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Pabst L, Hoyt CR, Felling RJ, Smith AE, Harpster K, Pardo AC, Bridge JA, Jiang B, Gehred A, Lo W. Neuroimaging and Neurological Outcomes in Perinatal Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis. Pediatr Neurol 2024; 157:19-28. [PMID: 38848613 DOI: 10.1016/j.pediatrneurol.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Prediction of outcomes in perinatal arterial ischemic stroke (PAIS) is challenging. We performed a systematic review and meta-analysis to determine whether infarct characteristics can predict outcomes in PAIS. METHODS A systematic search was conducted using five databases in January 2023. Studies were included if the sample included children with neonatal or presumed PAIS; if infarct size, location, or laterality was indicated; and if at least one motor, cognitive, or language outcome was reported. The level of evidence and risk of bias were evaluated using the Risk of Bias in Non-Randomized Studies of Interventions tool. Meta-analyses were conducted comparing infarct size or location with neurological outcomes when at least three studies could be analyzed. RESULTS Eighteen full-text articles were included in a systematic review with nine included in meta-analysis. Meta-analyses revealed that small strokes were associated with a lower risk of cerebral palsy/hemiplegia compared with large strokes (risk ratio [RR] = 0.263, P = 0.001) and a lower risk of epilepsy (RR = 0.182, P < 0.001). Middle cerebral artery (MCA) infarcts were not associated with a significantly different risk of cerebral palsy/hemiplegia compared with non-MCA strokes (RR = 1.220, P = 0.337). Bilateral infarcts were associated with a 48% risk of cerebral palsy/hemiplegia, a 26% risk of epilepsy, and a 58% risk of cognitive impairment. CONCLUSIONS Larger stroke size was associated with worse outcomes across multiple domains. Widely heterogeneous reporting of infarct characteristics and outcomes limits the comparison of studies and the analysis of outcomes. More consistent reporting of infarct characteristics and outcomes will be important to advance research in this field.
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Affiliation(s)
- Lisa Pabst
- Division of Neurology, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
| | - Catherine R Hoyt
- Program in Occupational Therapy, Department of Neurology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan J Felling
- Department of Neurology & Kennedy Krieger Institute, Johns Hopkins Medicine, Baltimore, Maryland
| | - Alyssa E Smith
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Andrea C Pardo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey A Bridge
- Departments of Pediatrics and Psychiatry & Behavioral Health, Nationwide Children's Hospital and The Ohio State University College of Medicine, Center for Suicide Prevention and Research, Columbus, Ohio
| | - Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Stanford, California
| | - Alison Gehred
- Nationwide Children's Hospital Library, Columbus, Ohio
| | - Warren Lo
- Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio
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2
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Yang J, Chen C, Chen N, Zheng H, Chen Y, Li X, Jia Q, Li T. Clinical characteristics and rehabilitation potential in children with cerebral palsy based on MRI classification system. Front Pediatr 2024; 12:1382172. [PMID: 38725982 PMCID: PMC11079180 DOI: 10.3389/fped.2024.1382172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Background The correlation of clinical characteristics of cerebral palsy (CP) and the magnetic resonance imaging classification system (MRICS) for (CP) is inconsistent. Specifically, the variance in rehabilitation potential across MRICS remains underexplored. Aims To investigate the clinical characteristics and potential for rehabilitation in children with CP based on MRICS. Materials and methods Children with CP admitted to the Department of Rehabilitation, Children's Hospital of Chongqing Medical University between 2017 and 2021 were included in the study. Qualified cases underwent a follow-up period of at least one year. The clinical characteristics of CP among different MRICS were analyzed, then the rehabilitation potential was explored by a retrospective cohort study. Results Among the 384 initially enrolled children, the male-to-female ratio was 2.3:1, and the median age of diagnosis was 6.5 months (interquartile range: 4-12). The most prevalent MRICS categorization was predominant white matter injury (40.6%), followed by miscellaneous (29.2%) and predominant gray matter injury (15.6%). For the predominant white matter injury and miscellaneous categories, spastic diplegia emerged as the leading subtype of CP, with incidences of 59.6% and 36.6%, respectively, while mixed CP (36.7%) was the most common type in children with predominant gray matter. Notably, 76.4% of children with predominant white matter injury were classified as levels I-III on the gross motor function classification system (GMFCS), indicating significantly less severity than other groups (χ2 = 12.438, p = 0.013). No significant difference across MRICS categories was observed for the manual ability classification system (MACS) (H = 8.176, p = 0.085). Rehabilitation potential regarding fine motor function and adaptability based on Gesell assessment was dependent on MRICS over the follow-up period. Children with normal MRI scans exhibited superior rehabilitation outcomes. Commencing rehabilitation at an earlier stage produced consistent and beneficial results in terms of fine motor function and adaptability across all MRICS categories. Moreover, participants below 2 years of age demonstrated enhanced rehabilitation potential regarding fine motor outcomes and adaptability within the MRICS framework. Conclusion MRICS displayed a significant association with clinical characteristics and rehabilitation efficacy in children with CP.
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Affiliation(s)
- Jie Yang
- Department of Rehabilitation, Children’s Hospital of Chongqing Medical University (CHCMU), Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Congjie Chen
- Department of Rehabilitation, Children’s Hospital of Chongqing Medical University (CHCMU), Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ningning Chen
- Department of Rehabilitation, Children’s Hospital of Chongqing Medical University (CHCMU), Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Helin Zheng
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Radiology, CHCMU, Chongqing, China
| | - Yuxia Chen
- Department of Rehabilitation, Children’s Hospital of Chongqing Medical University (CHCMU), Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaoli Li
- Department of Rehabilitation, Children’s Hospital of Chongqing Medical University (CHCMU), Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qingxia Jia
- Department of Rehabilitation, Children’s Hospital of Chongqing Medical University (CHCMU), Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Tingsong Li
- Department of Rehabilitation, Children’s Hospital of Chongqing Medical University (CHCMU), Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
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3
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Camilleri C, Wilson A, Beribisky N, Desrocher M, Williams T, Dlamini N, Westmacott R. Social skill and social withdrawal outcomes in children following pediatric stroke. Child Neuropsychol 2024:1-17. [PMID: 38557290 DOI: 10.1080/09297049.2024.2335107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
Pediatric stroke can result in long-term impairments across attention, functional communication and motor domains. The current paper utilized parent reports of the Behavioral Assessment System for Children 2nd Edition and the Pediatric Stroke Outcome Measure to examine children's social skills and withdrawal behavior within a pediatric stroke population. Using the Canadian Pediatric Stroke Registry at The Hospital for Sick Children, data were analyzed for 312 children with ischemic stroke. Children with ischemic stroke demonstrated elevated parent-reported social skills problems (observed = 20.51%, expected = 14.00%) and clinically elevated social withdrawal (observed = 11.21%, expected = 2.00%). Attentional problems significantly contributed to reduced social skills, F (3,164) = 30.68, p < 0.01, while attentional problems and neurological impairments accounted for increased withdrawal behavior, F (2, 164) = 7.47, p < 0.01. The presence of a motor impairment was associated with higher social withdrawal compared to individuals with no motor impairment diagnosis, t(307.73) = 2.25, p < .025, d = 0.25, 95% CI [0.42, 6.21]. The current study demonstrates that children with stroke who experience motor impairments, attentional problems, reduced functional communication skills, and neurological impairments can experience deficits in their social skills and withdrawal behavior.
