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Home / Equine Research Bank / J Vet Intern Med / Accuracy of transcranial magnetic stimulation and a Bayesian...
Journal of veterinary internal medicine2020; 34(2); 964-971; doi: 10.1111/jvim.15699

Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses.

Abstract: 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. Objective: To compare diagnostic accuracy of TMS, cervical radiography, and neurological examination. Methods: One hundred seventy-four horses admitted at the clinic for neurological examination. 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: 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. 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.
© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
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Publication Date: 2020-02-06 PubMed ID: 32030834PubMed Central: PMC7096606DOI: 10.1111/jvim.15699Google Scholar: Lookup
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Summary

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This research article compares the diagnostic accuracy of transcranial magnetic stimulation (TMS), cervical radiography, and neurological examination in diagnosing spinal cord dysfunction in horses. Results suggest that TMS offers the highest accuracy, making it the optimal diagnostic method.

Methodology

  • The study included 174 horses that went through a neurological examination at a clinic.
  • Examination methods included neurological examination, cervical radiography, and transcranial magnetic stimulation.
  • To account for the lack of a gold standard in evaluating the diagnostic tests for spinal cord dysfunction, Bayesian latent class modeling was used.

Results

  • The estimated prevalence of spinal cord dysfunction was found to be 58.1%.
  • Neurological examination showed a sensitivity of 97.6% and a specificity of 74.7% while radiography had a sensitivity of 43.0% and a specificity of 77.3%.
  • Transcranial magnetic stimulation displayed a sensitivity of 87.5% and a specificity of 97.4%. The highest accuracy for TMS was achieved using the minimum latency time for the pelvic limbs.
  • Among all evaluated models, cervical radiography performed the poorest.

Conclusions

  • The study concluded that transcranial magnetic stimulation-magnetic motor evoked potential (TMS-MMEP) was the most accurate way to diagnose spinal cord dysfunction in horses.
  • Neurological examination was found to be the second-most accurate method.
  • The accuracy of cervical radiography in diagnosing spinal cord dysfunction was low.
  • The optimal diagnostic strategy would be to use neurological examination for initial screening (due to its high sensitivity) and then confirm the disease with TMS-MMEP (which has the highest specificity).

Cite This Article

APA
Rijckaert J, Raes E, Buczinski S, Dumoulin M, Deprez P, Van Ham L, van Loon G, Pardon B. (2020). Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses. J Vet Intern Med, 34(2), 964-971. https://doi.org/10.1111/jvim.15699

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 34
Issue: 2
Pages: 964-971

Researcher Affiliations

Rijckaert, Joke
  • Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Raes, Els
  • Department of Veterinary medical imaging and small animal orthopedics, Ghent University, Merelbeke, Belgium.
Buczinski, Sebastien
  • Département des sciences cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Université de Montréal, St-Hyacinthe, Q, Canada.
Dumoulin, Michèle
  • Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Deprez, Piet
  • Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Van Ham, Luc
  • Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
van Loon, Gunther
  • Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Pardon, Bart
  • Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.

MeSH Terms

  • Animals
  • Bayes Theorem
  • Female
  • Horse Diseases / diagnosis
  • Horse Diseases / diagnostic imaging
  • Horses
  • Latent Class Analysis
  • Male
  • Neurologic Examination / veterinary
  • Reproducibility of Results
  • Retrospective Studies
  • Spinal Cord Compression / diagnosis
  • Spinal Cord Compression / veterinary
  • Transcranial Magnetic Stimulation / veterinary

Conflict of Interest Statement

Authors declare no conflict of interest.

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Citations

This article has been cited 1 times.
  1. Bokma J, Vereecke N, Pas ML, Chantillon L, Vahl M, Weesendorp E, Deurenberg RH, Nauwynck H, Haesebrouck F, Theuns S, Boyen F, Pardon B. Evaluation of Nanopore Sequencing as a Diagnostic Tool for the Rapid Identification of Mycoplasma bovis from Individual and Pooled Respiratory Tract Samples.. J Clin Microbiol 2021 Nov 18;59(12):e0111021.
    doi: 10.1128/JCM.01110-21pubmed: 34550807google scholar: lookup
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