1
|
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
|
2
|
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
|
3
|
Rivella C, Zanetti A, Bertamino M, Primavera L, Moretti P, Viterbori P. Emotional and social functioning after stroke in childhood: a systematic review. Disabil Rehabil 2023; 45:4175-4189. [PMID: 36384380 DOI: 10.1080/09638288.2022.2144490] [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: 05/20/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To provide an overview of the effects of pediatric stroke on emotional and social functioning in childhood. METHODS A literature review was completed in accordance with the Preferred Reporting Items for Systematic Reviews. A systematic search of studies on internalizing problems and social functioning after pediatric stroke in PsycInfo, PsycArticles, and PubMed databases was conducted from inception to November 2021. A total of 583 studies were identified, and 32 met the inclusion criteria. RESULTS The review suggests that children after stroke are at risk of developing internalizing problems and a wide range of social difficulties. Internalizing problems are often associated with environmental factors such as family functioning and parents' mental health. In addition, a higher risk of developing psychosocial problems is associated with lower cognitive functioning and severe neurological impairment. CONCLUSIONS The assessment of psychological well-being and social functioning after pediatric stroke is helpful to provide adequate support to children and their families. Future studies are needed to better investigate these domains and to develop adequate methodologies for specific interventions.Implication for rehabilitationThis paper reviews research concerning emotional and social functioning following pediatric stroke in order to provide helpful information to clinicians and families and to improve rehabilitation pathways.Emotional and social functioning should be addressed during post-stroke evaluation and follow-up, even when physical and cognitive recovery is progressing well.Care in pediatric stroke should include volitional treatment and address emotional and social issues.
Collapse
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
| | | | - Paolo Moretti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Viterbori
- Department of Educational Science, University of Genoa, Genoa, Italy
| |
Collapse
|
4
|
Champigny CM, Feldman SJ, Westmacott R, Wojtowicz M, Aurin C, Dlamini N, Dirks P, Desrocher M. Adjusting to life after pediatric stroke: A qualitative study. Dev Med Child Neurol 2023; 65:1357-1365. [PMID: 36866398 DOI: 10.1111/dmcn.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/28/2022] [Accepted: 01/23/2023] [Indexed: 03/04/2023]
Abstract
AIM To examine adjustment after stroke in adolescence from the perspective of affected young people. METHOD Fourteen participants (10 female) aged 13 to 25 years with a history of ischemic or hemorrhagic stroke in adolescence participated in one-on-one semi-structured interviews at the Hospital for Sick Children, Toronto, Canada. Interviews were audio-recorded and transcribed verbatim. Two independent coders conducted a reflexive thematic analysis. RESULTS Five themes were identified as representative of adjustment after stroke: (1) 'Processing the story'; (2) 'Loss and challenges'; (3) 'I've changed'; (4) 'Keys to recovery'; and (5) 'Adjustment and acceptance'. INTERPRETATION This qualitative study provides medical professionals with a personal, patient-driven lens through which to better understand the challenges of adjusting to life after pediatric stroke. Findings highlight the need to provide mental health support to patients to assist them in processing their stroke and adapting to long-lasting sequelae. WHAT THIS PAPER ADDS Processing the onset event is a key component of adjustment to stroke. Feelings of anxiety, sadness, frustration, and self-consciousness impede adjustment to stroke. Young people may feel overwhelmed academically owing to neurocognitive deficits. Sequelae may rid young people of hobbies and passions, and alter plans for the future. To adjust to stroke, survivors draw on resilience, patience, determination, and social support.