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Affiliation(s)
| | - Alyssia Wilson
- Department of Psychology, York University, Toronto, Canada
| | | | - Mary Desrocher
- Department of Psychology, York University, Toronto, Canada
| | - Tricia Williams
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nomazulu Dlamini
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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4
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Champigny CM, Feldman SJ, Beribisky N, Desrocher M, Isaacs T, Krishnan P, Monette G, Dlamini N, Dirks P, Westmacott R. Predictors of neurocognitive outcome in pediatric ischemic and hemorrhagic stroke. Child Neuropsychol 2024; 30:444-461. [PMID: 37204222 DOI: 10.1080/09297049.2023.2213461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
This clinical study examined the impact of eight predictors (age at stroke, stroke type, lesion size, lesion location, time since stroke, neurologic severity, seizures post-stroke, and socioeconomic status) on neurocognitive functioning following pediatric stroke. Youth with a history of pediatric ischemic or hemorrhagic stroke (n = 92, ages six to 25) underwent neuropsychological testing and caregivers completed parent-report questionnaires. Hospital records were accessed for medical history. Spline regressions, likelihood ratios, one-way analysis of variance, Welch's t-tests, and simple linear regressions examined associations between predictors and neuropsychological outcome measures. Large lesions and lower socioeconomic status were associated with worse neurocognitive outcomes across most neurocognitive domains. Ischemic stroke was associated with worse outcome in attention and executive functioning compared to hemorrhagic stroke. Participants with seizures had more severe executive functioning impairments than participants without seizures. Youth with cortical-subcortical lesions scored lower on a few measures than youth with cortical or subcortical lesions. Neurologic severity predicted scores on few measures. No differences were found based on time since stroke, lesion laterality, or supra- versus infratentorial lesion. In conclusion, lesion size and socioeconomic status predict neurocognitive outcome following pediatric stroke. An improved understanding of predictors is valuable to clinicians who have responsibilities related to neuropsychological assessment and treatments for this population. Findings should inform clinical practice through enhanced appraisals of prognosis and the use of a biopsychosocial approach when conceptualizing neurocognitive outcome and setting up support services aimed at fostering optimal development for youth with stroke.
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Affiliation(s)
- Claire M Champigny
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Samantha J Feldman
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | | | - Mary Desrocher
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Tamiko Isaacs
- Department of Psychology, York University, Toronto, Canada
| | - Pradeep Krishnan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | | | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
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5
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Bogavac I, Jeličić L, Marisavljević M, Bošković Matić T, Subotić M. Arterial Presumed Perinatal Ischemic Stroke: A Mini Review and Case Report of Cognitive and Speech-Language Profiles in a 5-Year-Old Girl. CHILDREN (BASEL, SWITZERLAND) 2023; 11:33. [PMID: 38255347 PMCID: PMC10814911 DOI: 10.3390/children11010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
Arterial presumed perinatal ischemic stroke is a type of perinatal stroke that emerges due to late or delayed diagnostics of perinatal or neonatal arterial ischemic stroke. It is usually recognized before one year of life due to hemiparesis. This injury may lead to cognitive, behavioral, or motor symptoms, and life-long neurodevelopmental disabilities. In this case report, we describe a five-year-old girl with a history of arterial presumed perinatal ischemic stroke in the left hemisphere, which adversely affected her cognitive and language outcomes. The girl's cognitive development has been uneven, ranging from below average to average, and she had specific language acquisition deficits in comprehension, vocabulary, morphology, use of complex syntax, and narrative structure. The obtained results point to the specificity of each child whose development is influenced not only by the timing of the brain lesion and the degree of damage, but also by the child's neurobiological capacity. In addition, we provide an updated review of the literature that includes information on epidemiology, risk factors, diagnostics, clinical manifestations, outcomes, and potential therapies. The present article highlights the importance of early intervention and systematic monitoring of children with perinatal stroke with the aim of improving the child's development.
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Affiliation(s)
- Ivana Bogavac
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (I.B.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Ljiljana Jeličić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (I.B.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Maša Marisavljević
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (I.B.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Tatjana Bošković Matić
- Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- Clinic of Neurology, University Clinical Centre of Kragujevac, 34000 Kragujevac, Serbia
| | - Miško Subotić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (I.B.); (M.M.); (M.S.)
