Study design: We performed transcranial magnetic stimulation (TMS) in children with sequelae of acute transverse myelitis. Single-pulse TMS protocol was implemented. Twenty controls and 24 patients with myelitis were enrolled. TMS was performed on 12-24 day after the onset of the first symptoms, average on 16th day. Objectives: The objective of our study was to evaluate motor pathways in children with viral myelitis using the TMS technique. Setting: All investigations were performed in Scientific Research Institute for Children's Infections, Russia. Results: There were statistically significant differences between the groups on central motor conduction time and motor evoked potential (MEPs) amplitudes. MEP thresholds were elevated, and MEP shape was abnormal in 96% of patients with myelitis (n = 23). Three neurophysiologic patterns were observed: the presence of both cortical and spinal MEP, the absence of cortical MEP with the spinal MEP present and the total absence of both cortical and spinal MEP. Last finding was associated with paraplegia, resistant to any sort of treatment. Conclusion: Thus, myelitis in 96% of the cases causes neurophysiologic changes, which may be detected by TMS; the method may be used as a predicting tool. Spinal Cord (2016) 54, 226-228; doi:10.1038/sc.2015.129; published online 4 August 2015 INTRODUCTIONAcute transverse myelitis is the infrequent, severe and potentially devastating condition that has been estimated to occur with an annual worldwide incidence of 4 cases per 100 000 individuals. 1 In pediatric population, it often results in motor, sensory and autonomic dysfunction, with growing demand for reliable diagnostic and prognostic tools. 2 Clinical examination in children is sometimes unreliable, and standard neurophysiologic tests could be insufficient in setting precise diagnosis; thus, transcranial magnetic stimulation (TMS) is considered as one of the valuable diagnostic methods. 3,4 TMS is a method for focal noninvasive brain stimulation that is based on the principles of electromagnetic induction. 5 TMS is an effective diagnostic and a therapeutic technique with applications in neurology, psychiatry and rehabilitation medicine, which can provide insight into developmental neurology and neurophysiology in children. 6 TMS can detect corticospinal tract abnormalities not identified by neuroimaging. 3,4,6 In the patients with compressive myelopathies, TMS was found to be helpful in determining the functional significance of neuroimaging findings. TMS can supplement clinical examination and neuroimaging findings also in the assessment of the spinal cord injury level. 3,4 However, reports of TMS use in pediatric acute myelitis are relatively rare, and mostly such works are case reports or small series consisting of 2-3 patients. 7 We have performed the investigation of corticospinal pathway characteristics in children with acute myelitis, with special attention toward clinical significance of TMS and its prognostic value in this case.

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Background. Unlike parameters of phrenic nerve conduction in healthy adults characterized by stability, in children variations with age are observed. The objective is to investigate the M-wave latency and amplitude in electroneurographic (ENG) examination of the phrenic nerve in healthy children of different ages for development of a normative database of neurophysiological data.Materials and methods. 48 healthy children (28 girls and 20 boys) were examined. Mean age was 9.19 ± 5.43 years (1–18 years). ENG examination of the phrenic nerve was performed with the modified standard procedure of stimulation at the level of the outer margin of the lower third of the sternocleidomastoid muscle with registration of M-wave from standard diaphragm point and parallel registration of the muscle activity from m.deltoideus and m.serratus anterior.Results. Mean values of the M-response latency were 5.64 ± 1.25 ms, amplitude – 0.66 ± 0.34 mV. For age-differentiated subgroups 1–2 years (n = 7), 3–5 years (n = 9), 6–12 years (n = 15), and 13–18 years (n = 17), the latency was 4.96 ± 1.94; 5.01 ± 1.13; 5.42 ± 0.84, and 6.44 ± 1.43 ms, respectively; the amplitude was 1.01 ± 0.37; 0.87 ± 0.31; 0.61 ± 0.24, and 0.45 ± 0.21 mV, respectively. The M-response amplitude values in children aged 1–2 years significantly differed from the values in children aged 6–12 and 13–18 years.Conclusion. ENG examination of the phrenic nerve is a technically uncomplicated procedure, and the obtained data is easy to interpret. During phrenic nerve ENG in children, it is necessary to take age variability of the M-wave latency and amplitude into account. The M-wave amplitude in healthy toddlers (1–2 years old) was significantly lower than in children aged 6–18 years.

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