Neuralgic amyotrophy in children: clinico-diagnostic features in 13 clinical cases

Introduction. Neuralgic amyotrophy is an acute painful inflammatory multifocal neuropathy with a predominant lesion of the brachial plexus followed after by muscle weakness and atrophy. The brachial plexus and the long nerves of the arms are mainly affected. NA is rare in pediatric practice and have appeared as isolated case or in small series in the literature.

Objective — to describe the clinical and diagnostic features of neuralgic amyotrophy patients amyotrophy.

Materials and methods. The clinical, electrophysiological and neuroimaging data about 13 patients (11 boys and 2 girls) aged of from 8 to 17 years (average age 13.6 ± 3.1) were retrospectively analyzed.

Results. All patients complained of neuropathic pain in the affected upper limb, with an average intensity of 8.5 ± 1.2 cm according to the visual analogue scale. The duration of the pain syndrome averaged of 7.4 ± 5.8 days. The average duration of the disease from the onset of pain to examination was 5.2 ± 4.3 months. All patients showed changes in the muscles of the affected side according to electromyography data in the form of neurogenic restructuring of motor units.

The peripheral nerve ultrasound reveals no significant differences in the average values of the cross-sectional area of the spinal and median nerves (in 7 patients over the acute phase and atrophy phase and 6 — during the recovery phase) revealed an increase in the cross-section area of the spinal nerves on the affected side in 38% and 15% on the unaffected side compared with the normative values. In 4 cases, one hourglass-like nerve constriction was detected in the axillary and 3 ones — in the radial nerves. Two patients received pathogenetic therapy with steroids. Two patients received surgical treatment. Residual motor deficiency was observed in 62% of patients.

Conclusion. It is a rare condition in children, but raising awareness about it will help avoid delay in diagnosis. In our series of cases, the clinical and diagnostic features were the same as in adults.

Compliance with ethical standards. The study was approved by the local Ethics Committee of the N.I. Pirogov Russian National Research Medical University (Protocol No. 209 of 06/28/2021).

Contribution:
Druzhinina E.S. — review of publications, data collection and analysis, writing the text of the manuscript;
Druzhinin D.S. — data collection and analysis, writing text;
Rogovskaya U.V. — data collection, writing text;
Kurbatov S.A. — data collection, writing text;
Zavadenko N.N. — writing the text of the article, final approval for the publication of the manuscript.
All co-authors are responsible for the integrity of all parts of the manuscript and approval of its final version.

Acknowledgements. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: July 7, 2024
Accepted: August 2, 2024
Published: October 30, 2024

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