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
| | - Robyn Westmacott
- Department of Psychology, the Hospital for Sick Children, Toronto, Canada
- Division of Neurology, the Hospital for Sick Children, Toronto, Canada
| | | | - Casey Aurin
- Department of Psychology, York University, 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
| | - Mary Desrocher
- Department of Psychology, the Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| |
Collapse
|
5
|
Sullivan AW, Johnson MK, Boes AD, Tranel D. Implications of age at lesion onset for neuropsychological outcomes: A systematic review focusing on focal brain lesions. Cortex 2023; 163:92-122. [PMID: 37086580 PMCID: PMC10192019 DOI: 10.1016/j.cortex.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/10/2023] [Accepted: 03/19/2023] [Indexed: 04/24/2023]
Abstract
Theories of the relation between age at lesion onset and outcomes posit different views of the young brain: resilient and plastic (i.e., the so-called "Kennard Principle"), or vulnerable (i.e., the Early Vulnerability Hypothesis). There is support for both perspectives in previous research and questions about the "best" or "worst" times to sustain brain injury remain. Here, we present a systematic review investigating the influence of age at focal brain lesion onset on cognitive functioning. This systematic review identifies and qualitatively synthesizes empirical studies from 1985 to 2021 that investigated age at lesion onset as a variable of interest associated with neuropsychological outcomes. A total of 45 studies were identified from PubMed, PsycINFO, and CINAHL databases. Almost all studies indicated that brain injury earlier in the developmental period predicts worse cognitive outcomes when compared to onset either later in the developmental period or in adulthood. More specifically, the overwhelming majority of studies support an "earlier is worse" model for domains of intellect, processing speed, attention and working memory, visuospatial and perceptual skills, and learning and memory. Relatively more variability in outcomes exists for domains of language and executive functioning. Outcomes for all domains are influenced by various other age and injury variables (e.g., lesion size, lesion laterality, chronicity, a history of epilepsy). Continued interdisciplinary understanding and communication about the influence of age at lesion onset on neuropsychological outcomes will aid in promoting the best possible outcomes for patients.
Collapse
Affiliation(s)
- Alyssa W Sullivan
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Marcie K Johnson
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Aaron D Boes
- Department of Neurology, University of Iowa, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Iowa City, IA, USA; Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
| | - Daniel Tranel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA; Department of Neurology, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA.
| |
Collapse
|
6
|
Leung KI, Dlamini N, Westmacott R, Molnar M. Language and Cognitive Outcomes Following Ischemic Stroke in Children With Monolingual and Bilingual Exposure. J Child Neurol 2023; 38:435-445. [PMID: 37134189 PMCID: PMC10467015 DOI: 10.1177/08830738231171466] [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: 03/03/2022] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 05/05/2023]
Abstract
Aim: Although many children who experience ischemic stroke come from bilingual backgrounds, it is unclear whether bilingual exposure affects poststroke development. Our research evaluates bilingual and monolingual exposure on linguistic/cognitive development poststroke across 3 stroke-onset groups. Method: An institutional stroke registry and medical charts were used to gather data on 237 children across 3 stroke-onset groups: neonatal, <28 days; first-year, 28 days to 12 months; and childhood, 13 months to 18 years. The Pediatric Stroke Outcome Measure (PSOM), administered several times poststroke, was used to evaluate cognition and linguistic development. Results: Similar cognitive outcomes were observed across language groups. However, an interaction effect with stroke-onset group was observed, with monolinguals in the first-year group having worse productive language outcomes as compared to bilinguals. Interpretation: Overall, no detrimental effects of bilingualism were found on children's poststroke cognition and linguistic development. Our study suggests that a bilingual environment may facilitate language development in children poststroke.
Collapse
Affiliation(s)
- Kai Ian Leung
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Monika Molnar
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| |
Collapse
|
7
|
Sun LR, Lynch JK. Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke. Neurotherapeutics 2023; 20:633-654. [PMID: 37072548 PMCID: PMC10112833 DOI: 10.1007/s13311-023-01373-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
Though rare, stroke in infants and children is an important cause of mortality and chronic morbidity in the pediatric population. Neuroimaging advances and implementation of pediatric stroke care protocols have led to the ability to rapidly diagnose stroke and in many cases determine the stroke etiology. Though data on efficacy of hyperacute therapies, such as intravenous thrombolysis and mechanical thrombectomy, in pediatric stroke are limited, feasibility and safety data are mounting and support careful consideration of these treatments for childhood stroke. Recent therapeutic advances allow for targeted stroke prevention efforts in high-risk conditions, such as moyamoya, sickle cell disease, cardiac disease, and genetic disorders. Despite these exciting advances, important knowledge gaps persist, including optimal dosing and type of thrombolytic agents, inclusion criteria for mechanical thrombectomy, the role of immunomodulatory therapies for focal cerebral arteriopathy, optimal long-term antithrombotic strategies, the role of patent foramen ovale closure in pediatric stroke, and optimal rehabilitation strategies after stroke of the developing brain.