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6
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Shinde K, Craig BT, Hassett J, Dlamini N, Brooks BL, Kirton A, Carlson HL. Alterations in cortical morphometry of the contralesional hemisphere in children, adolescents, and young adults with perinatal stroke. Sci Rep 2023; 13:11391. [PMID: 37452141 PMCID: PMC10349116 DOI: 10.1038/s41598-023-38185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Perinatal stroke causes most hemiparetic cerebral palsy and cognitive dysfunction may co-occur. Compensatory developmental changes in the intact contralesional hemisphere may mediate residual function and represent targets for neuromodulation. We used morphometry to explore cortical thickness, grey matter volume, gyrification, and sulcal depth of the contralesional hemisphere in children, adolescents, and young adults after perinatal stroke and explored associations with motor, attention, and executive function. Participants aged 6-20 years (N = 109, 63% male) with unilateral perinatal stroke underwent T1-weighted imaging. Participants had arterial ischemic stroke (AIS; n = 36), periventricular venous infarction (PVI; n = 37) or were controls (n = 36). Morphometry was performed using the Computational Anatomy Toolbox (CAT12). Group differences and associations with motor and executive function (in a smaller subsample) were assessed. Group comparisons revealed areas of lower cortical thickness in contralesional hemispheres in both AIS and PVI and greater gyrification in AIS compared to controls. Areas of greater grey matter volume and sulcal depth were also seen for AIS. The PVI group showed lower grey matter volume in cingulate cortex and less volume in precuneus relative to controls. No associations were found between morphometry metrics, motor, attention, and executive function. Cortical structure of the intact contralesional hemisphere is altered after perinatal stroke. Alterations in contralesional cortical morphometry shown in perinatal stroke may be associated with different mechanisms of damage or timing of early injury. Further investigations with larger samples are required to more thoroughly explore associations with motor and cognitive function.
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Affiliation(s)
- Karan Shinde
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
| | - Brandon T Craig
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jordan Hassett
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Brian L Brooks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Helen L Carlson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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7
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Felling RJ, Jordan LC, Mrakotsky C, deVeber G, Peterson RK, Mineyko A, Feldman SJ, Shapiro K, Lo W, Beslow LA. Roadmap for the Assessment and Management of Outcomes in Pediatric Stroke. Pediatr Neurol 2023; 141:93-100. [PMID: 36805967 DOI: 10.1016/j.pediatrneurol.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Neurological morbidity is common after pediatric stroke, with moderate to severe deficits that can significantly impact education and social function. Care and recovery occur in phases distinguished by the time interval after stroke onset. These phases include the hyperacute and acute periods in which the focus is on cerebral reperfusion and prevention of neurological deterioration, followed by the subacute and chronic phases in which the focus is on secondary stroke prevention and mitigation of disability through rehabilitation, adaptation, and reintegration into the community. In this article, a multidisciplinary group of pediatric stroke experts review the stages of recovery after pediatric stroke with an emphasis on critical assessment time points. Our goal is to encourage increased standardization of outcome assessment to facilitate future clinical trials comparing various treatment and intervention options and advance optimized care for children with stroke.
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Affiliation(s)
- Ryan J Felling
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christine Mrakotsky
- Departments of Psychiatry & Neurology, Center for Neuropsychology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabrielle deVeber
- Child Health Evaluative Sciences Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Rachel K Peterson
- Neuropsychology Department, Kennedy Krieger Institute, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Aleksandra Mineyko
- Section of Neurology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Samantha J Feldman
- Neurosciences and Mental Health Research Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Kevin Shapiro
- Cortica Healthcare, Westlake Village, California; Division of Neurology, Children's Hospital Lost Angeles, Los Angeles, California
| | - Warren Lo
- Departments of Pediatrics and Neurology, The Ohio State University Nationwide Children's Hospital, Columbus, Ohio
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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8
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Rivella C, Zanetti A, Bertamino M, Severino M, Primavera L, Signa S, Moretti P, Viterbori P. [Formula: see text] Executive functions and psychosocial impairment in children following arterial ischemic stroke. Child Neuropsychol 2023; 29:276-298. [PMID: 35668031 DOI: 10.1080/09297049.2022.2083093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study examined the executive function (EF) of children with a history of arterial ischemic stroke (AIS) and preserved intellectual abilities, with reference to age at stroke onset, lesion characteristics, language, and motor functioning. In addition, the associations between EF and emotional and behavioral functioning were investigated. A battery of standardized neuropsychological tests was administered to children with previous AIS aged 7-12 in order to assess EF, including inhibition, working memory, cognitive flexibility, and attention. Parents rated questionnaires regarding real-life emotional and behavioral functioning. Finally, clinical and neuroradiological data were also gathered. Thirty patients were enrolled. Eight children fall in the lower end of the normative range or below in more than half of the EF measures, with working memory, inhibition and cognitive flexibility equally impaired, and attention relatively better preserved. Larger lesion size and language deficits were significantly associated with higher EF impairment. Emotional and behavioral functioning was lower in children with weaker EF. Children with a history of AIS, even those with preserved intellectual functioning, have a high risk of showing poor EF, mostly regardless of clinical features or functional impairment. EF difficulties are in turn associated with emotional and behavioral problems. Therefore, a standardized evaluation of EF in this population is mandatory as part of the follow-up, in order to ensure an early intervention and prevent related difficulties.
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Affiliation(s)
- Carlotta Rivella
- Department of Educational Science, University of Genoa, Genoa, Italy
| | - Alice Zanetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Ludovica Primavera
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sara Signa
- Department of Neuroscience, Ophthalmology, Genetics and Maternal Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,Autoinflammatory Diseases and Immunodeficiencies Center, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Moretti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Viterbori
- Department of Educational Science, University of Genoa, Genoa, Italy
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9
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Malone LA, Levy TJ, Peterson RK, Felling RJ, Beslow LA. Neurological and Functional Outcomes after Pediatric Stroke. Semin Pediatr Neurol 2022; 44:100991. [PMID: 36456032 DOI: 10.1016/j.spen.2022.100991] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022]
Abstract
Pediatric stroke results in life-long morbidity for many patients, but the outcomes can vary depending on factors such as age of injury, or mechanism, size, and location of stroke. In this review, we summarize the current understanding of outcomes in different neurological domains (eg, motor, cognitive, language) for children with stroke of different mechanisms (ie, arterial ischemic stroke, cerebral sinus venous thrombosis, and hemorrhagic stroke), but with a focus on World Health Organization International Classification for Functioning, Disability, and Health (ICF-CY) framework for measuring health and disability for children and youth. We describe outcomes for the population as a whole and certain factors that may further refine prognostication.
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Affiliation(s)
- Laura A Malone
- Kennedy Krieger Institute, Baltimore, MD; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Todd J Levy
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rachel K Peterson
- Kennedy Krieger Institute, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lauren A Beslow
- The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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10
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Abstract
Perinatal ischemic stroke is a common cause of lifelong disability.
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Affiliation(s)
- Nicholas V Stence
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 125, Aurora, CO 80045, USA.
