AB0918 CERVICAL INSTABILITY AND VISUAL PATHWAYS COMPROMISE IN PATIENTS WITH JOINT LAXITY
Authors: sharareh Roshanzamir, Aida Askarian
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Cervical spine stability is to a great extent dependent on the capsular ligaments, laxity of which would lead to extensive movements of the vertebrae. This instability of the cervical spine, particularly in the upper segments (C0-C2) would be a major source of vertebrobasilar insufficiency. The resultant brain posterior circulation compromise would then make the foundation of white matter changes and cause many neurological signs and symptoms. Occipital lobe and visual pathways are certainly in danger in these circumstances. How and to what extent could the visual pathways be involved in patients with joint laxity is not well studied yet. <h3>Objectives</h3> This study was designed to find whether the visual evoked potential parameters (latency and amplitude) of the patients with generalized joint laxity differs from that of the normal population. <h3>Methods</h3> In this corss-sectional comparative study, 90 consecutive patients with generalized lax joints and 90 normal individuals were enrolled and underwent the visual evoked potential test by pattern reversal. The latency and amplitude of P100 were determind for all the participants and data from the 2 groups were compared statistically. <h3>Results</h3> The results demonstrated that although none of the VEP parameters fell in the abnormal range, there was significant difference between P100 latency in patients with generalized lax joints (mean:110.23 ms) versus normal population (100.18 ms) (P&lt;0.001) with longer latency in patients with generalized lax joints. But the amplitude was not significantly differed across the groups (P &gt; 0.05). <h3>Conclusion</h3> It can be concluded from this study that although the VEP parameters of the patients with generalized joint laxity don't exceed the normal range limits, P100 latency in these patients is significantly more prolonged than in normal population. This finding is valuable from two points of view, first P100 latency at the verge of abnormality (upper limit of normal range) in these patients is a warning sign implying the visual pathway involvement, and second VEP could be invaluable in diferentiating the signs and symptomes that are produced by vertebrobasilar insuficiancy secondary to the joint laxity from multiple sclerosis, which can be mimicd both clinically and in MRI findings by many vascular problems but shows a great percent of VEP abnormality as a particular fiture. <h3>References</h3> [1] Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326-45. [2] Jaumard NV, Welch WC, Winkelstein BA. Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. Journal of biomechanical engineering. 2011;133:071010. [3] Siva A. Common Clinical and Imaging Conditions Misdiagnosed as Multiple Sclerosis: A Current Approach to the Differential Diagnosis of Multiple Sclerosis. Neurologic clinics. 2018;36:69-117. [4] Lin P-C, Chang F-C, Huang H-C, Tsai J-Y, Lin Y-Y, Chung C-P. Greater periventricular white matter hyperintensity severity in basilar artery branch atheromatous disease. BMC neurology. 2017;17:135-. [5] Kose Ozlece H, Ilik F, Huseyinoglu N. Coexistence of Ehlers-Danlos syndrome and multiple sclerosis. Iranian journal of neurology. 2015;14:116-7. . [6] Pajak M, Majos MA, Szubert W, Stefanczyk L, Majos A. Acute brain ischemia as a complication of the Ehlers-Danlos syndrome, the case series. Vascular. 2014;22:341-5 [7] EL-Cart AK, Mahammoud A, Mahgoub EH. Hypermobility among egyptian childern: prevalence and features. J Rheum 1998; 25(5): 3-5. [8] Mishra MB, Ryan P, Atkinson P, et al. Extra-articular features of benign joint hypermobility syndrome. Br J Rheumatol. 1996; 35(9):861-6. <h3>Disclosure of Interests</h3> None declared