Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses.
Authors: Rijckaert Joke, Raes Els, Buczinski Sebastien, Dumoulin Michèle, Deprez Piet, Van Ham Luc, van Loon Gunther, Pardon Bart
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: TMS for Equine Spinal Cord Dysfunction Transcranial magnetic stimulation (TMS) offers a functional assessment of motor pathway integrity, but its clinical utility for diagnosing spinal cord dysfunction in horses has remained unclear—partly because no true gold standard exists for living animals, making validation challenging. Rijckaert and colleagues addressed this methodological problem by using a Bayesian latent class model to evaluate TMS recordings of magnetic motor evoked potentials (MMEPs) in horses with varying degrees of neurological dysfunction, sidestepping the need for a single reference standard. The analysis revealed that TMS-derived MMEP parameters could differentiate between clinically normal horses and those with documented spinal cord pathology, with the latent class model providing probabilistic estimates of disease presence that complemented rather than replaced traditional neurological examination and radiography. Key findings suggest TMS adds diagnostic sensitivity to conventional assessment methods, particularly in cases where neurological signs and imaging findings are incongruent or when early spinal cord involvement is suspected. For practitioners, this indicates that TMS may strengthen diagnostic confidence in ataxic horses when clinical examination and cervical radiographs alone leave uncertainty, though it should be integrated into a multi-modal diagnostic approach rather than used in isolation.
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Practical Takeaways
- •TMS with motor evoked potential recording may offer an objective diagnostic complement to traditional neurological exams and radiography for evaluating ataxic horses
- •The Bayesian latent class approach provides a statistical framework for validating diagnostic tests when necropsy confirmation is not available in clinical cases
- •Consider TMS as a potential additional diagnostic modality when spinal cord dysfunction is suspected but conventional imaging findings are equivocal
Key Findings
- •Transcranial magnetic stimulation with magnetic motor evoked potentials shows promise as a diagnostic tool for spinal cord dysfunction in horses
- •A Bayesian latent class model was developed to overcome the absence of a gold standard for diagnosing spinal cord dysfunction in living horses
- •Current presumptive diagnosis relies primarily on neurological examination and cervical radiography