuli were presented with grating lines parallel to meridians 45, 90, 135 and 180°. The repeatability of latencies of the main osVEP components (C1, C2 and C3) were investigated using two successive osVEPs recordings for each stimulus meridian and the CoR for each component's latencies were assessed. Seven amblyopic children (Visual acuity (VA) ranging from 0.08 to 0.40 LogMAR in the less amblyopic eye and 0.26-0.52 LogMAR in the more amblyopic eye) and 7 non-amblyopic controls (VA ranging from 0.00 to 0.02 LogMAR in either eye), with a median age of 4.6 and 7.0years, respectively, completed the study. C1 had the highest CoR for most conditions assessed. Ratio of CoRs C1:C2 was > 2 for all binocular meridians in controls and the 90 and 180 meridians in the amblyopes; C1:C3 was > 2 for the binocularly assessed 45, 90 and 135 meridians in the controls and the 90 and 180 meridians in the amblyopes; C2:C3 were all < 2 for all meridians assessed in both groups. The osVEP waveforms are reliable and useful for future investigations into the meridional anisotropies in children with refractive amblyopia, particularly the C3 component. Component C1 had the poorest repeatability, which consequentially affected C2 amplitude estimation. Only C3 amplitude and latency could be consistently estimated as C2 and C3 latencies were similarly repeatable. Coefficients of repeatability of osVEP latencies did not appear to systematically differ between non-amblyopic and amblyopic children.

Pattern-onset and OFFset visual evoked potentials in the diagnosis of hemianopic field defects.

Visual evoked potentials (VEPs) assess the function of the visual pathway from the retina to the primary visual cortex. There is much evidence that monocular pattern-reversal and flash VEPs can distinguish dysfunction due to chiasmal and post-chiasmal afferent pathway lesions. There is less evidence about the use of pattern-onset/OFFset VEPs to identify post-chiasmic dysfunction. We present nine patients with a range of visual pathway defects that caused dense hemianopic field defects. These patients had pattern onset-OFFset VEPs recorded from an array of occipital electrodes referred to a mid-frontal electrode to checks that appeared for 230ms and disappeared for 300ms into a background of mean luminance, in a stimulus field of 30°. We found pattern-onset VEP components lateralise to occipital electrodes overlaying the functional hemisphere, whereas pattern-OFFset VEP components demonstrate the paradoxical lateralisation phenomenon, described in reversal VEPs, and are maximal over the contralateral occiput. Our findings show how extending the recording time window to include an OFFset VEP facilitates identification of hemianopic visual field defects. We advocate the pattern-onset/OFFset VEP in the assessment of patients with hemianopia, having particular value for patients who are otherwise unable to perform more demanding half-field electrophysiology, imaging or psychophysical testing.

Differences in early and late pattern-onset visual-evoked potentials between self- reported migraineurs and controls

Striped patterns have been shown to induce strong visual illusions and discomforts to migraineurs in previous literature. Previous research has suggested that these unusual visual symptoms to be linked with the hyperactivity on the visual cortex of migraine sufferers. The present study searched for evidence supporting this hypothesis by comparing the visual evoked potentials (VEPs) elicited by striped patterns of specific spatial frequencies (0.5, 3, and 13 cycles-per-degree) between a group of 29 migraineurs (17 with aura/12 without) and 31 non-migraineurs. In addition, VEPs to the same stripped patterns were compared between non-migraineurs who were classified as hyperexcitable versus non-hyperexcitable using a previously established behavioural pattern glare task. We found that the migraineurs had a significantly increased N2 amplitude for stimuli with 13 cpd gratings but an attenuated late negativity (LN: 400 - 500ms after the stimuli onset) for all the spatial frequencies. Interestingly, non-migraineurs who scored as hyperexcitable appeared to have similar response patterns to the migraineurs, albeit in an attenuated form. We propose that the enhanced N2 could reflect disruption of the balance between parvocellular and magnocellular pathway, which is in support of the cortical hyperexcitation hypothesis in migraineurs. In addition, the attenuation of the late negativity could reflect a top-down feedback mechanism to suppress visual processing of an aversive stimulus.

