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Clinical, electrophysiological, and imaging findings in childhood brachial plexus injury

Katherin E Portwood1, Mehmet S Albayram2, Sarah Stone1

  • 1Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA.

Developmental Medicine and Child Neurology
|May 7, 2022
PubMed

Insights

Brachial plexus MRI and electrodiagnostic scores accurately predict outcomes for childhood brachial plexus injuries (BPIs). New scoring systems help multidisciplinary teams assess prognosis for BPIs.

Area of Science:

  • Pediatric neurology
  • Neuromuscular disorders
  • Diagnostic imaging

Background:

  • Childhood brachial plexus injuries (BPIs), including brachial plexus birth injury (BPBI), require accurate prognostication for effective management.
  • Assessing the prognostic capabilities of various diagnostic tools is crucial for guiding treatment decisions.

Purpose of the Study:

  • To evaluate the prognostic value of electrodiagnostic studies, magnetic resonance imaging (MRI), and the Active Movement Scale (AMS) in children with BPIs.
  • To develop and validate scoring systems for electrodiagnostic and MRI findings to predict surgical versus non-surgical outcomes.

Main Methods:

  • A retrospective cross-sectional study of 21 children with BPIs diagnosed between 2013 and 2020.
  • Development of scoring systems for electrodiagnostic studies (including nerve conduction studies and electromyography) and brachial plexus MRI.
  • Comparison of the prognostic value of different diagnostic modalities and their components.

Main Results:

  • Brachial plexus MRI scores, electromyography (EMG) denervation scores, and mean total EMG scores were most predictive of surgical outcomes.
  • A combined MRI and mean total EMG score demonstrated significant prognostic value.
  • The Active Movement Scale (AMS) was also assessed for its prognostic capabilities.

Conclusions:

  • Brachial plexus MRI and specific electrodiagnostic scores, particularly those quantifying denervation severity and composite EMG findings, offer the most accurate prognostic information for pediatric BPIs.
  • The developed grading scales can aid multidisciplinary teams in quantifying diagnostic results and determining prognosis.
  • Severity of denervation and composite EMG scores are valuable prognostic indicators for childhood BPIs.
Abstract

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