Association of Perinatal and Childhood Ischemic Stroke With Attention-Deficit/Hyperactivity Disorder

Bolk, Jenny; Simatou, Eleni; Söderling, Jonas; Thorell, Lisa B.; Persson, Martina; Sundelin, Heléne E.K.

doi:10.1001/jamanetworkopen.2022.8884

Cited by 11 publications

(5 citation statements)

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“…In a retrospective study from the Hospital for Sick Children, externalizing symptoms of aggression and defiance were reported in as many as 30% of perinatal stroke patients [40]. A Swedish cohort study analyzed 343 children with perinatal stroke and found an almost three-fold increased risk of developing attention deficit hyperactivity disorder (ADHD) [41 ▪▪ ]; this risk significantly increased with comorbid epilepsy and/or motor deficits. Another study found that children with perinatal stroke had increased prevalence of autism spectrum disorder (ASD) compared to the general population [42].…”

Section: Discussionmentioning

confidence: 99%

“…Evidence suggests survivors of pediatric stroke are at a high risk of behavioral disorders including ADHD and ASD [41 ▪▪ ,47]. A Swedish retrospective found that pediatric AIS increased the risk of developing ASD three-fold in survivors of childhood stroke [47].…”

Section: Discussionmentioning

confidence: 99%

“…A Swedish retrospective found that pediatric AIS increased the risk of developing ASD three-fold in survivors of childhood stroke [47]. In addition, stroke survivors had a two-fold increased risk of ADHD [41 ▪▪ ]. Comorbid epilepsy and motor disability increased the risk of ASD and ADHD.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology, causes, and morbidities of stroke in the young

Janas,

Barry,

Lee

2023

Current Opinion in Pediatrics

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Purpose of review The purpose is to describe the latest research on epidemiology, causes, and morbidities of stroke in neonates and children. Recent findings The global incidence of childhood stroke is approximately 2 per 100 000 person-years, which is significantly lower compared to neonates (20–40 per 100 000 live births) and adults (80–90 per 100 000 person-years). Placental abnormalities are a risk factor for perinatal stroke, although cause is usually multifactorial. In children, nonatherosclerotic arteriopathies and arteriovenous malformations are major causes of ischemic and hemorrhagic strokes, respectively. The perinatal period confers a high risk of stroke and can lead to long-term disability, including motor delay, cognitive or speech impairment, and epilepsy. Recent studies suggest that at least 50% of survivors of perinatal stroke have abnormal neurodevelopmental scores in long-term follow up. Childhood stroke is associated with significant morbidity, including epilepsy, motor impairments, and behavioral disability. Recent studies have also identified an association between pediatric stroke and behavioral disorders, such as attention deficit hyperactivity disorder and autism. Summary Perinatal and childhood strokes are important causes of neurological morbidity. Given the low incidence of childhood stroke, prospective research studies on epidemiology, causes, and outcomes remain limited, highlighting the need for continued multisite collaborations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Epidemiology, causes, and morbidities of stroke in the young

Janas,

Barry,

Lee

2023

Current Opinion in Pediatrics

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“…When deficits are identified, implementation of therapies, educational resources, and school accommodations can help optimize school function. For example, children with a history of stroke are at risk for attention-deficit/hyperactivity disorder (ADHD) [ 259 ]. ADHD can be medically managed when identified, thereby limiting the impact on a child’s daily life.…”

Section: Therapeuticsmentioning

confidence: 99%

Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke

Sun

Lynch

2023

Neurotherapeutics

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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. Supplementary Information The online version contains supplementary material available at 10.1007/s13311-023-01373-5.

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“…53,54 Also, risk of neuropsychiatric diseases, such as attention deficit/hyperactivity disorder and autism, is increased in children with ischemic stroke. 55,56 Stroke lesion size is correlated with worse cognitive outcome through all ages 57 while variations between ages can be seen in different domains of cognitive outcome. For example, ischemic stroke in early childhood (28 days to 6 years of age) resulted in less cognitive flexibility, processing speed, and verbal learning compared to perinatal or late childhood stroke.…”

Section: Adverse Outcomesmentioning

confidence: 99%

Pediatric ischemic stroke : Epidemiological aspects of validity, risk factors, and outcomes

Walås

2023

Linköping University Medical Dissertations

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Pediatric ischemic stroke is divided into perinatal stroke, 20 weeks gestation until the 28 th day of life, and childhood stroke, the 29 th day of life until 18 years of age. Perinatal and childhood stroke differ in risk factors and outcomes but both cause increased mortality and morbidity in the pediatric population. The overall aim of this thesis was to identify factors associated with risk of pediatric ischemic stroke or, risk of adverse outcome and morbidity after pediatric ischemic stroke, in a validated cohort.This thesis consists of four register-based epidemiological studies. First, a validation study of pediatric ischemic stroke diagnoses (International classification of diseases [ICD]-10: I63, I64; 434, 436) in children 1969-2016. Through medical chart review, we validated the diagnoses of pediatric ischemic stroke and found a positive predictive value of 89% (95% CI 0.85-0.92) in the Swedish National Patient Register. About 2/3 of the ischemic stroke cases were identified in the later years (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016), during which 98% of the diagnoses were confirmed by radiology. Second, a matched cohort study of long-term mortality after pediatric ischemic stroke showed that mortality was elevated over 20 years after the stroke, without difference between perinatal and childhood stroke. Mortality risk was also elevated in first-degree relatives of individuals with childhood stroke. Third, a matched cohort study showed that 32% (280 of 877) of the children with ischemic stroke were diagnosed with adverse motor outcome (i.e., cerebral palsy or hemiparesis). The risk of adverse motor outcome was higher after ischemic stroke in childhood compared to the perinatal period, but neither male sex, low gestational age nor high parental age showed any association. Fourth, a cohort study of all births in Sweden 1998-2019 assessed maternal body mass index (BMI) as a risk factor for perinatal ischemic stroke. In mothers with obesity (BMI >30) the risk of perinatal ischemic stroke in the infant increased two-fold.Pediatric ischemic stroke has a high positive predictive value in the National Patient Register, enabling high-quality register-based research using these diagnoses. Limitation to later years (>1997) give higher identification rate, with almost complete confirmation by radiology. Although there was no difference in long-term mortality risk between childhood and perinatal ischemic stroke, the underlying mechanisms are diverse. The analysis of the cause-specific mortality could indicate factors relevant to the risk of mortality after pediatric ischemic stroke. Adverse motor outcome is common after pediatric ischemic stroke, especially in childhood. The ICD codes My warmest gratitude towards all who have contributed throughout my PhD studies and in the writing of this thesis.To my supervisors Heléne Sundelin, Peter Bang, and Jenny Bolk for guiding me through the process. Heléne, for momentum and contagious love for...

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Association of Perinatal and Childhood Ischemic Stroke With Attention-Deficit/Hyperactivity Disorder

Cited by 11 publications

References 54 publications

Epidemiology, causes, and morbidities of stroke in the young

Epidemiology, causes, and morbidities of stroke in the young

Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke

Pediatric ischemic stroke : Epidemiological aspects of validity, risk factors, and outcomes

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