The Detection Of Misrouting In Albinism: Evaluation of Different VEP Procedures in a Heterogeneous Cohort.

To investigate the optimal procedures for multichannel visually evoked potentials (VEPs) to detect misrouting in albinism subjects. Investigations were done in a phenotypically heterogeneous group of 180 albinism subjects and 187 controls with and without ocular pathology. We retrospectively compared standard flash VEP (fVEP), high-frequency fVEP with a handheld device (hh fVEP), pattern-onset VEP (poVEP), and short-onset acuity sweep VEP. The diagnostic power of these stimuli were estimated by calculating the area under the curve (AUC). Subjects were divided in three age groups (<3, 3-6 [toddler], and ≥6 years). Subjects ≥6 years of age were further divided in two visual acuity groups (≤0.3 logMAR and >0.3 logMAR). The optimal stimulus was hh fVEP, standard fVEP, and poVEP 60' for subjects <3, 3-6, and ≥6 years of age, respectively. In subjects ≥6 years old with poor visual acuity, the area under the curve of fVEP was almost equal to that of poVEP 60'. For the optimal detection of misrouting with multichannel VEP recordings, we recommend using a high-frequency hh fVEP in children <3 years of age, standard fVEP in toddlers, and poVEP 60' in subjects ≥6 years of age. fVEP can also be used in the oldest age group for subjects with visual acuity of >0.3 logMAR. Remarkably, some albinism subjects showed misrouting on full-field stimulation but normal routing of the central retina, suggesting that not the whole line of decussation is shifted temporally.

Pattern Onset ERGs and VEPs Produced by Patterns Arising From Light Increment and Decrement.

Our aim was to elaborate how on and off signals contribute to pattern ERGs and pattern visual evoked potentials (VEPs) by using pedestal patterns arising from incremental and decremental onset stimulation. Pattern onset/offset ERGs and VEPs were produced by black and white checks of 60' side length and 88% spatial contrast appearing in a 16° field for 200 ms from white (110 cd/m2), black (7 cd/m2), and gray (48 cd/m2) backgrounds and disappeared for 1000 ms. Twenty healthy subjects participated in the study (median age 19.5, range, 5-31 years), 10 of whom also underwent pattern onset/offset ERG recordings to the same stimuli (median age 25.7, range, 22-31 years). VEPs were recorded from an occipital array referred to Fz. Pattern electroretinograms (PERGs) were recorded from "Dawson-Trick-Litzkow" (DTL) plus corneal electrodes referred to ipsilateral outer canthi. There was high correlation within subjects of the VEP waveform produced by patterns arising from light increment and decrement (group mean correlation coefficient of PVEPs to check appearance from black versus white: 87%). An average of increment and decrement PERGs simulated the onset PERG from a gray background. This waveform is akin to standard International Society for Clinical Electrophysiology of Vision (ISCEV) clinical PERGs to reversing checks. In healthy individuals, the early components of the pattern onset/offset VEP waveforms are comparable to light increment and decrement pedestal stimulation. Pattern onset/offset ERGs to pedestal stimulation may be used to probe simultaneous recording of ERGs with VEPs in order to obtain an assessment of retinal ganglion cell and optic pathway function in patients with less stable fixation.

