Childhood stroke study identifies the contraceptive pill and smoking as risk factors

November 01, 2010

Researchers are calling for clear guidelines on childhood stroke after a study, published in the November issue of Acta Paediatrica, found wide variations in time lag to diagnosis, investigation and treatment.

They are also keen to see the development of appropriate rehabilitation services, after a follow-up study found that 85% of the children who survived a stroke had neurological dysfunction or limitations.

Dr Sten Christerson studied the records of all children who had experienced their first stroke over a seven-year period in the Uppsala-Orebro Health Care Region, which covers a fifth of the Swedish population.

He found that risk factors included the combined effects of oral contraceptives plus smoking or anaemia and that having a stroke had a significant effect on most of the children's everyday lives and performance and impacted on the whole family.

"The aim of the study was to evaluate the incidence, presenting symptoms and signs, time lag to diagnosis, medical investigations, risk factors and short-term outcomes of childhood stroke" says Dr Christerson from the Centre for Rehabilitation Research and the Paediatric Clinic at Orebro University Hospital. A second paper in the journal, also co-authored with Dr Bo Stromberg, charts the long-term outcomes of the children the researchers identified during the initial study.

"Childhood stroke is defined as a cerebrovascular event occurring between 28 days and 18 years of age" explains Dr Christerson. "Studies in Europe and the United States have found that childhood stroke affects between 2.1 to 13 children per 100,000 a year and we found an incidence of 1.8. Although childhood stroke is not as common as many other childhood illnesses, it is a serious condition that results in considerable long-term ill health and severe functional disabilities."

Fifty-one children - 23 boys and 28 girls - were identified from the records and 46 of the 47 children who survived were followed up 1.6 to 8.6 years later (median: 4.2 years) to determine the long-term effects of their stroke. The researchers were unable to trace one patient and four had died, two during the acute stage and two later.

Key findings from the initial study included:The total time lag to diagnosis was long and treatment varied:Ongoing health problems were very common:"Stroke in children is a serious condition that results in considerable long-term ill health and severe functional disabilities" concludes Dr Christerson. "In our study 8% of the children died and 85% of the survivors were left with neurological dysfunctions or limitations.

"Clear guidelines are needed to provide more consistent diagnosis and treatment of childhood stroke and our study also highlights the need for long-term rehabilitation services. It also raises real concerns about young girls who take oral contraceptives and also smoke or have iron deficient anaemia. We feel that it is important to check anaemia levels before prescribing oral contraceptives, prescribing iron tablets as required, and stress the risks that smoking poses."
-end-
You can read the two papers free online at:
http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2010.01925.x/pdf
http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2010.01948.x/pdf

Notes to editors

Childhood stroke in Sweden I: incidence, symptoms, risk factors and short-term outcome. Christerson S and Stromberg B. Acta Paediatrica. 99, pp1641-1649. (November 2010). DOI: 10.1111/j.1651-2227.2010.01925.x

Stroke in Swedish children II: long-term outcome. Christerson S and Stromberg B. Acta Paediatrica. 99, pp1650-1656. (November 2010). DOI: 10.1111/j.1651-2227.2010.01948.x

Acta Paediatrica is a peer-reviewed monthly journal at the forefront of international paediatric research. It covers both clinical and experimental research in all areas of paediatrics including: neonatal medicine, developmental medicine, adolescent medicine, child health and environment, psychosomatic paediatrics and child health in developing countries. www.actapaediatrica.com

Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit http://www.wileyblackwell.com/ or our new online platform, Wiley Online Library (http://www.wileyonlinelibrary.com/), one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.

A Swedish language version of this press release is available on request.

Wiley

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