Collapse
Affiliation(s)
- Lisa R Sun
- Divisions of Pediatric Neurology and Cerebrovascular Neurology, Department of Neurology, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Ste 2158, Baltimore, MD, 21287, USA.
| | - John K Lynch
- Acute Stroke Research Section, Stroke Branch (SB), National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Bartha‐Doering L, Gleiss A, Knaus S, Schmook MT, Seidl R. Influence of socioeconomic status on cognitive outcome after childhood arterial ischemic stroke. Dev Med Child Neurol 2021; 63:465-471. [PMID: 33336807 PMCID: PMC7986130 DOI: 10.1111/dmcn.14779] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
AIM To determine whether socioeconomic status (SES) is a stronger predictor for cognitive outcome after childhood arterial ischemic stroke compared to clinical factors. METHOD We investigated perceptual reasoning, executive functions, language, memory, and attention in 18 children and adolescents (12 males, six females, median age at testing 13y 4mo, range 7y-17y 5mo) after arterial ischemic stroke; collected sociodemographic information (education of parents, household income); and used clinical information (initial lesion volume, residual lesion volume, age at stroke, time since stroke). Linear regression models were used to investigate the potential influence of SES and clinical parameters on cognitive abilities. RESULTS SES had a moderate effect on all cognitive outcome parameters except attention by explaining 41.9%, 37.9%, 38.0%, and 22.5% of variability in perceptual reasoning, executive functions, language, and memory respectively. Initial lesion volume was the only clinical parameter that showed moderate importance on cognitive outcome (33.1% and 25.6% of the variability in perceptual reasoning and memory respectively). Overall, SES was a stronger predictor of cognitive outcome than clinical factors. INTERPRETATION Future paediatric studies aiming at clinical predictors of cognitive outcome should control their analyses for SES in their study participants. The findings of the present study further point to the need for more attention to the treatment of children with low SES. WHAT THIS PAPER ADDS Socioeconomic status (SES) explains up to 42% of variance in cognitive outcome after childhood arterial ischemic stroke. SES is a stronger predictor of outcome than clinical factors.
Collapse
Affiliation(s)
- Lisa Bartha‐Doering
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Centre for PediatricsMedical University of ViennaViennaAustria
| | - Andreas Gleiss
- Centre for Medical Statistics, Informatics, and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Sarah Knaus
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Centre for PediatricsMedical University of ViennaViennaAustria
| | - Maria Theresa Schmook
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Rainer Seidl
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Centre for PediatricsMedical University of ViennaViennaAustria
| |
Collapse
|
10
|
Badar SA, Radhakrishnan R, Golomb MR. The Impact of Pediatric Basal Ganglia Stroke on Mental Health in Children: Report of 2 Cases. Child Neurol Open 2021; 7:2329048X20979248. [PMID: 33403220 PMCID: PMC7745549 DOI: 10.1177/2329048x20979248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/05/2020] [Accepted: 11/07/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The impact of basal ganglia stroke on mental health is better described in adults than in children. We report 2 children with significant mental health issues after basal ganglia stroke. Case Reports: Patient 1, an 8-year-old boy, had mild anxiety before his left basal ganglia stroke. Post-stroke, he developed severe anxiety, obsessions, depression, and attention deficit hyperactivity disorder, in addition to a right hemiplegia and some mild chorea. He gradually improved over 3 years with psychiatric care and medication but continued to have residual symptoms. Patient 2, a 10-year-old boy, had no history of mental health issues before his right basal ganglia stroke. Post-stroke, he developed significant anxiety and mild depression, along with a left hemiplegia. He improved over 9 months and returned to his mental health baseline. Conclusions: Mental health issues after basal ganglia stroke in children can be significant, and recovery can take months to years.