The changing shape of the ISCEV standard pattern onset VEP

PurposePattern onset VEPs do not always show distinct C1–C2–C3 peaks and troughs. Our purpose was to study changes in pattern onset VEP with age to determine when the illustrated ISCEV standard onset VEP waveform can be reliably recorded.MethodsWe recorded pattern onset VEPs from an Oz electrode referred to mid-frontal electrode according to ISCEV standards by presenting checks of 60′ and 15′ side length in a 15° field. Twenty-four adults aged 20–63 years participated. Amplitudes and latencies were collated. Pattern onset adult VEP shapes were compared to the waveform published in the ISCEV VEP standard and to paediatric pattern onset VEP waveforms recorded from 16 infants aged 7 months.ResultsThe shape of the pattern onset VEP changed gradually with age. The C1–C2–C3 morphology of the ISCEV standard pattern onset VEP becomes apparent consistently after 40 years to 60′ check stimulation. As age increases a negative trough, C2 is more frequently seen; however, the broad positive peak which characterises infant onset VEPs may still be recorded at 20 years. The group median measurements of onset VEPs to 60′ were C1 7 µV@ 88 ms (range 67–110 ms), C2 9 µV@109 ms (range 89–158 ms) and C3 13 µV@121–246 ms. To smaller 15′ checks, peak latencies were earlier and C2 became more obvious. The group median measures of onset VEPs to 15′ were C1 2 µV@69 ms (55–108 ms), C2 10 µV@90 ms (77–145 ms) and C3 14 µV@122 ms (99–200 ms).ConclusionThe ISCEV standard onset VEP best describes the waveform configuration and latency of the onset VEP produced by 60′ checks in adults of more than 40 years of age. The onset VEP waveform produced by 15′ checks is distinguished by more prominent negative C2 and earlier C1 and C2 latencies.

Non-organic visual loss in children: prospective and retrospective analysis of associated psychosocial problems and stress factors.

To report on the prevalence of non-organic visual loss (NOVL) and its associated psychopathology and psychosocial stress factors on children presenting with visual problems without an obvious cause at a routine ophthalmological examination. One hundred and seventy children presented at our paediatric ophthalmology department between 2007 and 2014 with visual loss. Routine examination showed no obvious underlying cause. Pattern-onset visual-evoked potentials (pVEPs) were performed to obtain an objective visual assessment. Selected patients underwent more investigations, and follow-up was organized in every child to differentiate organic visual loss (OVL) from NOVL. In the NOVL group, we retrospectively analysed the medical file data and prospectively the questionnaires completed by patients and their parents. Eighty-five children (50%) were diagnosed with OVL, the other 50% of children were diagnosed with NOVL. In the latter, girls predominated and the mean age was 11.0years. The most common presenting symptom was binocular reduced visual acuity. pVEPs were normal in all patients. We categorized associated comorbidity in the NOVL group in three subgroups: malingering, psychosocial stressors and child psychiatric disorders. Non-organic visual loss in children is a common diagnosis in clinical practice. The diagnosis is made by recognition of characteristic features and by exclusion of organic disease. pVEP is a useful tool to obtain an objective visual acuity and to differentiate functional from organic vision loss. The prognosis in NOVL is good with a spontaneous recovery in the majority of patients. Ophthalmologists should be aware of possible underlying psychosocial and psychiatric disorders; referral can be necessary.

Visual outcome in infants born to drug-misusing mothers prescribed methadone in pregnancy

BackgroundFlash visual evoked potentials (VEPs) were abnormal in a cohort of 100 neonates exposed to maintenance methadone in utero. This prospective cohort study now describes clinical visual and electrophysiological outcomes...

VEP characteristics in children with achiasmia, in comparison to albino and healthy children

Achiasmia is a rare disorder of visual pathway maldevelopment that can show diverse clinical and magnetic resonance imaging spectra. The aim of this study was to define the characteristics of visual evoked potentials (VEPs) that differentiate abnormal optic-nerve-fibre decussation in children with achiasmia versus children with albinism and healthy children. In four children with achiasmia, the following VEP characteristics were studied and compared to children with ocular albinism and with healthy control children: (a) flash and pattern onset VEP interhemispheric asymmetry; (b) flash N2, P2 and onset C1 amplitudes and latencies; (c) interocular polarity differences in interhemisphere potentials; and (d) chiasm coefficients (CCs). In the children with achiasmia, VEPs were related to an absence of or reduced optic-nerve-fibre decussation at the chiasm and showed: ipsilateral asymmetry, significantly higher VEP amplitudes over the ipsilateral hemisphere (p<0.05), interocular inverse polarity and negative CC. Other VEP features (uncrossed asymmetry and positive CC) were also seen if additional visual pathway maldevelopment (such as severe optic nerve hypoplasia and/or absence of the optic tractus on one side) were associated with achiasmia. In the children with albinism, the VEPs were related to excess optic-nerve-fibre decussation at the chiasm and showed: contralateral asymmetry, significantly higher VEP amplitudes over the contralateral hemisphere (p<0.001), interocular inverse polarity and negative CC. In achiasmia and albinism, the VEPs to flash stimulation were more robust and more clearly distinguished between the conditions compared with the VEPs to pattern onset stimulation. VEPs in achiasmia are associated with absent or reduced optic-nerve-fibre decussation, where ipsilateral interhemispheric asymmetry is associated with interocular inverse polarity and a negative CC.

