1
|
Villa M, Martínez-Vega M, Silva L, Romero A, de Hoz-Rivera M, Prados ME, Muñoz E, Martínez-Orgado J. Neuroprotective effects of VCE-004.8 in a rat model of neonatal stroke. Eur J Pharmacol 2024; 972:176554. [PMID: 38582276 DOI: 10.1016/j.ejphar.2024.176554] [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: 12/11/2023] [Revised: 03/12/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Currently there is no effective treatment for neonatal stroke, an acute neurologic syndrome with sequelae, due to focal ischemic, thrombotic, or hemorrhagic event occurring in the perinatal period. VCE-004.8, an aminoquinone exhibiting activity on CB2 and PPARγ receptors, is neuroprotective in adult mice models of acute and chronic brain damaging conditions. We hereby aimed to study VCE-004.8 neuroprotection in a rat model of neonatal stroke. METHODS 7-day-old (P7) Wistar rats of both sexes were submitted to Middle Cerebral Artery Occlusion (MCAO), receiving i.p. 30 min after vehicle (MCAO + VEH) or VCE-004.8 5 mg/kg (MCAO + VCE). Non-occluded rats served as controls (SHAM). MCAO consequences were assessed at P14 by MRI, histological (TUNEL staining), biochemical (lactate/n-acetyl aspartate ratio by 1H-NMR spectroscopy) and motor studies (grasp test), and at P37 assessing myelination (MBP signal), hemiparesis and hyperlocomotion. Effects of VCE-004.8 on excitotoxicity (glutamate/n-acetyl aspartate, 1H-NMR), oxidative stress (protein nitrosylation, Oxyblot) and neuroinflammation (Toll-like receptor 4 and TNFa expression, Western blot) were assessed at P14. Therapeutic window was assessed by delaying drug administration for 12 or 18 h. RESULTS Post-MCAO administration of VCE-004.8 reduced the volume of infarct and histological and biochemical brain damage, reducing hyperlocomotion, restoring motor performance and preserving myelination, in a manner linked to the modulation of excitotoxicity, oxidative stress and neuroinflammation. VCE-004.8 was still effective being administered 12-18 h post-insult. CONCLUSIONS These data suggest that this drug could be effective for the treatment of stroke in newborns.
Collapse
Affiliation(s)
- María Villa
- Biomedical Research Foundation, Hospital Clínico San Carlos - IdISSC, Madrid, 28040, Spain
| | - María Martínez-Vega
- Biomedical Research Foundation, Hospital Clínico San Carlos - IdISSC, Madrid, 28040, Spain
| | - Laura Silva
- Biomedical Research Foundation, Hospital Clínico San Carlos - IdISSC, Madrid, 28040, Spain
| | - Angela Romero
- Biomedical Research Foundation, Hospital Clínico San Carlos - IdISSC, Madrid, 28040, Spain
| | - María de Hoz-Rivera
- Biomedical Research Foundation, Hospital Clínico San Carlos - IdISSC, Madrid, 28040, Spain
| | | | - Eduardo Muñoz
- Maimonides Biomedical Research Institute of Córdoba, University of Córdoba, Córdoba, Spain; Department of Cellular Biology, Physiology and Immunology, University of Córdoba, Córdoba, Spain; Reina Sofía University Hospital, Córdoba, Spain
| | - José Martínez-Orgado
- Biomedical Research Foundation, Hospital Clínico San Carlos - IdISSC, Madrid, 28040, Spain; Department of Neonatology Hospital Clínico San Carlos - IdISSC, Madrid, 28040, Spain.
