Prospective review of the incidence, cause, and prognosis of pediatric sciatic neuropathy (SN) in a 30-year experience of 53 patients is reported from the Department of Neurology, Children's Hospital Boston, Lahey Clinic, Burlington, MA, and Royal Children's Hospital, Melbourne, Australia. Ages ranged from 2 days to 18 years. Mononeuropathies in children are rare, constituting <10% of referrals for EMG. Most patients presented with tibialis anterior weakness and foot drop. Weakness of plantar flexion was seen in 31 (58%) patients. Numbness below the knee occurred in all patients able to describe the symptom. The causes of SN included trauma (13), iatrogenic mechanisms related to orthopedic surgeries (13), extrinisic compression and immobilization (6), tumors (7), vascular (5), idiopathic and progressive (4), infantile and nonprogressive (2), and presumed postviral (3). Motor conduction was abnormal in 44/53 (83%) peroneal nerve studies, and 35/51 (67%) tibial nerve. Sensory conduction studies were abnormal in sural nerve in 34 of 43 cases (70%), and in 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 was variable and dependent on etiology and severity of nerve injury; good in traumatic and iatrogenic SN and poor in vascular or tumor cases. [1]
COMMENT. Electrophyiological studies are important in diagnosis of neuropathies in children but are limited by poor tolerance. MRI will become increasingly useful with higher resolution units. Causes of SN are more varied in children than in adults. Traumatic causes predominate.