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 125, Aurora, CO 80045, USA
| | - Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 125, Aurora, CO 80045, USA
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11
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Li E, Smithson L, Khan M, Kirton A, Pei J, Andersen J, Yager JY, Brooks BL, Rasmussen C. Effects of Perinatal Stroke on Executive Functioning and Mathematics Performance in Children. J Child Neurol 2022; 37:133-140. [PMID: 34985353 PMCID: PMC8801623 DOI: 10.1177/08830738211063683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this study was to examine executive functioning, math performance, and visuospatial processing skills of children with perinatal stroke, which have not been well explored in this population. Participants included 18 children with perinatal stroke (aged 6-16 years old) and their primary caregiver. Each child completed standardized tests of executive function and visuospatial processing skills, Intelligence Quotient (IQ), and math achievement. Performance on executive function, IQ, math, and visuospatial processing tests was significantly lower in children with perinatal stroke when compared to normative means. Poorer inhibitory control was associated with worse math performance. Increased age at testing was associated with better performance on visuospatial ability (using standardized scores), and females performed better than males on a test of inhibitory control. Children with perinatal stroke displayed a range of neuropsychological impairments, and difficulties with executive function (inhibition) may contribute to math difficulties in this population.
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Affiliation(s)
- Eliza Li
- University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Smithson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Adam Kirton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - John Andersen
- University of Alberta, Edmonton, Alberta, Canada,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | | | - Brian L. Brooks
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada,Faculty of Arts, University of Calgary, Calgary, Alberta, Canada,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Carmen Rasmussen
- University of Alberta, Edmonton, Alberta, Canada,Carmen Rasmussen, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 4-478, Edmonton Clinic Health Academy (ECHA), 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
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12
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Martin KC, Ketchabaw WT, Turkeltaub PE. Plasticity of the language system in children and adults. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:397-414. [PMID: 35034751 PMCID: PMC10149040 DOI: 10.1016/b978-0-12-819410-2.00021-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The language system is perhaps the most unique feature of the human brain's cognitive architecture. It has long been a quest of cognitive neuroscience to understand the neural components that contribute to the hierarchical pattern processing and advanced rule learning required for language. The most important goal of this research is to understand how language becomes impaired when these neural components malfunction or are lost to stroke, and ultimately how we might recover language abilities under these circumstances. Additionally, understanding how the language system develops and how it can reorganize in the face of brain injury or dysfunction could help us to understand brain plasticity in cognitive networks more broadly. In this chapter we will discuss the earliest features of language organization in infants, and how deviations in typical development can-but in some cases, do not-lead to disordered language. We will then survey findings from adult stroke and aphasia research on the potential for recovering language processing in both the remaining left hemisphere tissue and in the non-dominant right hemisphere. Altogether, we hope to present a clear picture of what is known about the capacity for plastic change in the neurobiology of the human language system.
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Affiliation(s)
- Kelly C Martin
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - W Tyler Ketchabaw
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - Peter E Turkeltaub
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States; Research Division, MedStar National Rehabilitation Hospital, Washington, DC, United States.
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13
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Núñez C, Stephan-Otto C, Arca G, Agut T, Arnaez J, Cordeiro M, Benavente-Fernández I, Boronat N, Lubián-López SP, Valverde E, Hortigüela M, García-Alix A. Neonatal arterial stroke location is associated with outcome at 2 years: a voxel-based lesion-symptom mapping study. Arch Dis Child Fetal Neonatal Ed 2022; 107:45-50. [PMID: 33990386 DOI: 10.1136/archdischild-2020-320400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In contrast to motor impairments, the association between lesion location and cognitive or language deficits in patients with neonatal arterial ischaemic stroke remains largely unknown. We conducted a voxel-based lesion-symptom mapping cross-sectional study aiming to reveal neonatal arterial stroke location correlates of language, motor and cognitive outcomes at 2 years of age. DESIGN Prospective observational multicentre study. SETTING Six paediatric university hospitals in Spain. PARTICIPANTS We included 53 patients who had a neonatal arterial ischaemic stroke with neonatal MRI and who were followed up till 2 years of age. MAIN OUTCOME MEASURES We analysed five dichotomous clinical variables: speech therapy (defined as the need for speech therapy as established by therapists), gross motor function impairment, and the language, motor and cognitive Bayley scales. All the analyses were controlled for total lesion volume. RESULTS We found that three of the clinical variables analysed significantly correlated with neonatal stroke location. Speech therapy was associated with lesions located mainly at the left supramarginal gyrus (p=0.007), gross motor function impairment correlated with lesions at the left external capsule (p=0.044) and cognitive impairment was associated with frontal lesions, particularly located at the left inferior and middle frontal gyri (p=0.012). CONCLUSIONS The identification of these susceptible brain areas will allow for more precise prediction of neurological impairments on the basis of neonatal brain MRI.
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Affiliation(s)
- Christian Núñez
- Departament de Psiquiatria, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Gemma Arca
- Departament de Neonatologia, Hospital Clínic, IDIBAPS, Barcelona, Spain.,NeNe Foundation, Madrid, Spain
| | - Thais Agut
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,NeNe Foundation, Madrid, Spain.,Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Juan Arnaez
- NeNe Foundation, Madrid, Spain.,Departamento de Neonatología, Hospital Universitario de Burgos, Burgos, Spain
| | - Malaika Cordeiro
- Departamento de Neonatología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Nuria Boronat
- Departamento de Neonatología, Hospital Universitario y Politécnico La Fe. Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Simón Pedro Lubián-López
- NeNe Foundation, Madrid, Spain.,Departamento de Neonatología, Hospital Puerta del Mar, Cádiz, Spain
| | - Eva Valverde
- NeNe Foundation, Madrid, Spain.,Departamento de Neonatología, Hospital Universitario La Paz, Madrid, Spain
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14
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PÅhlman M, Gillberg C, Himmelmann K. Neuroimaging findings in children with cerebral palsy with autism and/or attention-deficit/hyperactivity disorder: a population-based study. Dev Med Child Neurol 2022; 64:63-69. [PMID: 34370307 DOI: 10.1111/dmcn.15011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/23/2022]
Abstract
AIM To compare neuroimaging patterns according to the Magnetic Resonance Imaging Classification System (MRICS) in children with cerebral palsy (CP) with and without autism and/or attention-deficit/hyperactivity disorder (ADHD). METHOD This population-based study assessed 184 children (97 males, 87 females) with CP born from 1999 to 2006 from the CP register of western Sweden, who had completed comprehensive screening and clinical assessment for neuropsychiatric disorders and undergone neuroimaging. RESULTS Autism (total prevalence 30%) and ADHD (31%) were common in all neuroimaging patterns, including normal. Autism and ADHD were not more prevalent in children with bilateral than unilateral lesions, contrary to other associated impairments. Children with predominant white matter injury, related to insults in the late second or early third trimester, had the highest prevalence of autism (40%). Children who had sustained a middle cerebral artery infarction had the highest prevalence of ADHD (62%). INTERPRETATION Although autism and ADHD are common regardless of neuroimaging patterns, timing and localization of insult appear to be of importance for the occurrence of autism and ADHD in children with CP. Neuroimaging may be of prognostic value for these associated impairments. Further in-depth neuroimaging studies may lead to a better understanding of the association between CP and neuropsychiatric disorders.