| |
Collapse
|
2
|
Villa M, Martínez-Vega M, Silva L, Muneta-Arrate I, Gómez-Soria A, Muguruza C, Del Pozo A, de Hoz-Rivera M, Romero A, Callado LF, Casarejos MJ, Martínez-Orgado J. Effects of cannabidiol in post-stroke mood disorders in neonatal rats. Pediatr Res 2024; 95:1783-1790. [PMID: 38360979 DOI: 10.1038/s41390-024-03077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Neonatal rats can manifest post-stroke mood disorders (PSMD) following middle cerebral artery occlusion (MCAO). We investigated whether cannabidiol (CBD) neuroprotection, previously demonstrated in neonatal rats after MCAO, includes prevention of PSMD development. METHODS Seven-day-old Wistar rats (P7) underwent MCAO and received either vehicle or 5 mg/kg CBD treatment. Brain damage was quantified by MRI, and neurobehavioral and histological (TUNEL) studies were performed at P14 and P37. PSMD were assessed using the tail suspension test, forced swimming test, and open field tests. The dopaminergic system was evaluated by quantifying dopaminergic neurons (TH+) in the Ventral Tegmental Area (VTA), measuring brain dopamine (DA) concentration and DA transporter expression, and assessing the expression and function D2 receptors (D2R) through [35S]GTPγS binding. Animals without MCAO served as controls. RESULTS CBD reduced MCAO-induced brain damage and improved motor performance. At P14, MCAO induced depressive-like behavior, characterized by reduced TH+ cell population and DA levels, which CBD did not prevent. However, CBD ameliorated hyperactivity observed at P37, preventing increased DA concentration by restoring D2R function. CONCLUSIONS These findings confirm the development of PSMD following MCAO in neonatal rats and highlight CBD as a neuroprotective agent capable of long-term functional normalization of the dopaminergic system post-MCAO. IMPACT MCAO in neonatal rats led to post-stroke mood disorders consisting in a depression-like picture in the medium term evolving towards long-term hyperactivity, associated with an alteration of the dopaminergic system. The administration of CBD after MCAO did not prevent the development of depressive-like behavior, but reduced long-term hyperactivity, normalizing dopamine receptor function. These data point to the importance of considering the development of depression-like symptoms after neonatal stroke, a well-known complication after stroke in adults. Our work confirms the interest of CBD as a possible treatment for neonatal stroke.
Collapse
Affiliation(s)
- María Villa
- Biomedical Research Foundation, Hospital Clínico San Calos-IdISSC, Madrid, Spain
| | - María Martínez-Vega
- Biomedical Research Foundation, Hospital Clínico San Calos-IdISSC, Madrid, Spain
| | - Laura Silva
- Biomedical Research Foundation, Hospital Clínico San Calos-IdISSC, Madrid, Spain
| | - Itziar Muneta-Arrate
- Department of Pharmacology, University of the Basque Country, UPV/EHU, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Bizkaia, Spain
| | - Ana Gómez-Soria
- Servicio de Neurobiología-Investigación, Hospital Ramón y Cajal, Madrid, Spain
| | - Carolina Muguruza
- Department of Pharmacology, University of the Basque Country, UPV/EHU, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Bizkaia, Spain
| | - Aarón Del Pozo
- Biomedical Research Foundation, Hospital Clínico San Calos-IdISSC, Madrid, Spain
| | - María de Hoz-Rivera
- Biomedical Research Foundation, Hospital Clínico San Calos-IdISSC, Madrid, Spain
| | - Angela Romero
- Biomedical Research Foundation, Hospital Clínico San Calos-IdISSC, Madrid, Spain
| | - Luis F Callado
- Department of Pharmacology, University of the Basque Country, UPV/EHU, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Bizkaia, Spain
- Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | | | - José Martínez-Orgado
- Biomedical Research Foundation, Hospital Clínico San Calos-IdISSC, Madrid, Spain.
- Department of Neonatology, Hospital Clínico San Calos-IdISSC, Madrid, Spain.
| |
Collapse
|
3
|
Meghji S, Hilderley AJ, Murias K, Brooks BL, Andersen J, Fehlings D, Dlamini N, Kirton A, Carlson HL. Executive functioning, ADHD symptoms and resting state functional connectivity in children with perinatal stroke. Brain Imaging Behav 2024; 18:263-278. [PMID: 38038867 PMCID: PMC11156742 DOI: 10.1007/s11682-023-00827-w] [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] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
Perinatal stroke describes a group of focal, vascular brain injuries that occur early in development, often resulting in lifelong disability. Two types of perinatal stroke predominate, arterial ischemic stroke (AIS) and periventricular venous infarction (PVI). Though perinatal stroke is typically considered a motor disorder, other comorbidities commonly exist including attention-deficit hyperactivity disorder (ADHD) and deficits in executive function. Rates of ADHD symptoms are higher in children with perinatal stroke and deficits in executive function may also occur but underlying mechanisms are not known. We measured resting state functional connectivity in children with perinatal stroke using previously established dorsal attention, frontoparietal, and default mode network seeds. Associations with parental ratings of executive function and ADHD symptoms were examined. A total of 120 participants aged 6-19 years [AIS N = 31; PVI N = 30; Controls N = 59] were recruited. In comparison to typically developing peers, both the AIS and PVI groups showed lower intra- and inter-hemispheric functional connectivity values in the networks investigated. Group differences in between-network connectivity were also demonstrated, showing weaker anticorrelations between task-positive (frontoparietal and dorsal attention) and task-negative (default mode) networks in stroke groups compared to controls. Both within-network and between-network functional connectivity values were highly associated with parental reports of executive function and ADHD symptoms. These results suggest that differences in functional connectivity exist both within and between networks after perinatal stroke, the degree of which is associated with ADHD symptoms and executive function.
