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Published on: March 27, 2016
Pediatric sciatic neuropathies: a 30-year prospective study
J Srinivasan1, M M Ryan, D M Escolar
1Department of Neurology, Lahey Clinic, 41 Mall Road, Burlington, MA 01805, USA. jayashri_srinivasan@lahey.org
Insights
Sciatic neuropathy (SN) in children is uncommon and has varied causes like trauma and surgery. Recovery depends on the injury
Area of Science:
- Pediatric Neurology
- Nerve Injury
- Electrophysiology
Background:
- Sciatic neuropathy (SN) in children is poorly understood.
- This study reviews 30 years of pediatric SN cases.
Purpose of the Study:
- To understand the incidence, causes, and prognosis of pediatric sciatic neuropathy.
- To analyze electrophysiologic findings in children with SN.
Main Methods:
- Prospective review of 53 pediatric patients with sciatic neuropathy.
- Analysis of patient history, physical exams, electrophysiologic studies, and clinical course.
Main Results:
- Varied etiologies include trauma, iatrogenic causes, tumors, and vascular issues.
- Electrophysiologic studies showed high rates of abnormalities in motor and sensory nerves.
- Needle EMG was abnormal in all subjects for peroneal-innervated muscles.
Conclusions:
- Pediatric sciatic neuropathy is an uncommon mononeuropathy with diverse causes.
- Electrophysiologic studies are crucial for diagnosis in children, despite potential tolerance issues.
- Prognosis varies based on etiology and injury severity.
Objective:
The incidence, cause, and prognosis of sciatic neuropathy in children is not well understood. We report our 30-year experience of 53 patients with pediatric sciatic neuropathies (SN).
Methods:
Prospective review of the history, physical examination, electrophysiologic findings, and clinical course of children with SN.
Results:
The etiology of SN injury was varied and included trauma (13), iatrogenic causes (13) (8 orthopedic surgeries and 5 miscellaneous surgeries), prolonged extrinsic compression and immobilization (6), tumors (7), vascular (5), idiopathic and progressive (4), infantile and nonprogressive (2), and unknown, presumed postviral (3). Electrophysiologic studies demonstrated abnormalities in motor conduction studies of the peroneal nerve in 44/53 (83%) or tibial nerve in 35/51 (67%). Sensory conduction studies were abnormal in sural nerve in 34 of 43 cases (79%), and superficial peroneal nerves in 15/25 (60%). Needle EMG was abnormal in peroneal innervated muscles in all subjects, in tibial nerve innervated muscles in 43/51 (84%), and in the hamstrings in 18/29 (62%). Prognosis for recovery was variable and depended on the etiology and the severity of the nerve injury.
Conclusions:
SN is an uncommon mononeuropathy in children. The causes of SN are varied in children compared to adults. Electrophysiologic studies in children may be limited by poor tolerance but play an important role in establishing the diagnosis.
