Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom.
Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
J Vet Intern Med. 2023 May-Jun;37(3):1111-1118. doi: 10.1111/jvim.16717. Epub 2023 Apr 24.
Meningoencephalitis of unknown origin (MUO) comprises a group of debilitating inflammatory diseases affecting the central nervous system of dogs. Currently, no validated clinical scale is available for the objective assessment of MUO severity.
Design a neurodisability scale (NDS) to grade clinical severity and determine its reliability and whether or not the score at presentation correlates with outcome.
One hundred dogs with MUO were included for retrospective review and 31 dogs were subsequently enrolled for prospective evaluation.
Medical records were retrospectively reviewed for 100 dogs diagnosed with MUO to identify the most frequent neurological examination findings. The NDS was designed based on these results and evaluated for prospective and retrospective use in a new population of MUO patients (n = 31) by different groups of independent blinded assessors, including calculation of interobserver agreement and association with outcome.
The most common clinical signs in MUO patients were used to inform categories for scoring in the NDS: seizure activity, ambulatory status, posture and cerebral, cerebellar, brainstem, and visual functions. The intraclass correlation coefficient (ICC) for prospective use of the NDS was 0.83 (95% confidence interval [CI], 0.68-0.91) indicating good agreement, and moderate agreement was found between prospective and retrospective assessors (ICC, 0.71; 95% CI, 0.56-0.83). No association was found between NDS score and long-term outcome.
The NDS is a novel clinical measure for objective assessment of neurological dysfunction and showed good reliability when used prospectively in MUO patients but, in this small population, no association with outcome could be identified.
不明原因脑膜脑炎（MUO）是一组影响犬中枢神经系统的使人虚弱的炎症性疾病。目前，尚无经证实的临床量表可用于客观评估 MUO 的严重程度。
设计一种神经残疾量表（NDS）来分级临床严重程度，并确定其可靠性，以及就诊时的评分是否与结局相关。
纳入 100 例 MUO 犬进行回顾性分析，随后有 31 例犬纳入前瞻性评估。
回顾性分析 100 例 MUO 犬的病历，以确定最常见的神经系统检查结果。根据这些结果设计 NDS，并由不同的独立盲法评估小组对 MUO 患者（n = 31）进行前瞻性和回顾性评估，包括计算观察者间一致性和与结局的相关性。
MUO 患者最常见的临床体征被用于确定 NDS 的评分类别：癫痫发作活动、活动状态、姿势以及大脑、小脑、脑干和视觉功能。NDS 前瞻性使用的组内相关系数（ICC）为 0.83（95%置信区间[CI]，0.68-0.91），表明一致性良好，前瞻性和回顾性评估者之间存在中度一致性（ICC，0.71；95% CI，0.56-0.83）。NDS 评分与长期结局之间无相关性。
NDS 是一种用于评估神经功能障碍的客观评估的新的临床指标，在 MUO 患者中前瞻性使用时具有良好的可靠性，但在这个小样本中，无法确定与结局的相关性。
