Sarcouncil Journal of Medical Series

Abstract: Background: Pediatric neuromuscular disorders (NMDs) are a diverse group of disorders involving the motor unit at different levels, such as the anterior horn cell, the peripheral nerve, the neuromuscular junction, and the muscle fiber. Objective: To investigate the diagnostic value of using electrogoniography in early detection and classification of neuromuscular diseases in children between 6 months and 16 years. Methods: This was a cross-sectional study carried out in the Al-Anbar–Iraq hospitals from March 2025 to March 2026. One hundred five pediatric patients (62 male, 43 females; mean age 7.8 ± 4.2 years) with signs and symptoms suggestive of a neuromuscular disease were enrolled. Concentric needle EMG and NCS were performed on at least four limb muscles and two sensory nerves in all patients. EMG parameters evaluated were insertional activity, spontaneous activity (fibrillation potential, positive sharp wave, fasciculation potential), MUAP morphology (duration, amplitude, polyphasia), recruitment pattern and interference pattern. Various diagnostic accuracy measures such as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined. Results: Of the 105 patients who were seen, 78 (74.3%) were diagnosed with a neuromuscular disorder and 27 (25.7%) were classified as non-neuromuscular etiologies (benign hypotonia, developmental delay of central origin, or functional complaints). Of those with a confirmed diagnosis, 31 (39.7%) had myopathies, 24 (30.8%) had neuropathies, 12 (15.4%) had motor neuron disease and 11 (14.1%) had neuromuscular junction disorders. EMG demonstrated an overall sensitivity of 91.0% (95% CI: 82.4–96.3%) and specificity of 85.2% (95% CI: 66.3–95.8%) for detecting neuromuscular pathology. The longest MUAPs (>20% prolongation) were the most sensitive to the neuropathic processes (93.8%), and the short-duration, low-amplitude polyphasic MUAPs were the most sensitive to the myopathic processes (90.3%). The patients with EMG-confirmed diagnosis within 6 months of onset of symptoms had significantly better functional outcomes at 12-month follow-up. Summary: We conclude that EMG is a very sensitive and specific diagnostic tool for early diagnosis and classification of pediatric NM disorders. EMG is a valuable part of the initial diagnostic evaluation of children suffering with unexplained motor weakness, hypotonia, and/or delayed milestones, allowing for significant reduction in diagnostic delay and early initiation of disease-specific therapies with the potential to improve functional prognosis.