Collapse
Affiliation(s)
- Sidrah A Badar
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rupa Radhakrishnan
- Division of Pediatric Neuroradiology, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Meredith R Golomb
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
11
|
Gschaidmeier A, Heimgärtner M, Schnaufer L, Hernáiz Driever P, Wilke M, Lidzba K, Staudt M. Non-verbal Intelligence in Unilateral Perinatal Stroke Patients With and Without Epilepsies. Front Pediatr 2021; 9:660096. [PMID: 34136439 PMCID: PMC8200455 DOI: 10.3389/fped.2021.660096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The risk factors for impaired cognitive development after unilateral perinatal stroke are poorly understood. Non-verbal intelligence seems to be at particular risk, since language can shift to the right hemisphere and may thereby reduce the capacity of the right hemisphere for its originary functions. Pharmaco-refractory epilepsies, a frequent complication of perinatal strokes, often lead to impaired intelligence. Yet, the role of well-controlled epilepsies is less well-understood. Here, we investigated whether well-controlled epilepsies, motor impairment, lesion size, lesion side, and lateralization of language functions influence non-verbal functions. Methods: We recruited 8 patients with well-controlled epilepsies (9-26 years), 15 patients without epilepsies (8-23 years), and 23 healthy controls (8-27 years). All underwent the Test of Non-verbal Intelligence, a motor-independent test, which excludes biased results due to motor impairment. Language lateralization was determined with functional MRI, lesion size with MRI-based volumetry, and hand motor impairment with the Jebson-Taylor Hand Function-Test. Results: Patients with epilepsies showed significantly impaired non-verbal intelligence [Md = 89.5, interquartile range (IQR) = 13.5] compared with controls (Md = 103, IQR = 17). In contrast, patients without epilepsies (Md = 97, IQR = 15.0) performed within the range of typically developing children. A multiple regression analysis revealed only epilepsy as a significant risk factor for impaired non-verbal functions. Conclusion: In patients with unilateral perinatal strokes without epilepsies, the neuroplastic potential of one healthy hemisphere is able to support the development of normal non-verbal cognitive abilities, regardless of lesion size, lesion side, or language lateralization. In contrast, epilepsy substantially reduces this neuroplastic potential; even seizure-free patients exhibit below-average non-verbal cognitive functions.
Collapse
Affiliation(s)
- Alisa Gschaidmeier
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Magdalena Heimgärtner
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - Lukas Schnaufer
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marko Wilke
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Karen Lidzba
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Division of Neuropediatrics, Development, and Rehabilitation, University Children's Hospital Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| |
Collapse
|
12
|
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
|
13
|
Peterson RK, Williams T, Dlamini N, Westmacott R. Parent experiences and developmental outcomes following neonatal stroke. Clin Neuropsychol 2020; 35:973-987. [PMID: 32924802 DOI: 10.1080/13854046.2020.1815855] [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 Parents of children with neonatal stroke offer critical insight into potential avenues to direct neuropsychological care from the time of diagnosis through the early years. The aims of this study were to (1) describe what parents remember about early prognostic discussions with the medical team and (2) to examine the relationships between initial prognoses and the child's current neurodevelopmental status and parents' mental health. Method: Thirty parents of children with neonatal stroke completed the Depression Anxiety Stress Scales (DASS) and Parent Experiences Questionnaire (PEQ). The children of these parents were also seen for neurodevelopmental/neuropsychological assessments. Results: Parents recalled discussions with the medical team about motor, language, cognitive, and academic outcomes, with fewer discussions about the impact of neonatal stroke on their child's social skills, behavior, attention, mental health, and adaptive functioning. Many parents recalled poor initial prognoses following their child's diagnosis, with better than expected outcomes 3 years later. Parent self-reported depression, anxiety, and stress were associated with higher ratings of externalizing symptoms in their child. There were no significant correlations between parent mental health and their perception of their child's internalizing symptoms, neurodevelopmental functioning, or any of the child's medical/demographic factors. Conclusions: This study highlights the role of the neuropsychologist in the child's care in educating families and monitoring outcomes, emphasizes mental health support for parents of children with a history of neonatal stroke, and reiterates how environmental factors outside of the neonatal stroke itself can impact the child's functioning.