Collapse
Affiliation(s)
- Suraya Meghji
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
| | - Alicia J Hilderley
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Kara Murias
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Darcy Fehlings
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Children's Stroke Program, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 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
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada.
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Wilson A, Beribisky N, Desrocher M, Dlamini N, Williams T, Westmacott R. Predictors of externalizing behavior outcomes following pediatric stroke. Child Neuropsychol 2024; 30:241-263. [PMID: 36891616 DOI: 10.1080/09297049.2023.2185216] [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: 05/16/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
Children who experience pediatric stroke are at higher risk for future behavioral problems in childhood. We examined the prevalence of parent reported externalizing behaviors and executive function problems in children following stroke and neurological predictors. This study included 210 children with pediatric ischemic stroke (mean age 9.18 years (SD = 3.95)). The parent form of the Behavioral Assessment System for Children-Second Edition (BASC-2) and Behavior Rating Inventory of Executive Function (BRIEF) were used to evaluate externalizing behavior and executive function. No externalizing behavior or executive function differences were found between perinatal (n = 94) or childhood (n = 116) stoke, except for the shift subscale which had higher T-scores among the perinatal group (M = 55.83) than childhood group (M = 50.40). When examined together, 10% of children had clinically elevated hyperactivity T-scores as opposed to the expected 2%. Parents endorsed higher ratings of concern on the behavior regulation and metacognition indices of the BRIEF. Externalizing behaviors were correlated moderately to strongly with executive functions (r = 0.42 to 0.74). When examining neurological and clinical predictors of externalizing behaviors, only female gender was predictive of increased hyperactivity (p = .004). However, there were no significant gender differences in diagnosis of attention deficit hyperactivity disorder (ADHD). In summary, in this cohort, children with perinatal and childhood stroke did not differ on parent reported externalizing behavior or executive function outcomes. However, compared to normative data, children with perinatal or childhood stroke are significantly more likely to experience clinically elevated levels of hyperactivity.
Collapse
Affiliation(s)
- Alyssia Wilson
- Department of Psychology, York University, Toronto, ON, Canada
| | | | - Mary Desrocher
- Department of Psychology, York University, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tricia Williams
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
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 PMCID: PMC11439373 DOI: 10.1016/j.pediatrneurol.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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.
Collapse
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
| |
Collapse
|
8
|
The Role of the Dopamine System in Post-Stroke Mood Disorders in Newborn Rats. Int J Mol Sci 2023; 24:ijms24043229. [PMID: 36834637 PMCID: PMC9958627 DOI: 10.3390/ijms24043229] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Post-stroke mood disorders (PSMD) affect disease prognosis in adults. Adult rodent models underlie the importance of the dopamine (DA) system in PSMD pathophysiology. There are no studies on PSMD after neonatal stroke. We induced neonatal stroke in 7-day-old (P7) rats by temporal left middle cerebral artery occlusion (MCAO). Performance in the tail suspension test (TST) at P14 and the forced swimming test (FST) and open field test (OFT) at P37 were studied to assess PSMD. DA neuron density in the ventral tegmental area, brain DA concentration and DA transporter (DAT) expression as well as D2 receptor (D2R) expression and G-protein functional coupling were also studied. MCAO animals revealed depressive-like symptoms at P14 associated with decreased DA concentration and reduced DA neuron population and DAT expression. At P37, MCAO rats showed hyperactive behavior associated with increased DA concentration, normalization of DA neuron density and decreased DAT expression. MCAO did not modify D2R expression but reduced D2R functionality at P37. MCAO-induced depressive-like symptoms were reversed by the DA reuptake inhibitor GBR-12909. In conclusion, MCAO in newborn rats induced depressive-like symptoms and hyperactive behavior in the medium and long term, respectively, that were associated with alterations in the DA system.
