Clinical Neurophysiology in Pediatrics: A Practical Approach to Neurodiagnostic Testing and Management

Gloria M. Galloway. Clinical Neurophysiology in Pediatrics: A Practical Approach to Neurodiagnostic Testing and Management. New York, NY: Demos Medical Publishing; 2016 (285 pp). List price: $85 (US), ISBN: 9781620700457

Clinical neurophysiology is a rapidly growing field with many tools and approaches for diagnosing different neurologic conditions. These techniques include electroencephalogram (EEG), electromyogram (EMG), nerve conduction studies (NCS), sleep studies, intraoperative monitoring, and evoked potentials. Primarily designed for and standardized in adults, these tests are now being increasingly used in children as well. This expanding application of neurophysiological tools in the pediatric age range raises many logistical challenges with regard to test indications, methodology, and interpretation. This book was written by a group of established authorities in pediatric neurophysiological testing as a way to educate providers who both order and interpret neurophysiological tests in children.

The book focuses on the individual techniques as they apply to different ages and patient populations. A basic understanding of the methods is assumed; for example, the basics of EEG waveforms are not covered, but the chapters do provide some detailed technical advice about the logistical challenges specific to the child. Expected findings in different age groups are reviewed as well as how various pathologies appear at different ages. Tables and diagrams, some in color but mostly in black and white, describe findings in different neurologic conditions and show examples of the output of the different techniques. Four chapters examine EEG findings in neonatal epilepsies, febrile seizures, epileptic and nonepileptic paroxysmal events, and childhood epilepsies. Many examples of abnormal EEG findings are shown, although some montage labels are difficult to read. A well-organized chapter on pediatric sleep disorders discusses the spectrum of available diagnostic tests and guides the reader as to when to order a sleep study and which study is optimal for the clinical situation.

Subsequently, five chapters discuss EMG and NCS in neuromuscular diseases, including the muscular dystrophies, myopathies, neuropathies, and plexopathies. The authors stress that a child's ability to tolerate these procedures is limited, emphasizing the importance of understanding what a test can and cannot answer. Providing a clear history and diagnostic question will allow the prioritization of which muscle and nerves to examine. The authors also describe in detail the maturational changes in nerve and muscle development that affect EMG results and interpretation, especially in the neonatal period.

The last few chapters focus on intraoperative monitoring, evoked potentials, and tests of autonomic dysfunction in children. They discuss how multimodal intraoperative monitoring in infants varies because of differential myelin maturation. Additionally, brainstem auditory evoked potentials are discussed as a sensitive clinical tool to detect brainstem pathology, especially in neonates with hypoxic ischemic encephalopathy. Finally, a useful review of the different tests of autonomic function covers the rare situations in which such tests might be informative beyond clinical assessment. In all electrophysiological tests, interpretation in pediatric patients should be done only in the setting of adequate normative controls.

This text could be useful for pediatric neurology residents and fellows in understanding the indications and some aspects of the interpretation of neurophysiological tests in children. The book lacks the scope and detail found in similar texts (e.g., Holmes, Moshé, Jones, eds., Clinical Neurophysiology of Infancy, Childhood, and Adolescence) but has the advantage of being brief, readable, and relatively inexpensive.