Collapse
Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Tricia Williams
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, USA
| | - Nomazulu Dlamini
- Department of Neurology, The Hospital for Sick Children, Toronto, ON, USA
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, USA
| |
Collapse
|
14
|
Ledochowski J, Desrocher M, Williams T, Dlamini N, Westmacott R. Mental health outcomes in children with acquired dystonia after basal ganglia stroke and associations with cognitive and motor outcomes. Child Neuropsychol 2020; 26:691-710. [PMID: 31996083 DOI: 10.1080/09297049.2020.1721453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pediatric arterial ischemic stroke involving the basal ganglia and/or thalamus is one of the most common causes of dystonia in children. Dystonia is a movement disorder in which excessive, involuntary muscle contractions result in twisting or repetitive movements, and abnormal posturing. The basal ganglia have been implicated in mood functioning and difficulties in these domains have been noted in adults with dystonia, yet little is currently known about these outcomes in children with dystonia following stroke. The objective of this study was to explore mental health outcomes in children with basal ganglia stroke and to determine whether children with post-stroke dystonia experience additional mental health difficulties. We also examined associations between mental health, cognitive, and motor outcomes. Participants were 75 children with stroke involving the basal ganglia and/or thalamus (dystonia n = 24, no dystonia n = 51). Results supported the presence of greater levels of anxiety and depression symptoms in children with post-stroke dystonia after stroke relative to those with similar patterns of stroke, but no dystonia. There were no significant associations between motor, cognitive, and mental health outcomes in children with post-stroke dystonia aside from depression and behavioral regulation. Motor and cognitive outcome were significantly associated in the stroke only group. These findings suggest maladaptive reorganization after stroke may contribute to motor, cognitive, and mental health outcomes in children with post-stroke dystonia, and that these outcomes are independent from one another.
Collapse
Affiliation(s)
- Justine Ledochowski
- Division of Neurology, Department of Psychology, The Hospital for Sick Children , Toronto, Ontario, Canada.,Department of Psychology, York University , Toronto, Ontario, Canada
| | - Mary Desrocher
- Department of Psychology, York University , Toronto, Ontario, Canada
| | - Tricia Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children , Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, The University of Toronto , Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Department of Pediatrics, Faculty of Medicine, The University of Toronto , Toronto, Ontario, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Psychology, The Hospital for Sick Children , Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, The University of Toronto , Toronto, Ontario, Canada
| |
Collapse
|
15
|
Champigny CM, Deotto A, Westmacott R, Dlamini N, Desrocher M. Academic outcome in pediatric ischemic stroke. Child Neuropsychol 2020; 26:817-833. [DOI: 10.1080/09297049.2020.1712346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Angela Deotto
- Department of Psychology, York University, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, the Hospital for Sick Children, Toronto, Canada
| | - Nomazulu Dlamini
- Division of Neurology, the Hospital for Sick Children, Toronto, Canada
| | - Mary Desrocher
- Department of Psychology, York University, Toronto, Canada
- SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
16
|
Kaseka ML, Dlamini N, Westmacott R. Ischemic sequelae and other vascular diseases. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:485-492. [PMID: 32958192 DOI: 10.1016/b978-0-444-64150-2.00033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although pediatric stroke is associated with higher survival rates compared with adult stroke, a substantial body of evidence indicates significant neuropsychologic morbidity in pediatric stroke survivors. Neuroplasticity does not guarantee good outcome in children. The general trends observed in the literature are reviewed as is the profile observed in common causes of pediatric stroke: congenital heart disease, moyamoya disease, and sickle cell disease. The neuropsychologic profile of pediatric stroke patients is heterogeneous due to the multiplicity of associated causes. Stroke in early infancy and large strokes are associated with cognitive impairment while more limited disorders, such as phasic deficit, are observed in childhood stroke. Executive dysfunction is common in pediatric stroke, but social interaction skills are usually preserved. Congenital heart disease and sickle cell disease are associated with global neuropsychologic dysfunction while cognition is usually preserved in moyamoya. Executive dysregulation is instead more frequently reported in this population. Further study of maladaptive processes after pediatric stroke will allow identification of predictors of functional and neuropsychologic outcomes and permit personalization of care.
