An evaluation of motor evoked potential surrogate endpoints during XXXX .

@entity1 @entity86 @entity5122 @entity1504
OBJECTIVE: MEPs are used as surrogate endpoints to predict the effectiveness of interventions, made in response to MEP deterioration, in avoiding new @entity86 . MEP performance in capturing intervention effects on these outcomes was investigated. METHODS: A meta-analysis of studies using MEPs during intracranial vascular surgeries between 2003 and 2014 was performed. MEP diagnostic performance and relative risk of new @entity86 for reversible compared with irreversible MEP changes were determined. Intervention efficacy in reversing MEP deterioration and postoperative outcomes was compared across studies. RESULTS: MEP diagnostic performance compared favorably with that of other tests used in medicine, with all likelihood ratios >10. The summary relative risk comparing reversible and irreversible changes was 0.40, indicating a 60% decrease in new deficits for reversible MEP changes. The proportion of @entity5122 which recovered was negatively correlated with the proportion of new @entity86 (r=-0.81, p<.005). CONCLUSIONS: The effectiveness of interventions in recovering an MEP decline was predictive of preserved neurologic status. MEPs are provisionally qualified as surrogate endpoints given potentially major harms to the @entity1 if they are not used, compared to the minimal harms and costs associated with their use. SIGNIFICANCE: The performance of MEPs as substitute, or surrogate, endpoints during @entity1504 in motor strength in the immediate postoperative period was directly assessed for ten recent studies.