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Affiliation(s)
- Magnus PÅhlman
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Rehabilitation Centre, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kate Himmelmann
- Regional Rehabilitation Centre, Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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15
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Yin H, Wang X, Yang H, Zhu X, Wang J, Li Z. A pilot study of the General Movement Optimality Score detects early signs of motor disorder in neonates with arterial ischemic stroke. Early Hum Dev 2021; 163:105484. [PMID: 34655917 DOI: 10.1016/j.earlhumdev.2021.105484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 08/12/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
AIM To explore whether the General Movement Optimality Score (GMOS) could help to identify asymmetric movement in infants with neonatal arterial ischemic stroke (NAIS) in the early stage. METHOD Twenty-seven infants with NAIS (16 males, 11 females) were enrolled. The general movement video was recorded approximately one month after birth. The GMOS focused separately on the neck and trunk and the upper and lower extremities. The differences between the ipsilesional and contralesional limbs were analyzed. RESULTS Eight infants who developed cerebral palsy (CP) had middle cerebral artery (MCA) infarction involving the main branch. By GMOS evaluation, the scores of the contralesional upper and/or lower limbs were lower than those of the ipsilesional side (p < 0.05). In the contralesional limbs, the CP group had a lower GMOS than the non-CP group. Distal rotatory components of the contralesional upper limbs and tremulous movement of the lower limbs showed significant differences. INTERPRETATION The GMOS could help to quantitatively find and assess the asymmetric movement of global and contralesional limbs. Distal rotatory movement of the upper limbs could be an early sign of abnormal motor function in infants with NAIS.
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Affiliation(s)
- Huanhuan Yin
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xinrui Wang
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xiaoyun Zhu
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Jun Wang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China.
| | - Zhihua Li
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China.
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16
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Hamner T, Shih E, Ichord R, Krivitzky L. Children with perinatal stroke are at increased risk for autism spectrum disorder: Prevalence and co-occurring conditions within a clinically followed sample. Clin Neuropsychol 2021; 36:981-992. [PMID: 34308766 DOI: 10.1080/13854046.2021.1955150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Children with perinatal stroke are at increased risk for developmental language disorders, learning difficulties, and other mental health conditions. However to date, autism (ASD) prevalence in this group has not been reported. Given that early identification of ASD is essential to promoting optimal outcomes, our goal was to establish prevalence of ASD in children with perinatal stroke. METHOD A prospectively enrolled, single-center stroke registry maintained at our institution since 2005 was queried for all potentially eligible patients with a history of perinatal stroke. Information regarding stroke features, ASD diagnosis/concern, intellectual disability/global developmental delay, cerebral palsy/hemiparesis, epilepsy, and language disorder were collected via retrospective chart review from electronic health records. RESULTS 311 children were identified, of which 201 complete records were analyzed. Twenty-three cases were formally diagnosed with ASD (11.4%). First concerns were noted in toddlerhood (Mage = 2.66 years), yet the average age of diagnosis was 6.26 years. Children with ASD were more likely to have earlier diagnoses of intellectual disability/global developmental delay or a mixed receptive-expressive language disorder (ps < .001) but did not differ on CP/hemiplegia or epilepsy diagnoses. Risk for ASD increased with accumulating diagnoses. DISCUSSION Children with perinatal stroke have an increased prevalence of ASD (11.4%) than in the general population. ASD concerns arise at a similar age as the general population, yet ASD is diagnosed almost two years later than the general population and 3.60 years after first concerns present. Co-occurring neurological conditions are common. Clinicians must be aware of increased prevalence and implement screening as part of routine care for all pediatric patients with perinatal stroke.
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Affiliation(s)
- Taralee Hamner
- Drexel University, Philadelphia, PA, USA.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Evelyn Shih
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology & Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Ichord
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology & Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Krivitzky
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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17
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Perinatal stroke: mapping and modulating developmental plasticity. Nat Rev Neurol 2021; 17:415-432. [PMID: 34127850 DOI: 10.1038/s41582-021-00503-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/04/2023]
Abstract
Most cases of hemiparetic cerebral palsy are caused by perinatal stroke, resulting in lifelong disability for millions of people. However, our understanding of how the motor system develops following such early unilateral brain injury is increasing. Tools such as neuroimaging and brain stimulation are generating informed maps of the unique motor networks that emerge following perinatal stroke. As a focal injury of defined timing in an otherwise healthy brain, perinatal stroke represents an ideal human model of developmental plasticity. Here, we provide an introduction to perinatal stroke epidemiology and outcomes, before reviewing models of developmental plasticity after perinatal stroke. We then examine existing therapeutic approaches, including constraint, bimanual and other occupational therapies, and their potential synergy with non-invasive neurostimulation. We end by discussing the promise of exciting new therapies, including novel neurostimulation, brain-computer interfaces and robotics, all focused on improving outcomes after perinatal stroke.