Collapse
|
9
|
Mrakotsky C, Williams TS, Shapiro KA, Westmacott R. Rehabilitation in Pediatric Stroke: Cognition and Behavior. Semin Pediatr Neurol 2022; 44:100998. [PMID: 36456041 DOI: 10.1016/j.spen.2022.100998] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Pediatric stroke is associated with a range of maladaptive cognitive and behavioral outcomes that often require targeted intervention. Despite increasing research on neuropsychological outcomes over the past decade, evidence for effective therapies and interventions for the most commonly reported cognitive and behavioral challenges is still limited. The most widely prescribed interventions address more overt deficits in sensorimotor and speech/language functions, yet interventions for higher-order cognitive, linguistic and behavioral deficits are notably less defined. Moreover, concepts of rehabilitation in adult stroke cannot be easily translated directly to pediatric populations because the effect of stroke and recovery in the developing brain takes a very different course than in the mature brain. In pediatric stroke, neuropsychological deficits often emerge gradually over time necessitating a long-term approach to intervention. Furthermore, family and school context often play a much larger role. The goal of this review is to describe cognitive and behavioral interventions for perinatal and childhood stroke, as motor rehabilitation is covered elsewhere in this issue. We also discuss cognitive aspects of current rehabilitative therapies and technology. Acknowledging the current limited state of stroke-specific rehabilitation research in children, findings from pediatric acquired brain injury intervention and use of transdiagnostic approaches lend important insights. Because there is limited support for single domain (cognitive) trainings and translation of research rehabilitation programs to clinical practice can be challenging, the value of holistic multidisciplinary approaches to improve everyday function in children and adolescents following stroke is emphasized.
Collapse
Affiliation(s)
- Christine Mrakotsky
- Departments of Neurology & Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Tricia S Williams
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kevin A Shapiro
- Cortica Healthcare, Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Kang J, Liu X, Cao S, Zeiler SR, Graham EM, Boctor EM, Koehler RC. Transcranial photoacoustic characterization of neurovascular physiology during early-stage photothrombotic stroke in neonatal piglets in vivo. J Neural Eng 2022; 18:10.1088/1741-2552/ac4596. [PMID: 34937013 PMCID: PMC9112348 DOI: 10.1088/1741-2552/ac4596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/22/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Perinatal ischemic stroke is estimated to occur in 1/2300-1/5000 live births, but early differential diagnosis from global hypoxia-ischemia is often difficult. In this study, we tested the ability of a hand-held transcranial photoacoustic (PA) imaging probe to non-invasively detect a focal photothrombotic stroke (PTS) within 2 h of stroke onset in a gyrencephalic piglet brain. APPROACH About 17 stroke lesions of approximately 1 cm2area were introduced randomly in anterior or posterior cortex via the light/dye PTS technique in anesthetized neonatal piglets (n= 11). The contralateral non-ischemic region served as control tissue for discrimination contrast for the PA hemoglobin metrics: oxygen saturation, total hemoglobin (tHb), and individual quantities of oxygenated and deoxygenated hemoglobin (HbO2and HbR). MAIN RESULTS The PA-derived tissue oxygen saturation at 2 h yielded a significant separation between control and affected regions-of-interest (p< 0.0001), which were well matched with 24 h post-stroke cerebral infarction confirmed in the triphenyltetrazolium chloride-stained image. The quantity of HbO2also displayed a significant contrast (p= 0.021), whereas tHb and HbR did not. The analysis on receiver operating characteristic curves and multivariate data analysis also agreed with the results above. SIGNIFICANCE This study shows that a hand-held transcranial PA neuroimaging device can detect a regional thrombotic stroke in the cerebral cortex of a neonatal piglet. In particular, we conclude that the oxygen saturation metric can be used alone to identify regional stroke lesions. The lack of change in tHb may be related to arbitrary hand-held imaging configuration and/or entrapment of red blood cells within the thrombotic stroke.
