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Pediatric Neurodiagnostic Tests: A Modern Perspective

The past decade has witnessed unprecedented advances in our ability to study the pediatric nervous system by various imaging and electrophysiologic recording techniques. A profusion of imaging devices and "brain mapping" machines have been developed and aggressively marketed to neurologists. The pediatric practitioner now has a veritable "Chinese menu" of various neurodiagnostic tests from which to choose in evaluating a child who has a neurologic complaint. The quality of the images obtained from newer studies, particularly magnetic resonance imaging (MRI), is truly astounding, and it is tempting to order such a study when evaluating almost any child with a neurologic problem.

Deciding which test to order as a screening procedure, which one might be most useful as a secondary examination, or which study should be performed as the most definitive diagnostic procedure can be difficult. These questions may result in a "shotgun" approach or a "full diagnostic onslaught,"¹ with all available tests being done when one or two might have been sufficient.

The pediatrician's dilemma during the modern era is clear: Despite the increased quality of images now available, the newer tests are expensive (Table 1), and their overuse in the pediatric population has contributed significantly to the higher costs of evaluating children who have neurologic disorders.

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