Optic Nerve Projections in Patients with Primary Ciliary Dyskinesia

Recently, it has been suggested that misprojections of the temporal retina to the contralateral hemisphere might not be specific for patients with albinism and might also be associated with the Kartagener syndrome (i.e., with situs inversus totalis in the presence of primary ciliary dyskinesia [PCD]). The authors tested whether such projection abnormalities are associated with PCD and situs inversus. In 10 patients with PCD (five with situs inversus totalis) and in 10 age- and sex-matched controls, visual evoked potentials (VEPs) were recorded monocularly, as follows: conventional pattern-onset VEPs (cVEPs) and multifocal VEPs (mfVEPs) for 60 locations constituting a visual field of 44° diameter. cVEPs from 13 albinotic subjects were included as a reference. For each eye, interhemispheric difference potentials were calculated and correlated with each other to assess the lateralization of the responses: positive and negative correlation coefficients indicated lateralizations on same or opposite hemispheres, respectively. Misrouted optic nerves are expected to yield negative interocular correlations. For both cVEPs and mfVEPs, the distribution of the correlation coefficients in the PCD patients yielded largely positive values and did not differ from that of the controls. Consequently, neither large- nor small-scale lateralization abnormalities were observed in PCD. Further, the optic nerve projection did not depend on the presence of situs inversus. The absence of evidence for projection abnormalities in a cohort of 10 subjects with PCD, five of whom had Kartagener syndrome, underscores that misrouting of the optic nerves is not a common trait of these subjects.

Low-Luminance Contrast Stimulation Is Optimal for Early Detection of Glaucoma Using Multifocal Visual Evoked Potentials

The blue-on-yellow multifocal visual evoked potential (BonY mfVEP) stimulus is more sensitive than the conventional black-and-white pattern-reversal stimulus in identifying early glaucoma. BonY employs pattern-onset stimulation and lower luminance contrast (40%) in addition to color. This study was conducted to elucidate the mechanism responsible for the enhanced performance of the BonY stimulus. Multifocal pattern-onset VEPs were recorded in response to BonY, high-luminance contrast achromatic (HLA) and low-luminance contrast achromatic (LLA) stimulations in 30 normal subjects (to construct normative databases) and 23 patients with early glaucoma (mean deviation [MD] < 6 dB). In addition, the specificity of BonY and LLA stimulation was examined in a subset of 25 normal subjects. In normal subjects, LLA mfVEPs had significantly lower amplitudes than did BonY and HLA mfVEPs (P < 0.001), which were not significantly different from each other. In glaucomatous eyes, all three stimuli demonstrated significantly reduced amplitudes in comparison with those of normal eyes. Although the sensitivities of both BonY and LLA in identifying subjective visual field defects were similarly high (93% and 89.7%, respectively), HLA showed only a 79.3% detection rate. BonY and LLA demonstrated significantly higher defect severity scores than did HLA (P < 0.05 for both). Specificities for BonY and LLA were similar (96%). BonY and LLA mfVEPs performed comparably, and both were significantly better than the HLA mfVEP in identifying early glaucoma. Enhanced performance of BonY stimulation is most likely due to its low-luminance contrast component rather than the pattern-onset mode of presentation or its chromatic properties.

Exposure to maternal methadone in utero: visual and developmental outcomes at 6 months

AimsThere is increasing evidence that maternal drug misuse in pregnancy may have adverse effects on infant visual and/or developmental outcome, but to date this has not been quantified. We have...