Collapse
Affiliation(s)
- Matsanga Leyila Kaseka
- Department of Pediatrics, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada.
| | - Nomazulu Dlamini
- Department of Pediatrics, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Psychology, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
17
|
Peterson RK, Williams TS, McDonald KP, Dlamini N, Westmacott R. Cognitive and Academic Outcomes Following Childhood Cortical Stroke. J Child Neurol 2019; 34:897-906. [PMID: 31402724 DOI: 10.1177/0883073819866609] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The majority of pediatric neuropsychological stroke research has focused on perinatal stroke outcomes given its relative frequency. Meanwhile, childhood-onset stroke is under-represented in the literature, resulting in limited knowledge about its neurocognitive sequelae. This retrospective study examined cognitive outcomes in children and youth (n = 27) with childhood arterial ischemic stroke (stroke occurring between 29 days and 18 years of life) isolated to the cortical region. Intellectual, academic, language, visual-perception, visual-motor integration, fine motor coordination, and executive function scores were examined relative to normative means. Results indicate that although these children are doing well in terms of general intellectual ability, they demonstrate lower scores on tasks of processing speed and fine motor coordination. Exploratory analysis also revealed that of the personal and neurologic factors examined, age at stroke was positively correlated with perceptual reasoning and fine motor control, age at assessment was negatively correlated with math calculation abilities, and maternal education was positively correlated with working memory and parent-reported behavioral regulation and impulse inhibition abilities. While neurologic variables were not predictive of cognitive neuropsychological outcomes, those with significant poorer performance had higher rates of medium/large, right-sided lesions with frontal lobe involvement. Our results highlight the overall resilience of the injured developing brain but also the vulnerability of specific cognitive skills within this unique population.
Collapse
Affiliation(s)
- Rachel K Peterson
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Tricia S Williams
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kyla P McDonald
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Alderson L. Early intervention following neonatal stroke: closer towards targeted therapy. Dev Med Child Neurol 2019; 61:625. [PMID: 30548862 DOI: 10.1111/dmcn.14136] [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: 11/26/2022]
Affiliation(s)
- Lucy Alderson
- Physiotherapy Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
19
|
Peterson RK, McDonald KP, Vincent M, Williams TS, Dlamini N, Westmacott R. Characterizing language outcomes following childhood basal ganglia stroke. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:14-25. [PMID: 31006275 DOI: 10.1080/21622965.2019.1590202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The basal ganglia are important for movement and executive function, but its contribution to language is less understood. This study explored language outcomes associated with childhood basal ganglia stroke. A detailed language coding scheme, which examined expressive and receptive language, verbal fluency, narrative discourse, pragmatic/applied language, and academics, was developed from qualitative and quantitative data acquired from neuropsychological testing and reports. Overall intellectual functioning and verbal comprehension was in the average range. Twelve participants had psychological diagnoses, including Learning Disorder. No one had a Language Disorder diagnosis. Among the 18 children who did not receive a diagnosis, many exhibited language issues in the mild to severe range according to our coding scheme. These children had higher-order language difficulties in verbal fluency, narrative, and pragmatic language rather than overt expressive difficulties noted in Diagnostic and Statistical Manual (DSM) diagnostic criteria. There was an association between infarct size and ESL/immersion education, math performance, and presence of a psychological diagnosis. Psychological diagnosis was also associated with literacy skills. The results highlight that language issues following basal ganglia stroke may not be fully captured by standardized neuropsychological tests and psychological diagnoses. Findings reinforce the need to integrate quantitative and qualitative findings when examining language functioning.
Collapse
Affiliation(s)
- Rachel K Peterson
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kyla P McDonald
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Megan Vincent
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tricia S Williams
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|