Place of perineal electrophysiologic testing in multiple sclerosis patients.

At present, apart from visual evoked potential testing, clinical neurophysiological testing is rarely used in multiple sclerosis (MS) patients at all. In MS patients with lower urinary tract, bowel and/or sexual dysfunction, which are highly prevalent in MS, clinical neurophysiological tests of the sacral nervous system have been introduced in the past and reported as abnormal. Their usefulness is--in selected patients--to substantiate the suspicion of the neurogenic nature of the pelvic organ dysfunction, but there is no specific recommendation for MS patients. Concentric needle EMG of the perineal muscles, bulbocavernosus reflex latency measurement and pudendal SEP may be particularly useful in those rare patients in whom MS may affect the conus medullaris, to demonstrate "directly" this lesion of the lower sacral segments. Clinical neurophysiological testing retains the potential to further clarify interesting research questions of correlation of nervous system function and pelvic organ dysfunction, particularly relevant for application of sophisticated new rehabilitative methods including electrical stimulation of the nervous system.