Attentional shifts have little effect on the waveform of the chromatic onset VEP

Attention is important for sufficient performance on many visual tasks. This has been shown using achromatic steady-state and pattern-reversal VEPs. Waveform characteristics typically attenuate when attending to distractor stimuli and ignoring VEP stimuli. Chromatic pattern-onset responses have not been tested under conditions of selective attention: as they can be used in clinical settings to test color vision, it is important to know what effects attentional shifts would have on this response. In the present study chromatic pattern-onset VEPs were recorded using spatially divided and spatially contiguous VEP and distractor stimuli. VEP stimuli were 1 cycle.deg(-1) horizontal sine wave patterns (onset mode 100 ms on/400 ms off) used to selectively modulate the L-M and S-(L+M) visual pathways. Distracter stimuli were letters. Subjects attended to either the letters or the gratings and pressed a button when a predetermined stimulus appeared. In Experiment one, VEP and distractor stimuli were superimposed and spatially contiguous. In Experiment two, stimuli were presented to different hemifields. No significant changes in waveform amplitude and latency were found between VEP and distractor attention conditions for either visual pathway. For the chromatic pattern-onset response, modulation of attention does not change responses either with spatially contiguous or spatially separate selective attention manipulations. Consequently, it may not be necessary to monitor attention during recording of this response.

Chromatic pattern-onset VEPs are robust to inattention

Chromatic pattern-onset VEPs are robust to inattention

Studying electrophysiological characteristics in children with congenital sensory nystagmus‐ case presentations

Abstract Purpose In classification of sensory congenital nystagmus (CN) is important to recognize the underlying retinal or visual pathway dysfunction. The aim was to distinguish ERGs and VEPs charcteristics which may identify among variety of disorders associated with sensory CN. Methods In infants and small children that were ophthalmologically classified as sensory CN were ERGs and VEPs recorded simultaneously in the same session. ERGs were detected without dilated pupils and with skin electrodes. Under darkened laboratory conditions were ERGs recorded to white (cone/rod mediated response) and dim blue (rod mediated response) flash and under lighten room were ERGs recorded to white, red and 30 Hz flicker flash (cone mediated responses). VEPs were recorded from three occipital electrodes to flash and onset stimulation. Results Cases with abnormal ERGs showed: in Leber’s congenital amaurosis were undetectable both rod and cone mediated responses from early infancy; in cone‐rod retinal dystrophy abnormal cone and rod mediated responses progressed in time; in achromatopsia abnormal cone mediated responses did not progress in time; in congenital stationary night blindness a negative ERG did not progress in time. Cases with abnormal VEPs showed: in ocular albinism VEP contralateral asymmetry; in achiasmia VEP ipsilateral asymmetry; in severe optic nerve hypoplasia flash VEP was non‐recordable, while in moderate optic nerve hypoplasia flash and pattern onset VEP findings might not correlate with clinic findings. Conclusion Sensory CN is associated with a variety of disorders affecting the retina, optic nerve, chiasm and electrophysiology may characterize retinal or postretinal pathway dysfunction and therefore help in early diagnosis.

Changes in chromatic pattern-onset VEP with full-body inversion

Intra-ocular pressure (IOP) increases to double that of its normal level under full-body inversion, in part simulating high IOPs found in glaucoma and ocular hypertension. Inversion also simulates negative g-forces experienced in aerobatic maneuvers such as those produced during aerial combat. Studies using achromatic pattern-reversal visual evoked potentials (VEPs) have shown losses in response amplitude when subjects are inverted and IOP is increased. In other studies, chromatic, pattern-onset VEPs have been shown to be a sensitive and objective indicator of ocular and systemic pathology. Thus, chromatic pattern-onset VEPs may also show changes in amplitude and/or latency when subjects are subjected to full-body inversion. In this study we employed chromatic, pattern-onset VEPs to determine if there were changes in response latency for the different visual pathways with healthy subjects during full-body inversion. Stimuli were 1 cpd horizontal sine-wave patterns presented in an onset mode (100 ms on/400 ms off). Subjects (n = 7) were tested at low to medium contrast levels, which were subjectively equated across chromatic pathways (S, LM, and achromatic). Patterns were presented using LCD goggles. All subjects showed a small but statistically significant increase in latency in the large negative component (CII) for both L - M and S - (L + M) pathways during inversion. The achromatic pathway also showed a statistically significant increase in latency to the positive component (CI) during inversion. These results demonstrate that changes in ocular and/or systemic physiology during full-body inversion can result in increased latencies of chromatic and achromatic pattern-onset VEPs.

