Immunotherapy for arterial ischaemic stroke in childhood: a systematic review

Edwards, Hannah B; Mallick, Andrew A; O'Callaghan, Finbar

doi:10.1136/archdischild-2016-311034

Cited by 10 publications

(6 citation statements)

References 52 publications

(34 reference statements)

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“…Two papers that addressed the use of steroids in childhood AIS were identified. 74,75 A systematic review of 32 observational studies and two trials involving 152 children provided weak evidence for the benefits of steroid treatment in childhood AIS, in the context of tuberculous or bacterial meningitis, and some subtypes of arteriopathy. It was noted, however, that the studies reviewed had no internal controls or comparison groups.…”

Section: Section 4: Recommendations For Primary Pediatric Stroke Centmentioning

confidence: 99%

Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke

Medley

Miteff

Andrews

et al. 2018

International Journal of Stroke

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Stroke is among the top 10 causes of death in children and survivors carry resulting disabilities for decades, at substantial cost to themselves and their families. Children are not currently able to access reperfusion therapies, due to limited evidence supporting safety and efficacy and long diagnostic delays. The Australian Clinical Consensus Guideline for the Diagnosis and Acute Management of Childhood Stroke was developed to minimize unwarranted variations in care and document best evidence on the risk factors, etiologies, and conditions mimicking stroke that differ from adults. Clinical questions were formulated to inform systematic database searches from 2007 to 2017, limited to English and pediatric studies. SIGN methodology and the National Health and Medical Research Council system were used to screen and classify the evidence. The Grades of Recommendation, Assessment, Development, and Evaluation system (GRADE) was used to grade evidence as strong or weak. The Guideline provides more than 60 evidence-based recommendations to assist prehospital and acute care clinicians in the rapid identification of childhood stroke, choice of initial investigation, to confirm diagnosis, determine etiology, selection of the most appropriate interventions to salvage brain at risk, and prevent recurrence. Recommendations include advice regarding the management of intracranial pressure and congenital heart disease. Implementation of the Guideline will require reorganization of prehospital and emergency care systems, including the development of regional stroke networks, pediatric Code Stroke, rapid magnetic resonance imaging and accreditation of primary pediatric stroke centers with the capacity to offer reperfusion therapies. The Guideline will allow auditing to benchmark timelines of care, access to acute interventions, and outcomes. It will also facilitate the development of an Australian childhood stroke registry, with data linkage to international registries, to allow for accurate data collection on stroke incidence, treatment, and outcomes.

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Section: Section 4: Recommendations For Primary Pediatric Stroke Centmentioning

confidence: 99%

Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke

Medley

Miteff

Andrews

et al. 2018

International Journal of Stroke

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“…The authors concluded that there was little robust evidence in favor or against the use of immunotherapy in childhood AIS. 32 Another study of 27 children found no reduction in rates of vascular progression in children receiving steroids. 34 A retrospective Australian and Swiss study compared outcomes between 21 children with AIS due to an FCA treated with combined corticosteroid and antithrombotic treatment, and 53 treated with antithrombotic treatment alone.…”

Section: Arteriopathies In Pediatric Stroke Predictive Biomarkers Amentioning

confidence: 98%

“…31 Three studies have assessed the use of corticosteroids in pediatric stroke. [32][33][34] A systematic review of studies involving 152 children with stroke provided very weak evidence for the benefits of steroid treatment in the context of tuberculous or bacterial meningitis, and some subtypes of arteriopathy. The studies reviewed had no internal controls or comparison groups.…”

Section: Treatmentsmentioning

confidence: 99%

Recent developments and new frontiers in childhood arterial ischemic stroke

Mackay

Steinlin

2018

International Journal of Stroke

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This review will discuss important developments in childhood arterial ischemic stroke over the past decade, focusing on improved understanding of the causes, consequences, and targets for intervention. Risk factors for childhood arterial ischemic stroke are different to adults. Infections, particularly herpes group viruses, are important precipitants for stroke. Non-atherosclerotic arteriopathies are the most common cause of childhood arterial ischemic stroke and an important predictor of recurrent events. Recent advances include the identification of serum biomarkers for inflammation and endothelial injury, and imaging biomarkers to monitor for vascular progression. Multicenter trials of immunotherapies in focal cerebral arteriopathies are currently in development. Recognition of clinical and radiological phenotypic patterns has facilitated the discovery of multisystem disorders associated with arterial ischemic stroke including ACTA2 arteriopathy and adenosine deaminase 2 deficiency. Identification of these Mendelian disorders provide insights into genetic mechanisms of disease and have implications for medical and surgical management. In contrast to adults, there are long diagnostic delays in childhood arterial ischemic stroke. Refinement of pediatric Code Stroke protocols and clinical decision support tools are essential to improve diagnostic certainty and improve access to reperfusion therapies. Children do not recover better than adults following arterial ischemic stroke, with more than half of survivors having long-term impairments. The physical, cognitive, and behavioral consequences of childhood arterial ischemic stroke are increasingly reported but further research is required to understand their impact on participation, quality of life, psychosocial, and family functioning. Longitudinal studies and the use of advanced imaging techniques, to understand neurobiological correlates of functional reorganization, are essential to developing targeted intervention strategies to facilitate recovery.

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“…Although anecdotally corticosteroids have been used in post-varicella arteriopathy, and focal cerebral arteriopathy of childhood, a recent systematic review of 34 studies concluded that robust evidence of efficacy is lacking. 61 A recent physician survey concluded that a clinical trial of corticosteroids in focal cerebral arteriopathy of childhood is a priority (with concomitant use of acyclovir in post-varicella arteriopathy). 62 However, a recent analysis of 84 UK AIS cases did not find a high recurrence rate in focal cerebral arteriopathy of childhood.…”

Section: Treatmentmentioning

confidence: 99%