SSEP results- can anyone explain?

[Hellsbells39]

I have left sided weakness in my leg and arm, tingling (comes and goes), numb fingers on right hand, increased tone, weird muscle twitches, abnormal gait (foot drop) and lost hearing completely in left ear (just 2 days ago). The latest brain MRI showed no active space occupying lesions, but SSEP abnormal (all numbers differ between left and right leg) Should I be asking for an MRI of my spine? Could anyone explain the normal ranges for SSEP? There's such a long wait to see my neuro again and I'm stuck in limbo- off work and fed up. Any advice/help gratefully received. Thank you

[supermum_ms]

I honestly don't know if patients can make requests for specific tests or not, you would think the types of tests you need is determined by your individual medical situation and the types of tests you need isn't something you need worry about but that's not always how it works, what tests you get can sometimes depend on your countries health system, VA or public hospital policies and funding situation, the type of private health insurance you have etc etc etc

You really shouldn't need to have concerns about you not getting a spinal MRI though, from what your saying you are potentially thinking about you needing to make something happen that is likely going to happen anyway.....you might be better off taking a step back for a moment, see the ENT on Wednesday and IF he/she doesn't mention the topic of you needing additional tests by the end of the appointment, you should then consider bringing the topic up...

eg 'the last time i was here i was told i'd need an MRI if my hearing hadn't improved by today, so are you organising a spinal MRI because of my other symptoms or just another brain MRI?'  

Limbo can be very stressful so make a point of being kind to your self and keeping your stress levels down!

Good luck........JJ

ps let me know what happens                        

[Hellsbells39]

Thank you. I am spending a lot of time stressing and researching, but you're right, I need to trust that the hospital are on the case and will organise tests accordingly. It probably doesn't help that two referrals have been lost in the system somehow and I've had to really fight to be seen. There isn't a neuro department at my hospital so they travel in and I think it's all very under resourced (I'm in the U.K. and very relieved to have the NHS, it's just slow!)
I will let you know how this all progresses. Thanks again for your help x

[supermum_ms]

Hearing issues are generally rare in MS so my understanding is rather limited sorry....from what i understand if treatment is started quickly it will usually take around 2 weeks for recovery, it could take up to 12 months though that's not typical.

The majority of people dx-ed with sudden sensorineural hearing loss have no know cause (idiopathic), other identified causes are trauma, viral infections, some autoimmune conditions, toxic exposure, even vit B i think is associated with it too.

To be honest i'm not sure if the ENT would be able to move your neuro appointment up unless there is an identified causation that requires a neuro consult and considering it's something like 75-90% are classed as idiopathic, and an ENT is the type of dr who treats it, it's probably unlikely that you'll need too, though it never hurts to ask...

It wouldn't hurt to ask the ENT next week if your sudden sensorineural hearing loss could be related to your other symptoms which are suggestive of a possible peripheral nerve issue? [ie foot drop, bilateral upper and lower (arms and legs) paresthesia of numbness and tingling is more suggestive of a peripheral nervous system condition]

Just mentioning your other symptoms could prompt you to need a spinal MRI to help identify causation, cervical spinal issues can cause some types of hearing abnormalities.....even a prior whip lash injury can cause disc issues years down the road...the spine is just one possible explanation worth looking into considering all your other associated peripheral nervous symptoms.

Hope this helps.....JJ  

[Hellsbells39]

Thanks.
ENT said that my hearing loss is quite possibly connected to my other neuro symptoms. I was told that if my hearing hasn't improved on Weds when I go back they will do an MRI to look more closely. If I'm having another MRI anyway, do you think I can request that my spine is done also? I'm not sure whether you can request things like this as a patient, but it's likely I think that my neuro will request this anyway when I see him next (currently a delay so not until end of May- was supposed to see him this month)
Thanks again for you help x

[supermum_ms]

Hi and welcome,

Unfortunately the SSEP is one of the types of tests that takes a lot of expertise to interpret, basically there are different formulas needing to be applied for each individual eg, gender, limb length, medication, age etc etc that it's honestly far to complicated for most patients to even try to make sense of their results....

See this detailed article to get an idea of just how complicated these types of tests are to make sense of;

"For lower limb SEPs, conduction distances along both the peripheral nerve and the spinal cord portions of the afferent pathway vary considerably among subjects as a function of height. Some laboratories use height-adjusted norms for the analysis of lumbar SEP components; others measure the conduction distances and calculate conduction velocities. When no height corrections are used, interpeak latencies should be interpreted with caution in patients whose heights are at the extremes of the range of heights for which the normative data were collected.

The major criteria for abnormality are absence of obligate components and abnormal prolongation of interpeak intervals. As with any evoked-potential test involving unilateral stimulation, excessive symmetries between the measurements following left-sided stimulation and those following right-sided stimulation also may reveal abnormalities. The stationary cervical/stationary lumbar and cervicomedullary far-field components may be difficult to identify in some healthy subjects who are not sedated...."

https://emedicine.medscape.com/article/1139906-overview

IF you are saying you "lost hearing completely in left ear (just 2 days ago)" and this has happened after you were last seen by this neurologist and or you haven't seen your family dr, been to the ER etc about this new symptom yet, what i'd highly recommend you do is make this your priority medical issue!

Contact both your family dr and your neurology clinic, and explain that you've gone completely deaf in your left ear and request their earliest available appointment. You could also ask both clinics to be put you on their cancellation list so if another patient cancels they'll contact you with an earlier date and time and if that doesn't get you an appointment straight away, you really need to consider going to the ER.

Hope that helps a little......JJ  

[Hellsbells39]

Thank you very much for all of the information, it is really helpful. I saw my GP straight away and she sent me to the hospital where I was seen quickly. The hearing test revealed that it's sudden sensorineural hearing loss and I've been taking 60 mg of Prednisolone (now on day 3 of this) so far no improvement.
I rang neurology as was told I won't be seen for another 2 months, but I am going back to ENT next week to check hearing again and they said possibly another MRI if not improved. Is it worth asking ENT when I see them to try to speed up neuro follow up?
Thanks again for your help, limboland is stressful and this community is such a great support x