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

Joke Rijckaert (UGent) , Els Raes (UGent) , Sebastien Buczinski, Michèle Dumoulin (UGent) , Piet Deprez (UGent) , Luc Van Ham (UGent) , Gunther van Loon (UGent) and Bart Pardon (UGent)
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Abstract
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: To compare diagnostic accuracy of TMS, cervical radiography, and neurological examination. Animals: 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. Clinical Relevance: 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.
Keywords
MOTOR-EVOKED-POTENTIALS, CERVICAL VERTEBRAL MALFORMATION, DIAMETER, FEATURES, ataxia, cervical radiographs, cervical vertebral malformation, magnetic, motor evoked potentials, myelogram

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MLA
Rijckaert, Joke, et al. “Accuracy of Transcranial Magnetic Stimulation and a Bayesian Latent Class Model for Diagnosis of Spinal Cord Dysfunction in Horses.” JOURNAL OF VETERINARY INTERNAL MEDICINE, 2020.
APA
Rijckaert, J., Raes, E., Buczinski, S., Dumoulin, M., Deprez, P., Van Ham, L., … Pardon, B. (2020). Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses. JOURNAL OF VETERINARY INTERNAL MEDICINE.
Chicago author-date
Rijckaert, Joke, Els Raes, Sebastien Buczinski, Michèle Dumoulin, Piet Deprez, Luc Van Ham, Gunther van Loon, and Bart Pardon. 2020. “Accuracy of Transcranial Magnetic Stimulation and a Bayesian Latent Class Model for Diagnosis of Spinal Cord Dysfunction in Horses.” JOURNAL OF VETERINARY INTERNAL MEDICINE.
Chicago author-date (all authors)
Rijckaert, Joke, Els Raes, Sebastien Buczinski, Michèle Dumoulin, Piet Deprez, Luc Van Ham, Gunther van Loon, and Bart Pardon. 2020. “Accuracy of Transcranial Magnetic Stimulation and a Bayesian Latent Class Model for Diagnosis of Spinal Cord Dysfunction in Horses.” JOURNAL OF VETERINARY INTERNAL MEDICINE.
Vancouver
1.
Rijckaert J, Raes E, Buczinski S, Dumoulin M, Deprez P, Van Ham L, et al. Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses. JOURNAL OF VETERINARY INTERNAL MEDICINE. 2020;
IEEE
[1]
J. Rijckaert et al., “Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses,” JOURNAL OF VETERINARY INTERNAL MEDICINE, 2020.
@article{8648832,
  abstract     = {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: To compare diagnostic accuracy of TMS, cervical radiography, and neurological examination. 
Animals: 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. 
Clinical Relevance: 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.},
  author       = {Rijckaert, Joke and Raes, Els and Buczinski, Sebastien and Dumoulin, Michèle and Deprez, Piet and Van Ham, Luc and van Loon, Gunther and Pardon, Bart},
  issn         = {0891-6640},
  journal      = {JOURNAL OF VETERINARY INTERNAL MEDICINE},
  keywords     = {MOTOR-EVOKED-POTENTIALS,CERVICAL VERTEBRAL MALFORMATION,DIAMETER,FEATURES,ataxia,cervical radiographs,cervical vertebral malformation,magnetic,motor evoked potentials,myelogram},
  language     = {eng},
  title        = {Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses},
  url          = {http://dx.doi.org/10.1111/jvim.15699},
  year         = {2020},
}

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