Collapse
Affiliation(s)
- Jeeun Kang
- Laboratory for Computational Sensing and Robotics, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21218, United States of America,These authors equally contributed
| | - Xiuyun Liu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States of America,These authors equally contributed
| | - Suyi Cao
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States of America
| | - Steven R Zeiler
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, United States of America
| | - Ernest M Graham
- Division of Maternal-Fetal Medicine, Department of Gynecology-Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States of America,Neuroscience Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States of America
| | - Emad M Boctor
- Laboratory for Computational Sensing and Robotics, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21218, United States of America,Authors to whom any correspondence should be addressed. and
| | - Raymond C Koehler
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States of America,Authors to whom any correspondence should be addressed. and
| |
Collapse
|
12
|
Larsen N, Craig BT, Hilderley AJ, Virani S, Murias K, Brooks BL, Kirton A, Carlson HL. Frontal interhemispheric structural connectivity, attention, and executive function in children with perinatal stroke. Brain Behav 2022; 12:e2433. [PMID: 34825521 PMCID: PMC8785614 DOI: 10.1002/brb3.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
Perinatal stroke affects ∼1 in 1000 births and concomitant cognitive impairments are common but poorly understood. Rates of Attention Deficit/Hyperactivity Disorder (ADHD) are increased 5-10× and executive dysfunction can be disabling. We used diffusion imaging to investigate whether stroke-related differences in frontal white matter (WM) relate to cognitive impairments. Anterior forceps were isolated using tractography and sampled along the tract. Resulting metrics quantified frontal WM microstructure. Associations between WM metrics and parent ratings of ADHD symptoms (ADHD-5 rating scale) and executive functioning (Behavior Rating Inventory of Executive Function (BRIEF)) were explored. Eighty-three children were recruited (arterial ischemic stroke [AIS] n = 26; periventricular venous infarction [PVI] n = 26; controls n = 31). WM metrics were altered for stroke groups compared to controls. Along-tract analyses showed differences in WM metrics in areas approximating the lesion as well as more remote differences at midline and in the nonlesioned hemisphere. WM metrics correlated with parental ratings of ADHD and executive function such that higher diffusivity values were associated with poorer function. These findings suggest that underlying microstructure of frontal white matter quantified via tractography may provide a relevant biomarker associated with cognition and behavior in children with perinatal stroke.
Collapse
Affiliation(s)
- Nicole Larsen
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada
| | - Brandon T Craig
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Alicia J Hilderley
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Shane Virani
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Kara Murias
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Psychology, University of Calgary, Calgary, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| |
Collapse
|
13
|
Virani S, Rasmussen C, Zivanovic N, Smithson L, Pei J, Andersen J, Yager JY, Kirton A, Brooks BL. Learning and memory profiles in youth with perinatal stroke: a study of the Child and Adolescent Memory Profile (ChAMP). Child Neuropsychol 2021; 28:99-106. [PMID: 34375160 DOI: 10.1080/09297049.2021.1957089] [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: 10/20/2022]
Abstract
There is limited understanding of the effect of perinatal stroke on child and adolescent learning and memory abilities. This study sought to evaluate the clinical utility of the Child and Adolescent Memory Profile (ChAMP) in quantifying memory performance in youth with perinatal stroke. Children and adolescents aged 6-16 years old with a history of perinatal stroke (PS; n = 41) completed two subtests from the ChAMP (Lists and Objects). Age, sex, and ethnicity-matched healthy control (HC) data were obtained from the test publisher's standardization data set. Participants with a history of PS performed significantly worse (p < .05) with medium effect size (ƞp2 ≥ .06) than HC on the ChAMP Screening Index and on all ChAMP Lists and Objects scaled scores. Classification accuracy for the ChAMP scores ranged from 57% to 68% with the area under the curve ranging from .62-.75. No significant group differences on ChAMP performance (p > .05) were found for stroke side (left versus right-sided) or for seizure history (present versus absent). This study supports the utility of the ChAMP in perinatal stroke patients by demonstrating significantly worse performance in verbal and visual memory than HC. Classification accuracy is limited, but supportive for the Screening Index and Objects Delayed scores. The ChAMP may be a useful tool for evaluating cognition in this population when taken alongside the context of other tests, background history, and clinical observations.
