During this period, one hundred and twenty seven cases of AFP were reported. Adequate amount of stool sample was collected in 82 patients and in 45 cases sample was inadequate for viral studies. All patients with inadequate stool sample were referred for further clinical and electrophysiological classification. In cases where stool sample was inadequate we identified twenty-six cases of PIP on the basis of (i) asymmetrical monomelic involvement in the distribution of affected nerve, and (ii) temporal relation with injection (within few hours to few days of injection). These patients were subject to nerve conduction studies to differentiate between other causes. The average gap between trauma and nerve conduction studies was 2 months. Twenty-four patients with PIP had residual deficit on 60 days follow up. Two patients recovered completely during follow up.

The age range was between 1-11.5 years. Seventeen cases were below 5-years of age, and nine cases were above 5 years. Fever of 1-2 day duration was the most common indication for receiving injection. Trunk of sciatic nerve was affected in 24 patients and radial nerve was affected in 2 patients. Nerve conduction studies performed in 24 cases showed either absence or very low amplitude potential in motor peroneal (n = 20), and sometimes posterior tibial (n = 6) nerve when injection was given in proximity of the sciatic nerve. Similar results were found on radial nerve stimulation if injection was given in proximity to radial nerve (n = 2). Neurogenic EMG was recorded in innervated muscles if voluntary recruitment was possible.

Post injection palsy is an injury of the nerve, usually resulting from irritant effect of the injected drug(1), however the possibility of direct injury can not be ruled out in those children who developed palsy soon after the injection. Although we analysed only a small subgroup of AFP cases, looking at it, a very high incidence of PIP is expected in the Chhattisgarh Region. In our study lower limb was more often affected. Most of the injury resulted in more severe deficits of the peroneal division and foot drop as compared to the tibial division of sciatic nerve. The prevalence of PIP is not much reported in literature from India. Ahuja and Dhamija(2), followed fifty such patients, 40% of these cases had no recovery on six months follow up. In a study from United States over a 24 year involving 230 cases of gluteal sciatic nerve injury, 50% cases were due to injection trauma(3). In a similar report from China the incidence of gluteal sciatic nerve injury due to injection was even higher (86.32%) over the span of 35 years(4).

It is recommended that unnecessary intra muscular injections as a popular mode of therapy should be discouraged in pediatric practice by untrained practioners. It is also desirable to look at distribution of PIP among various states as a by-product of AFP surveillance.

S. Sharma,
R. Kale*,
Department of Neurology and Pediatrics*,
MMI Hospital, Lalpur, Raipur 492 007, India.
E-mail: [email protected]

1. Mayer M, Romain O. Sciatic paralysis after a buttock intramuscular injection in children: an ongoing risk factor. (Article in French). Arch Pediatr 2001; 8: 321-323.

2. Ahuja B, Dhamija K. Sciatic neuropathy. Indian Pediatr 1984; 21: 797-801.

3. Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injury: A 24-year experience. J Neurosurg 1998; 89: 13-23.

4. Huang Y, Yan Q, Lei W. Gluteal sciatic nerve injury and its treatment. (Article in Chinese) Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2000; 14: 83-86.