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18
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Hasbani GE, Taher AT, Sunji N, Sciascia S, Uthman I. Antiphospholipid antibodies and cerebrovascular thrombosis in the pediatric population: Few answers to many questions. Lupus 2021; 30:1365-1377. [PMID: 34082580 DOI: 10.1177/09612033211021488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most of the knowledge in pediatric antiphospholipid syndrome (APS) is derived from studies performed on the adult population. As in adults, antiphospholipid antibodies (aPL) can contribute to thrombosis, especially cerebrovascular thrombosis, in neonates and children. Since aPL have the potential to cross the placental barrier, and since the pediatric population is prone to infections, re-testing for their positivity is essential to specify their role in cerebrovascular thrombosis.In this review, we aimed at assessing the prevalence of aPL, criteria or non-criteria, in neonatal and childhood ischemic stroke and sinovenous thrombosis trying to find an association between aPL and cerebrovascular thrombosis in the neonatal and pediatric population. Also, we looked into the effect of aPL and anticoagulants/antiplatelets on the long term neurological outcomes of affected neonates or children. The questions regarding the prevalence of aPL among pediatric patients with cerebrovascular thrombosis, the relationship between the titers of aPL and incidence and recurrence of cerebrovascular events, the predictability of the long term neurological outcomes, and the most optimal anticoagulation plan are still to be answered. However, it is crucial for clinicians to screen neonates and children with cerebrovascular thrombosis for aPL and confirm their presence if positive.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine Sunji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, University of Turin, Turin, Italy.,Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, Turin, Italy.,Nephrology and Dialysis, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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19
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Himmelmann K, Horber V, Sellier E, De la Cruz J, Papavasiliou A, Krägeloh-Mann I. Neuroimaging Patterns and Function in Cerebral Palsy-Application of an MRI Classification. Front Neurol 2021; 11:617740. [PMID: 33613420 PMCID: PMC7887285 DOI: 10.3389/fneur.2020.617740] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/17/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Cerebral palsy (CP) is a disorder of movement and posture and every child with CP has a unique composition of neurological symptoms, motor severity, and associated impairments, constituting the functional profile. Although not part of the CP definition, magnetic resonance imaging (MRI) sheds light on the localization, nature, and severity of brain compromise. The MRI classification system (MRICS), developed by the Surveillance of Cerebral Palsy in Europe (SCPE), describes typical MRI patterns associated with specific timing of vulnerability in different areas of the brain. The classification has proven to be reliable and easy to use. Aims: The aim of this study is to apply the MRICS on a large dataset and describe the functional profile associated with the different MRI patterns of the MRICS. Materials and Methods: Data on children with CP born in 1999-2009 with a post-neonatal MRI from 20 European registers in the JRC-SCPE Central Registry was included. The CP classification and the MRICS was applied, and The Gross Motor Function Classification (GMFCS) and the Bimanual Fine Motor Function (BFMF) classification were used. The following associated impairments were documented: intellectual impairment, active epilepsy, visual impairment, and hearing impairment. An impairment index was used to characterize severity of impairment load. Results: The study included 3,818 children with post-neonatal MRI. Distribution of CP type, motor, and associated impairments differed by neuroimaging patterns. Functional profiles associated with neuroimaging patterns were described, and the impairment index showed that bilateral findings were associated with a more severe outcome both regarding motor impairment and associated impairments than unilateral compromise. The results from this study, particularly the differences in functional severity regarding uni- and bilateral brain compromise, may support counseling and service planning of support of children with CP.
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Affiliation(s)
- Kate Himmelmann
- Department of Pediatrics, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Elodie Sellier
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France.,RHEOP, Grenoble, France
| | - Javier De la Cruz
- Research Institute (i+12), SAMID, University Hospital "12 Octubre", Madrid, Spain
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20
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Rivella C, Viterbori P. [Formula: see text] Executive function following pediatric stroke. A systematic review. Child Neuropsychol 2020; 27:209-231. [PMID: 32969322 DOI: 10.1080/09297049.2020.1820472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Pediatric strokes are rare events that can lead to neuropsychological impairment or disability. While motor deficits are relatively easy to identify and investigate, cognitive outcomes after stroke are more complex to define. Many studies have focused on global cognitive outcomes, while only a few recent studies have focused on specific cognitive processes. The aims of the present review were to provide an overview of the effects of pediatric strokes on executive function and to investigate the relations between executive functioning and clinical factors. METHOD Studies concerning executive functioning after pediatric stroke were identified using PsycInfo, PsycArticles and PubMed. A total of 142 studies were identified, and 22 met the inclusion criteria. RESULTS The review of the 22 studies included clearly indicates that childhood and perinatal strokes can affect executive function, and in particular inhibition. In contrast, the results concerning clinical factors related to EF outcomes are inconsistent. DISCUSSION Our results highlight the importance to assess EF following pediatric stroke. Early identification of difficulties in EF is crucial to provide adequate training to the children and to prevent the development of other correlated difficulties, such as behavioral problems or learning difficulties. Methodological issues regarding the heterogeneity of samples and measurement difficulties limit the conclusions that can be made about the clinical predictors of the outcomes. Studies are needed to better understand this aspect and to develop adequate EF interventions for children following stroke.
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Affiliation(s)
- Carlotta Rivella
- Department of Educational Science, University of Genoa , Genoa, Italy
| | - Paola Viterbori
- Department of Educational Science, University of Genoa , Genoa, Italy
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21
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Hawe RL, Kuczynski AM, Kirton A, Dukelow SP. Robotic assessment of rapid motor decision making in children with perinatal stroke. J Neuroeng Rehabil 2020; 17:94. [PMID: 32664980 PMCID: PMC7362540 DOI: 10.1186/s12984-020-00714-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background Activities of daily living frequently require children to make rapid decisions and execute desired motor actions while inhibiting unwanted actions. Children with hemiparetic cerebral palsy due to perinatal stroke may have deficits in executive functioning in addition to motor impairments. The objective of this study was to use a robotic object hit and avoid task to assess the ability of children with hemiparetic cerebral palsy to make rapid motor decisions. Methods Forty-five children with hemiparetic cerebral palsy due to perinatal stroke and 146 typically developing children (both groups ages 6–19 years) completed a robotic object hit and avoid task using the Kinarm Exoskeleton. Objects of different shapes fell from the top of the screen with increasing speed and frequency. Children were instructed to hit two specific target shapes with either hand, while avoiding six distractor shapes. The number of targets and distractors hit were compared between children with hemiparetic cerebral palsy and typically developing children, accounting for age effects. We also compared performance to a simpler object hit task where there were no distractors. Results We found that children with hemiparetic cerebral palsy hit a greater proportion of total distractors compared to typically developing children, demonstrating impairments in inhibitory control. Performance for all children improved with age. Children with hemiparetic cerebral palsy hit a greater percentage of targets with each arm on the more complex object hit and avoid task compared to the simpler object hit task, which was not found in typically developing children. Conclusions Children with hemiparetic cerebral palsy due to perinatal stroke demonstrated impairments in rapid motor decision making including inhibitory control, which can impede their ability to perform real-world tasks. Therapies that address both motor performance and executive functions are necessary to maximize function in children with hemiparetic cerebral palsy.