Collapse
Affiliation(s)
- Shane Virani
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada.,Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Nikola Zivanovic
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Lisa Smithson
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Adam Kirton
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Brian L Brooks
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada.,Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Psychology, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
14
|
Di Lorenzo M, Desrocher M, Westmacott R. The clinical utility of the behavior rating inventory of executive function in preschool children with a history of perinatal stroke. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:429-437. [PMID: 33535801 DOI: 10.1080/21622965.2021.1875828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The current study examined the utility of the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P) in capturing emerging deficits in executive function in preschool children with a history of perinatal stroke. Parents and teachers of 55 clinically referred preschool children (3-5 years of age) provided ratings using the BRIEF-P. Both parent (M = 56.02, p = .001) and teacher ratings (M = 58.61, p = .002) indicated significant scale elevations for working memory compared to the normative sample, albeit below the clinically elevated range. Parent and teacher ratings were low-to-moderately correlated (r = .05-.55). Greater deficits in working memory (r = -.58), inhibition (r = -.45), and planning/organization (r = -.51), as rated by teachers, were associated with lower intellectual functioning. Parents' ratings were not associated with intellectual functioning. Further, no neurological or personal characteristics were associated with ratings of executive function. The current study demonstrates children with a history of perinatal stroke are, on average, following a normal trajectory of executive function development according to BRIEF-P ratings. The needs for multi-informant ratings and performance-based measures to comprehensively assess executive functioning in preschoolers with a history of stroke are discussed.
Collapse
Affiliation(s)
| | - Mary Desrocher
- Department of Psychology, York University, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology and Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
15
|
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.
Collapse
Affiliation(s)
- Carlotta Rivella
- Department of Educational Science, University of Genoa , Genoa, Italy
| | - Paola Viterbori
- Department of Educational Science, University of Genoa , Genoa, Italy
| |
Collapse
|
16
|
Khan MH, Smithson L, Li E, Kirton A, Pei J, Andersen J, Yager JY, Brooks BL, Rasmussen C. Executive behavior and functional abilities in children with perinatal stroke and the associated caregiver impact. Child Neuropsychol 2020; 27:83-95. [PMID: 32718269 DOI: 10.1080/09297049.2020.1796953] [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
Perinatal stroke is the most common form of stroke in childhood and is followed by a variety of outcomes, with many children experiencing specific functional and neuropsychological deficits. The association of these outcomes with the psychosocial impact caregivers face is not well documented. The goal of our pilot study was to examine caregivers' perception of executive behavior and functional abilities among children with perinatal stroke, and how these outcomes impact the caregivers. We administered three questionnaires to primary caregivers of children with perinatal stroke to obtain caregiver-reported measures of (1) executive behavior of their child (Behavior Rating Inventory of Executive Function, Second Edition), (2) the functional abilities of their child (Pediatric Evaluation of Disability Inventory Computer Adaptive Test), and (3) the psychosocial impact experienced by the caregiver themselves (Parental Outcome Measure). Participants included 20 children (mean age = 9.3 years, range = 6-16 years) with perinatal stroke and their primary caregivers. Functional abilities in the children were rated as clinically impaired in the domains of daily activities and mobility. Half of the children exhibited clinically impaired ratings on at least one executive behavior domain, but the mean scores for these domains did not reach clinically impaired levels. Greater ratings of problems in daily activities for the child was associated with greater caregiver guilt (r = -0.55, p = 0.02). Caregivers of children with perinatal stroke who experience limitations in performing daily activities should be more closely monitored for adverse impact and be provided the necessary support and education to alleviate the associated guilt.
Collapse
Affiliation(s)
- Muhammad H Khan
- Department of Pediatrics, University of Alberta , Edmonton, Canada
| | - Lisa Smithson
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Eliza Li
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada.,Child Health, Glenrose Rehabilitation Hospital , Edmonton, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada
| | - Brian L Brooks
- Department of Pediatrics, University of Calgary , Calgary, Canada.,Neuropsychology Service, Alberta Children's Hospital , Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine , Calgary, Canada.,Department of Psychology, University of Calgary , Calgary, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta , Edmonton, Canada
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
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: 9] [Impact Index Per Article: 1.8] [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.
