Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement

Abstract

Nerve conduction studies and needle electromyography, collectively known as electrodiagnostic (EDX) studies, have been available for pediatric patients for decades, but the accessibility of this diagnostic modality and the approach to testing vary significantly depending on the physician and institution. The maturation of molecular diagnostic approaches and other diagnostic technologies such as neuromuscular ultrasound indicate that an analysis of current needs and practices for EDX studies in the pediatric population is warranted. The American Association of Neuromuscular & Electrodiagnostic Medicine convened a consensus panel to perform literature searches, share collective experiences, and develop a consensus statement. The panel found that electrodiagnostic studies continue to have high utility for the diagnosis of numerous childhood neuromuscular disorders, and that standardized approaches along with the use of high-quality reference values are important to maximize the diagnostic yield of these tests in infants, children, and adolescents. K E Y W O R D S adolescents, children, electrodiagnostic medicine, electromyography, infants, neuromuscular disorders, pediatric

Childhood focal compressive mononeuropathies during the COVID‐19 pandemic in Buenos Aires, Argentina

“…Compressive lesions are the second most common cause of acute focal mononeuropathies in children after trauma, but etiologies vary 1 . Focal mononeuropathies in children have been reported in the median, radial, ulnar, fibular, and sciatic nerves associated with metabolic or genetic disorders, bone abnormalities, tumors, vascular malformations, trauma, entrapment, and compression, or rarely idiopathic 3‐17 …”

“…1 Focal mononeuropathies in children have been reported in the median, radial, ulnar, fibular, and sciatic nerves associated with metabolic or genetic disorders, bone abnormalities, tumors, vascular malformations, trauma, entrapment, and compression, or rarely idiopathic. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 …”

Does specificity of electrodiagnostic test referrals predict test outcome in children?

“…EDX is helpful in interpreting genetic variants of uncertain significance (VUS) and refining the phenotype of complex inherited disorders 5 . It also remains first line for evaluating indeterminate proximal weakness, suspected neuropathy, myotonic and neuromuscular junction (NMJ) disorders in children 1,4,9 . As the number of specific first‐line indications has narrowed, the percentage of referrals for non‐specific indications has grown and rates of test normality in published series are high 3 .…”

Pins and needles: The neurological examination and electrodiagnosis in children

“…Over the past decades, astonishing technological breakthroughs in genetic analysis and neuroimaging have shifted the traditional territories of electrodiagnostic (EDx) testing in the pediatric population. 1,2 Motor neuron disorders, muscular dystrophies, congenital myopathies, and channelopathies, 2 as well as many peripheral neuropathies, 3 are now diagnosed predominantly through genetic testing, whereas magnetic resonance imaging (MRI) and ultrasound (US) gain increasing popularity in neuromuscular practice. 4 In that ever-changing landscape, one naturally wonders what role traditional approaches of clinical examination and EDx testing still play?…”

“…18 Finally, one should not ignore the potential of EDx testing distress for patients and families. 1,6 How can we mitigate this phenomenon? From a clinical standpoint, it can be done merely by returning to our Bayesian grassroots as physicians, 19 making history-taking and clinical examination the cornerstone of our evaluation, and re-establishing the traditional perspective of seeing the forest and not just the trees, despite the increased trend toward subspecialization.…”