Effects of attention on the chromatic pattern on-set VEP

Effects of attention on the chromatic pattern on-set VEP

Is Optic Nerve Fibre Mis-Routing a Feature of Congenital Stationary Night Blindness?

To determine whether patients with congenital stationary night blindness (CSNB) have electrophysiological evidence of optic nerve fibre mis-routing similar to that found in patients with ocular albinism (OA). We recorded the Pattern Onset VEP using a protocol optimised to detect mis-routing of optic nerve fibres in older children and adults. We tested 20 patients (age 15-69 yrs) with X-linked or autosomal recessive CSNB, 14 patients (age 9-56 yrs) with OA and 13 normally pigmented volunteers (age 21-66 yrs). We measured the amplitude and latency of the CI component at the occipital midline and over left and right occipital hemispheres. We also assessed the computed inter-hemispheric "difference" signal. Subjects with CSNB were classified as having the "complete" or "incomplete" phenotype on the basis of their ERG characteristics. Members of X-linked CSNB pedigrees underwent mutation screening of the NYX and CACNA1F genes. CI was significantly smaller over the ipsilateral hemisphere and more prominent over the contralateral hemisphere in OA patients compared with both controls and CSNB patients. In CSNB patients CI response amplitudes were not significantly different from controls but peak latency was prolonged at all three electrodes compared with controls. The inter-hemispheric "difference" signal was abnormal for the OA group but not for the CSNB group. Contralateral dominance of CI could be identified in the majority of OA patients and the "difference" signal was opposite in polarity for left compared with right eye stimulation in every patient in this group. Only 3 of 20 patients with CSNB showed significant inter-hemispheric asymmetry similar to that seen in the OA patients. All 3 CSNB patients with evidence for optic nerve fibre mis-routing had X-linked pedigrees: 2 had an identified mutation in the NYX gene but no mutation in either the NYX or CACNA1F genes was identified in the third. VEP evidence of optic nerve fibre mis-routing was present in 3 of the 11 subjects with "complete" phenotype and none of the 9 patients with "incomplete" phenotype CSNB. Mis-routing of optic nerve fibres does occur in CSNB but we found evidence of it in only 15% of our patients.

Simulated nystagmus reduces pattern-reversal more strongly than pattern-onset multifocal visual evoked potentials

Objective In patients with nystagmus conventional pattern-reversal visual evoked potentials are severely degraded, while sizeable pattern-onset VEPs can often still be obtained. We tested whether this differential effect of retinal image motion on pattern-reversal and pattern-onset responses also applies to multifocal VEPs (mfVEPs). Methods In eight subjects with normal oculomotor behaviour and vision we recorded pattern-reversal and pattern-onset mfVEPs from an occipital electrode pair to 60 locations of a scaled dartboard-pattern, and to 64 locations of a uniform checkerboard-pattern. Subjects viewed the stimulus monocularly via a mirror, which was placed close to the eye and driven by a scanner with a 4 Hz sawtooth waveform at an amplitude of 2° to simulate horizontal jerk nystagmus and of 0° for the reference condition. Results For the scaled dartboard-stimulus we observed an eccentricity-dependent effect of induced retinal image motion on mfVEP responses: in the central visual field (0–0.5°), pattern-reversal and pattern-onset responses were reduced by 73 and 42%, respectively. In the periphery (10–16°), only pattern-reversal responses were reduced (by 27%), while pattern-onset responses were enhanced by 39%. Pattern-onset responses to the uniform checkerboard stimulus were enhanced by 17%, while pattern-reversal responses were reduced by 27%. Conclusions Pattern-onset mfVEPs are more efficient than pattern-reversal mfVEPs, if retinal image motion is superimposed onto the stimulus. This is in close correspondence to previous reports on conventional VEPs. Significance This study demonstrates a differential effect of retinal image motion on pattern-reversal and pattern-onset mfVEPs and thus suggests stimulus conditions to enhance the efficiency of mfVEP recordings in patients with moderate nystagmus.