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Affiliation(s)
- Rachel L Hawe
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Andrea M Kuczynski
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Adam Kirton
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,Department of Pediatrics, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.,Alberta Children's Hospital Research Institute, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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22
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Abstract
Perinatal stroke is a heterogeneous syndrome resulting from brain injury of vascular origin that occurs between 20 weeks of gestation and 28 days of postnatal life. The incidence of perinatal stroke is estimated to be between 1:1600 and 1:3000 live births (approximately 2500 children per year in the United States), though its actual incidence is difficult to estimate because it is likely underdiagnosed. Perinatal arterial ischemic stroke (PAIS) accounts for approximately 70% of cases of perinatal stroke. Cerebral sinovenous thrombosis, while less common, also accounts for a large proportion of the morbidity and mortality seen with perinatal stroke. Hemorrhagic stroke leads to disruption of neurologic function due to intracerebral hemorrhage that is nontraumatic in origin. While most cases of PAIS fall into one of these three categories, other patterns of injury should also be considered perinatal stroke. In some cases, the etiology of PAIS is not known but is idiopathic. This chapter will review the classification, risk factors, pathogenesis, clinical presentation, management, and long-term sequelae of perinatal stroke.
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Affiliation(s)
- Emmett E Whitaker
- Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, VT, United States; Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States.
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States; Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States; Department of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT, United States
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23
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Abstract
Perinatal strokes are a diverse but specific group of focal cerebrovascular injuries that occur early in brain development and affect an estimated 5 million people worldwide. The objective of this review is to describe the epidemiology, clinical presentations, pathophysiology, outcomes, and management for the 6 subtypes of perinatal stroke. Some perinatal strokes are symptomatic in the first days of life, typically with seizures, including neonatal arterial ischemic stroke, neonatal hemorrhagic stroke, and cerebral sinovenous thrombosis. The remaining subtypes present in the first year of life or later, usually with motor asymmetry and include arterial presumed perinatal ischemic stroke, presumed perinatal hemorrhagic stroke, and in utero periventricular venous infarction. The consequences of these injuries include cerebral palsy, epilepsy, and cognitive and behavioral challenges, in addition to the psychosocial impact on families. While there have been significant advances in understanding mechanisms of both injury and recovery, there is still a great deal to learn regarding causation and the optimization of outcomes.
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Affiliation(s)
- Mary Dunbar
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada; Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.
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24
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Affiliation(s)
- Manus J Donahue
- From the Department of Radiology (M.J.D., A.B.), Vanderbilt Medical Center, Nashville, TN
| | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada (N.D.)
| | - Aashim Bhatia
- From the Department of Radiology (M.J.D., A.B.), Vanderbilt Medical Center, Nashville, TN
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology (L.C.J.), Vanderbilt Medical Center, Nashville, TN
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25
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Lockrow JP, Wright JN, Saneto RP, Amlie-Lefond C. Epileptic Spasms Predict Poor Epilepsy Outcomes After Perinatal Stroke. J Child Neurol 2019; 34:830-836. [PMID: 31339419 DOI: 10.1177/0883073819863278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perinatal stroke is a significant cause of severe epilepsy, including epileptic spasms. Although epileptic spasms due to underlying structural lesion often respond poorly to treatment and evolve into drug-resistant epilepsy, outcomes are not uniformly poor, and predictors of outcomes are not well described. We performed a single-institution retrospective review of epileptic spasms following perinatal stroke to determine if outcome depended on vascular subtype. We identified 24 children with epileptic spasms due to perinatal ischemic stroke: 11 cases of perinatal arterial stroke and 13 cases of perinatal venous infarct. Initial response to treatment was similar between groups; however, although children with perinatal arterial stroke who responded to epileptic spasms therapy had high rates of seizure freedom, many children with perinatal venous infarct, regardless of initial response, had residual drug-resistant epilepsy. We consider whether the mechanism for epileptogenesis may be different between arterial and venous strokes, and whether these 2 groups should be monitored for epileptic spasms, and subsequent epilepsy, differently.
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Affiliation(s)
- Jason P Lockrow
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA
| | - Jason N Wright
- Department of Neurology, Section of Neuroradiology, University of Washington, Seattle, WA, USA
| | - Russell P Saneto
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA
| | - Catherine Amlie-Lefond
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA
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26
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Roberts SD, McDonald KP, Danguecan A, Crosbie J, Westmacott R, Andrade B, Dlamini N, Williams TS. Longitudinal Academic Outcomes of Children with Secondary Attention Deficit/Hyperactivity Disorder following Pediatric Stroke. Dev Neuropsychol 2019; 44:368-384. [DOI: 10.1080/87565641.2019.1613660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Samantha D. Roberts
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Kyla P. McDonald
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Ashley Danguecan
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Brendan Andrade
- Centre for addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Tricia S. Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
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27
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Krivitzky L, Bosenbark DD, Ichord R, Jastrzab L, Billinghurst L. Brief report: Relationship between performance testing and parent report of attention and executive functioning profiles in children following perinatal arterial ischemic stroke. Child Neuropsychol 2019; 25:1116-1124. [PMID: 30909791 DOI: 10.1080/09297049.2019.1588957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Children with perinatal arterial ischemic stroke (PAIS) have increased rates of attention and executive functioning (EF) weaknesses. Research in other pediatric disorders has documented poor consistency between parent report of these skills and performance-based measures. We compared these data sources in children with PAIS. Forty full-term (≥37 weeks) children ages 3-16 (median = 7.2 years; 58% male) with PAIS completed neuropsychological testing and composite scores were created for seven attention and EF domains (Processing Speed; Attention; Working Memory; Verbal Retrieval; Inhibitory Control; Flexibility/Shifting; Planning). Parents completed "real-world" functioning questionnaires (ADHD Rating Scale-IV, BRIEF). Correlational analysis were used to compare parent and performance measures. Correlations between ADHD Rating Scale-IV scores and the performance-based Attention and Inhibition composite scores were nonsignificant. Significant negative correlations were found between the BRIEF GEC and performance-based Verbal Retrieval and Processing Speed composites, but remaining GEC/composite comparisons were nonsignificant. Analyses between parent report BRIEF index scores and the corresponding performance-based domain identified one significant negative correlation between the BRIEF Working Memory Index and the Working Memory composite score. While children with PAIS demonstrate difficulties in attention and EF on both parent report and performance measures, little significance was found in comparisons of these two types of measures. There may be several explanations for this dissociation: measures assessing different aspects of the same underlying construct; performance-based measures lacking ecological validity; and parents underestimating/underreporting their child's deficits. Thus, multiple sources of informant and performance data are necessary to make more accurate conclusions about functioning in these domains.
