Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses.
ataxia
cervical radiographs
cervical vertebral malformation
magnetic motor evoked potentials
myelogram
Journal
Journal of veterinary internal medicine
ISSN: 1939-1676
Titre abrégé: J Vet Intern Med
Pays: United States
ID NLM: 8708660
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
10
07
2019
accepted:
20
12
2019
pubmed:
8
2
2020
medline:
15
12
2020
entrez:
8
2
2020
Statut:
ppublish
Résumé
Spinal cord dysfunction/compression and ataxia are common in horses. Presumptive diagnosis is most commonly based on neurological examination and cervical radiography, but the interest into the diagnostic value of transcranial magnetic stimulation (TMS) with recording of magnetic motor evoked potentials has increased. The problem for the evaluation of diagnostic tests for spinal cord dysfunction is the absence of a gold standard in the living animal. To compare diagnostic accuracy of TMS, cervical radiography, and neurological examination. One hundred seventy-four horses admitted at the clinic for neurological examination. Retrospective comparison of neurological examination, cervical radiography, and different TMS criteria, using Bayesian latent class modeling to account for the absence of a gold standard. The Bayesian estimate of the prevalence (95% CI) of spinal cord dysfunction was 58.1 (48.3%-68.3%). Sensitivity and specificity of neurological examination were 97.6 (91.4%-99.9%) and 74.7 (61.0%-96.3%), for radiography they were 43.0 (32.3%-54.6%) and 77.3 (67.1%-86.1%), respectively. Transcranial magnetic stimulation reached a sensitivity and specificity of 87.5 (68.2%-99.2%) and 97.4 (90.4%-99.9%). For TMS, the highest accuracy was obtained using the minimum latency time for the pelvic limbs (Youden's index = 0.85). In all evaluated models, cervical radiography performed poorest. Transcranial magnetic stimulation-magnetic motor evoked potential (TMS-MMEP) was the best test to diagnose spinal cord disease, the neurological examination was the second best, but the accuracy of cervical radiography was low. Selecting animals based on neurological examination (highest sensitivity) and confirming disease by TMS-MMEP (highest specificity) would currently be the optimal diagnostic strategy.
Sections du résumé
BACKGROUND
BACKGROUND
Spinal cord dysfunction/compression and ataxia are common in horses. Presumptive diagnosis is most commonly based on neurological examination and cervical radiography, but the interest into the diagnostic value of transcranial magnetic stimulation (TMS) with recording of magnetic motor evoked potentials has increased. The problem for the evaluation of diagnostic tests for spinal cord dysfunction is the absence of a gold standard in the living animal.
OBJECTIVES
OBJECTIVE
To compare diagnostic accuracy of TMS, cervical radiography, and neurological examination.
ANIMALS
METHODS
One hundred seventy-four horses admitted at the clinic for neurological examination.
METHODS
METHODS
Retrospective comparison of neurological examination, cervical radiography, and different TMS criteria, using Bayesian latent class modeling to account for the absence of a gold standard.
RESULTS
RESULTS
The Bayesian estimate of the prevalence (95% CI) of spinal cord dysfunction was 58.1 (48.3%-68.3%). Sensitivity and specificity of neurological examination were 97.6 (91.4%-99.9%) and 74.7 (61.0%-96.3%), for radiography they were 43.0 (32.3%-54.6%) and 77.3 (67.1%-86.1%), respectively. Transcranial magnetic stimulation reached a sensitivity and specificity of 87.5 (68.2%-99.2%) and 97.4 (90.4%-99.9%). For TMS, the highest accuracy was obtained using the minimum latency time for the pelvic limbs (Youden's index = 0.85). In all evaluated models, cervical radiography performed poorest.
CLINICAL RELEVANCE
CONCLUSIONS
Transcranial magnetic stimulation-magnetic motor evoked potential (TMS-MMEP) was the best test to diagnose spinal cord disease, the neurological examination was the second best, but the accuracy of cervical radiography was low. Selecting animals based on neurological examination (highest sensitivity) and confirming disease by TMS-MMEP (highest specificity) would currently be the optimal diagnostic strategy.
Identifiants
pubmed: 32030834
doi: 10.1111/jvim.15699
pmc: PMC7096606
doi:
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
964-971Informations de copyright
© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Références
Equine Vet J. 2002 Mar;34(2):156-63
pubmed: 11902758
Aust Vet J. 1993 Dec;70(12):445-9
pubmed: 8117210
Prev Vet Med. 2005 May 10;68(2-4):145-63
pubmed: 15820113
Vet Rec. 2005 Nov 19;157(21):656-8
pubmed: 16299367
Vet J. 2003 Nov;166(3):244-50
pubmed: 14550735
Prev Vet Med. 2017 Mar 1;138:37-47
pubmed: 28237234
BMJ. 2018 Jan 18;360:j5779
pubmed: 29348126
Equine Vet J. 2004 Jan;36(1):51-7
pubmed: 14756372
J Am Vet Med Assoc. 2011 Sep 15;239(6):823-33
pubmed: 21916766
J Vet Med Sci. 1994 Apr;56(2):227-33
pubmed: 8075209
J Vet Intern Med. 2020 Mar;34(2):964-971
pubmed: 32030834
Vet Radiol Ultrasound. 2008 Jan-Feb;49(1):1-6
pubmed: 18251286
Health Technol Assess. 2007 Dec;11(50):iii, ix-51
pubmed: 18021577
Am J Vet Res. 2003 Nov;64(11):1382-6
pubmed: 14620774
Vet Med (Auckl). 2018 Sep 07;9:63-67
pubmed: 30234005
Equine Vet J. 2014 Nov;46(6):681-6
pubmed: 24329734
J Vet Intern Med. 2014 Mar-Apr;28(2):630-8
pubmed: 24612411
Biometrics. 2001 Mar;57(1):158-67
pubmed: 11252592
Equine Vet J. 2004 Jan;36(1):14-20
pubmed: 14756366
Am J Vet Res. 1994 Jan;55(1):5-13
pubmed: 8141496
J Equine Vet Sci. 2018 Sep;68:101-107
pubmed: 31256880
J Vet Intern Med. 2007 Jul-Aug;21(4):812-9
pubmed: 17708404
J Vet Intern Med. 2019 Sep;33(5):2312-2318
pubmed: 31490026
J Vet Intern Med. 2017 Nov;31(6):1871-1876
pubmed: 28887894
J Am Vet Med Assoc. 2010 Oct 1;237(7):812-22
pubmed: 20919847
Equine Vet J. 2009 Jul;41(6):518-24
pubmed: 19803045