Development of a reliable clinical assessment tool for meningoencephalitis in dogs: The neurodisability scale

Abstract

Background 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. Objectives Design a neurodisability scale (NDS) to grade clinical severity and determine its reliability and whether or not the score at presentation correlates with outcome. Animals One hundred dogs with MUO were included for retrospective review and 31 dogs were subsequently enrolled for prospective evaluation. Methods 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. Results 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. Conclusions and Clinical Importance 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.

Usefulness of neurological assessment scales in prognosis of meningoencephalitis of unknown origin in Yorkshire Terriers

“…Noteworthily, no other factor recognized at presentation was signi cantly linked with the short-term prognosis. On the other hand, the neurological scales do not appear to be associated with either mid-term or long-term prognosis, what is consistent with the ndings of previous studies [1,23].…”

Prognosis in meningoencephalitis of unknown origin in dogs: Risk factors associated with survival, clinical relapse, and long‐term disability

“…The NDS has been recently proposed as a reliable clinical scale for initial assessment of patients with MUO. 11 Our study found an association between the NDS score and increased risk of death within the 6 months after diagnosis, relapse, and incomplete resolution of clinical signs within that time. In human patients, higher baseline score in the expanded disability status scale (EDSS), the most commonly used clinical outcome measure for patients with MS, is predictive for worse outcomes.…”

Magnetic resonance imaging prognostic factors for survival and relapse in dogs with meningoencephalitis of unknown origin

“…The following data were extracted from the medical records: age, sex, neuter status, breed and duration of the clinical signs and survival information. The findings of the neurological examination recorded on the patient files were used to retrospectively assign the neurodisability scale (NDS) ( 16 ) score for each dog (calculated by the same assessor in all dogs).…”

“…Recently, a neurodisability scale (NDS) has been shown to be a reliable clinical assessment tool for dogs with MUO. Initial data from a small population of dogs was unable to show an association between this score and outcome ( 16 ) but retrospective use of this scale in a large population of dogs with MUO showed an association between higher NDS score and death at 6 months as well as long-term relapse ( 13 ).…”