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Affiliation(s)
- Lauren Krivitzky
- a Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania , Philadelphia , PA , USA
| | | | - Rebecca Ichord
- c Departments of Neurology & Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania , Philadelphia , PA , USA
| | - Laura Jastrzab
- d Department of Neurology, The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Lori Billinghurst
- c Departments of Neurology & Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania , Philadelphia , PA , USA
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28
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Olivé G, Agut T, Echeverría-Palacio CM, Arca G, García-Alix A. Usefulness of Cranial Ultrasound for Detecting Neonatal Middle Cerebral Artery Stroke. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:885-890. [PMID: 30642660 DOI: 10.1016/j.ultrasmedbio.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Magnetic resonance imaging is the gold standard technique in establishing the diagnosis of neonatal arterial ischemic stroke (NAIS). The diagnostic value of cranial ultrasound scanning in this clinical context is controversial. We aimed to assess the current sensitivity of the cranial ultrasound scan (CUS) in detecting NAIS, as this issue has not been well described in the literature. Newborns with NAIS diagnosed by magnetic resonance imaging between 2010 and 2016 were included. All CUSs were blindly analyzed retrospectively by a neonatologist expert in neuroimaging and compared with the findings of non-expert evaluators recorded on medical charts immediately after performing the evaluation. The overall sensitivity of CUS in detecting an imaging finding suggestive of NAIS was 87% (95% confidence interval (CI): 79%-95%) for an expert evaluator, but declined to 72% (61%-83%) when performed by a non-expert evaluator (p 0.002). Sensitivity was 83% and 61% in the first 24 h and 86% and 66% at 24-48 h for expert and non-expert evaluators, respectively (p < 0.05). CUS has higher sensitivity than previously reported in the detection of a NAIS, for both expert and non-expert evaluators. These findings may be explained by the advanced technology of new ultrasound equipment. Expertise in performing CUS is useful, particularly in the first 48 h after clinical debut.
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Affiliation(s)
- Gemma Olivé
- Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Thais Agut
- Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain.
| | | | - Gemma Arca
- Department of Neonatology, Agrupació Sanitaria Hospital Clinic, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Alfredo García-Alix
- Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER de Enfermedades Raras (CIBERER), U724, Madrid, Spain
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29
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Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2019; 50:e51-e96. [DOI: 10.1161/str.0000000000000183] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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30
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Abstract
Perinatal arterial ischemic stroke is a relatively common and serious neurologic disorder that can affect the fetus, the preterm, and the term-born infant. It carries significant long-term disabilities. Herein we describe the current understanding of its etiology, pathophysiology and classification, different presentations, and optimal early management. We discuss the role of different brain imaging modalities in defining the extent of lesions and the impact this has on the prediction of outcomes. In recent years there has been progress in treatments, making early diagnosis and the understanding of likely morbidities imperative. An overview is given of the range of possible outcomes and optimal approaches to follow-up and support for the child and their family in the light of present knowledge.
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32
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Dunbar M, Kirton A. Perinatal stroke: mechanisms, management, and outcomes of early cerebrovascular brain injury. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:666-676. [PMID: 30119760 DOI: 10.1016/s2352-4642(18)30173-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/24/2022]
Abstract
Perinatal stroke encompasses a heterogeneous group of focal neurological injuries early in brain development that probably affects more than 5 million people worldwide. Many such injuries are symptomatic in the first days of life, including neonatal arterial ischaemic stroke, cerebral sinovenous thrombosis, and neonatal haemorrhagic stroke. The remaining focal neurological injuries usually present later in the first year with motor asymmetry, such as arterial presumed perinatal ischaemic stroke, periventricular venous infarction, and presumed perinatal haemorrhagic stroke. The numerous sequelae of these injuries include hemiparesis (cerebral palsy), epilepsy, and cognitive, language, and behavioural challenges. In this Review we summarise each perinatal stroke disease, examining the epidemiology, pathophysiology, acute management, and outcomes, including the effect on parents and families, and emerging therapies to mitigate these lifelong morbidities.
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Affiliation(s)
- Mary Dunbar
- Department of Community Health Services, University of Calgary, Calgary, Alberta, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada.
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Abstract
Perinatal brain injury may lead to long-term morbidity and neurodevelopmental impairment. Improvements in perinatal care have resulted in the survival of more infants with perinatal brain injury. The effects of hypoxia-ischemia, inflammation, and infection during critical periods of development can lead to a common pathway of perinatal brain injury marked by neuronal excitotoxicity, cellular apoptosis, and microglial activation. Various interventions can prevent or improve the outcomes of different types of perinatal brain injury. The objective of this article is to review the mechanisms of perinatal brain injury, approaches to prevention, and outcomes among children with perinatal brain injury.
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34
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Williams TS, McDonald KP, Roberts SD, Dlamini N, deVeber G, Westmacott R. Prevalence and Predictors of Learning and Psychological Diagnoses Following Pediatric Arterial Ischemic Stroke. Dev Neuropsychol 2017; 42:309-322. [DOI: 10.1080/87565641.2017.1353093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Tricia S. Williams
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyla P. McDonald
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha D. Roberts
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gabrielle deVeber
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
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35
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Roach ES. Seeing Wisely: Imaging Recommendations for Suspected Childhood Stroke. Pediatr Neurol 2017; 69:1-2. [PMID: 28209245 DOI: 10.1016/j.pediatrneurol.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Steve Roach
- Division of Child Neurology, Ohio State University College of Medicine, Columbus, Ohio.
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