Turkish Journal of Physical Medicine and Rehabilitation 2008 , Vol 54 , Num 3

The Consistency of Clinical Referral Diagnosis and Electrophysiological Diagnosis in Pediatric Cases

İlker Yağcı 1 ,Demet Ofluoğlu 2 ,Osman Hakan Gündüz 1 ,Evrim Karadağ Saygı 1 ,Zeynep Güven 3 ,Nadire Berker 4 ,Gülseren Akyüz 5
1 Marmara Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul, Türkiye
2 Başkent Üniverstesi Tıp Fakültesi İstanbul Hastanesi, İstanbul, Türkiye
3 Acıbadem Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul, Türkiye
4 Marmara Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul
5 Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, İstanbul, Turkey

Objective: Electroneuromyography (ENMG) is an important diagnostic tool in the evaluation of neurophysiologic status of adults and children. However, the diagnostic value of ENMG in childhood has not been established definitely. The objective of the study was to investigate the consistency of referral diagnosis and ENMG conclusions in pediatric cases.

Materials and Methods: The ENMG reports of pediatric patients who were referred to electrophysiological laboratory in the 10 year period between the years 1997 to 2007 were assessed retrospectively. The distribution of referral diagnosis and consistency of referral and electrophysiological diagnosis were evaluated. 

Results: A total of 4963 ENMG studies were performed during this period and 148 (3%) were in the pediatric age group. There were 55 girls and 93 boys. The mean age was 91.26±64.99 months. The referral diagnosis criteria of patients were brachial plexopathy (n: 26), peripheral nerve injury (n: 26), myopathy (n: 24), polyneuropathy (n: 14), facial nerve palsy (n: 9), floppy infant (hypotonia) (n: 7), entrapment neuropathy (n: 7), spinal muscular atrophy (SMA) (n: 5), Guillain Barre syndrome (GBS) (n: 4), radiculopathy (n: 2) and myasthenia gravis (n: 1). Twenty three patients were referred without any referral diagnosis and comprised the unclassified group. The ENMG conclusion was consistent with the referral diagnosis in 89 of 148 patients (60.1%). In patients with a referral diagnosis of SMA, entrapment neuropathy, unclassified group, hypotonia, and myopathy, higher rates of inconsistency were detected (100%, 85.7%, 78.3%, 71.4%, and 58.3%, respectively). The inconsistency rates were lower in patients with brachial plexopathy, facial nerve palsy, GBS, peripheral nerve injury and polyneuropathy (15.4%, 0%, 0%, 17.6%, and 21.4%, respectively).

Conclusion: In the pediatric age group, ENMG results can frequently be inconsistent with some referral diagnoses such as myopathy, floppy infant, nerve entrapments and also in patients with an unspecified suspected diagnosis.

Keywords : Pediatrics, electromyography, nerve conduction study