Collapse
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
| |
Collapse
|
20
|
Povroznik JM, Ozga JE, Haar CV, Engler-Chiurazzi EB. Executive (dys)function after stroke: special considerations for behavioral pharmacology. Behav Pharmacol 2018; 29:638-653. [PMID: 30215622 PMCID: PMC6152929 DOI: 10.1097/fbp.0000000000000432] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke is a worldwide leading cause of death and long-term disability with concurrent secondary consequences that are largely comprised of mood dysfunction, as well as sensory, motor, and cognitive deficits. This review focuses on the cognitive deficits associated with stroke specific to executive dysfunction (including decision making, working memory, and cognitive flexibility) in humans, nonhuman primates, and additional animal models. Further, we review some of the cellular and molecular underpinnings of the individual components of executive dysfunction and their neuroanatomical substrates after stroke, with an emphasis on the changes that occur during biogenic monoamine neurotransmission. We concentrate primarily on changes in the catecholaminergic (dopaminergic and noradrenergic) and serotonergic systems at the levels of neurotransmitter synthesis, distribution, reuptake, and degradation. We also discuss potential secondary stroke-related behavioral deficits (specifically, poststroke depression as well as drug-abuse potential and addiction) and their relationship with stroke-induced deficits in executive function, an especially important consideration given that the average age of the human stroke population is decreasing. In the final sections, we address pharmacological considerations for the treatment of ischemia and the subsequent functional impairment, as well as current limitations in the field of stroke and executive function research.
Collapse
Affiliation(s)
- Jessica M. Povroznik
- Center for Basic and Translational Stroke Research, West Virginia University, Morgantown, WV, USA
- Department of Physiology, Pharmacology, and Neuroscience, West Virginia University, Morgantown, WV, USA
- Rodent Behavior Core, Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Jenny E. Ozga
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cole Vonder Haar
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Elizabeth B. Engler-Chiurazzi
- Center for Basic and Translational Stroke Research, West Virginia University, Morgantown, WV, USA
- Department of Physiology, Pharmacology, and Neuroscience, West Virginia University, Morgantown, WV, USA
- Rodent Behavior Core, Health Sciences Center, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
21
|
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: 105] [Impact Index Per Article: 17.5] [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.
Collapse
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.
| |
Collapse
|
22
|
Bosenbark DD, Krivitzky L, Ichord R, Vossough A, Bhatia A, Jastrzab LE, Billinghurst L. Clinical Predictors of Attention and Executive Functioning Outcomes in Children After Perinatal Arterial Ischemic Stroke. Pediatr Neurol 2017; 69:79-86. [PMID: 28274640 DOI: 10.1016/j.pediatrneurol.2017.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children with perinatal arterial ischemic stroke (PAIS) are at risk for later neurocognitive and behavioral deficits, yet the clinical predictors of these outcomes are understudied. We examined the influence of clinical and infarct characteristics on attention and executive functioning in children following PAIS. METHODS Forty children born at term (≥37 weeks' gestation) with PAIS (28 with neonatal arterial ischemic stroke and 12 with presumed PAIS) underwent a comprehensive neuropsychological battery at age three to 16 years (median age 7.2 years; 58% male) to assess attention and executive functioning. Parents also completed questionnaires regarding real-world functioning. Clinical variables including perinatal stroke subtype, infarct characteristics (location, laterality, and volume), and the presence of comorbid epilepsy were ascertained from the medical record. RESULTS Presumed PAIS, larger infarct volume, and comorbid epilepsy negatively influenced the performance on attention and executive functioning measures. These clinical variables were also associated with greater functional problems on parent reports, including a higher frequency of attention-deficit/hyperactivity disorder symptoms and greater difficulties in some subdomains of executive functioning. Infarct location and laterality were not associated with performance measures or parental report of functioning. CONCLUSION Although all children with PAIS are at risk for later deficits in attention and executive functioning, those with presumed PAIS, larger infarct size, and comorbid epilepsy appear to be the most vulnerable. As they approach and reach school age, these children should undergo neuropsychological assessment to ensure timely implementation of therapeutic interventions and behavioral strategies.
Collapse
Affiliation(s)
- Danielle D Bosenbark
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lauren Krivitzky
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rebecca Ichord
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Arastoo Vossough
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aashim Bhatia
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura E Jastrzab
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lori Billinghurst
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| |
Collapse
|