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Gabrielle Deveber - One of the best experts on this subject based on the ideXlab platform.

  • swallowing oral motor motor speech and language impairments following acute Pediatric ischemic Stroke
    Stroke, 2021
    Co-Authors: Victoria Sherman, Nomazulu Dlamini, Gabrielle Deveber, Daune Macgregor, Rosemary Martino, Ishvinder Bhathal, Elizabeth Pulcine, Deryk S Beal, Kevin E Thorpe
    Abstract:

    Background and Purpose: Following adult Stroke, dysphagia, dysarthria, and aphasia are common sequelae. Little is known about these impairments in Pediatric Stroke. We assessed frequencies, co-occu...

  • Validation of the Pediatric Stroke outcome measure for classifying overall neurological deficit
    Pediatric Research, 2020
    Co-Authors: Mahmoud Slim, Nomazulu Dlamini, Sharon Friefeld, Robyn Westmacott, Daune Macgregor, Mahendranath Moharir, Gabrielle Deveber
    Abstract:

    Background The Pediatric Stroke outcome measure (PSOM) is a standardized, disease-specific outcome measure. We aimed to validate the overall classification of neurological deficit severity using PSOM. Methods We identified 367 neonates/children with arterial ischemic Stroke (AIS) (Derivation Cohort). We analyzed the PSOM subscales (scored as 0 [no deficit], 0.5 [minimal/mild deficit; normal function], 1 [moderate deficit; slowing function], or 2 [severe deficit; missing function]) to derive severity levels using latent class analysis (LCA). We validated a severity classification scheme (PSOM-SCS) in: (a) children who had Pediatric Evaluation of Disability Inventory (PEDI; n  = 63) and/or the Pediatric Quality-of-Life Inventory (PedsQL; n  = 97) scored; and (b) an external cohort (AIS; n  = 102) with concurrently scored modified Rankin Scale (mRS), King’s Outcome Scale for Childhood Head-Injury (KOSCHI) and PSOM. Results Within the Derivation Cohort, LCA identified three severity levels: “normal/mild,” “moderate,” and “severe” (83.7%, 13.3%, and 3%, respectively). We developed severity classification based on PSOM subscale scores: “normal/mild”—normal function in all domains or slowing in one domain, “moderate”—slowing in ≥2 domains or missing function in one domain, and “severe”—missing function in ≥2 domains or slowing in ≥1 plus missing in one domain. PEDI and PedsQL both differed significantly across the severity groups. PSOM-SCS displayed high concordance with mRS (agreement coefficient [AC2] = 0.88) and KOSCHI (AC2 = 0.79). Conclusion The PSOM-SCS constitutes a valid tool for classifying overall neurological severity emphasizing function and encompassing the full range of severity in Pediatric Stroke. Impact Arithmetic summing of the PSOM subscales scores to assess severity classification is inadequate. The prior severity classification using PSOM overestimates poor outcomes. Three distinct severity profiles using PSOM subscales are identified. The PSOM-SCS is in moderate to excellent agreement with other disability measures. PSOM-SCS offers a valid tool for classifying the overall neurological deficit severity.

  • validation of the Pediatric Stroke outcome measure for classifying overall neurological deficit
    Pediatric Research, 2020
    Co-Authors: Mahmoud Slim, Nomazulu Dlamini, Sharon Friefeld, Robyn Westmacott, Daune Macgregor, Mahendranath Moharir, Christine K Fox, Gabrielle Deveber
    Abstract:

    The Pediatric Stroke outcome measure (PSOM) is a standardized, disease-specific outcome measure. We aimed to validate the overall classification of neurological deficit severity using PSOM. We identified 367 neonates/children with arterial ischemic Stroke (AIS) (Derivation Cohort). We analyzed the PSOM subscales (scored as 0 [no deficit], 0.5 [minimal/mild deficit; normal function], 1 [moderate deficit; slowing function], or 2 [severe deficit; missing function]) to derive severity levels using latent class analysis (LCA). We validated a severity classification scheme (PSOM-SCS) in: (a) children who had Pediatric Evaluation of Disability Inventory (PEDI; n = 63) and/or the Pediatric Quality-of-Life Inventory (PedsQL; n = 97) scored; and (b) an external cohort (AIS; n = 102) with concurrently scored modified Rankin Scale (mRS), King’s Outcome Scale for Childhood Head-Injury (KOSCHI) and PSOM. Within the Derivation Cohort, LCA identified three severity levels: “normal/mild,” “moderate,” and “severe” (83.7%, 13.3%, and 3%, respectively). We developed severity classification based on PSOM subscale scores: “normal/mild”—normal function in all domains or slowing in one domain, “moderate”—slowing in ≥2 domains or missing function in one domain, and “severe”—missing function in ≥2 domains or slowing in ≥1 plus missing in one domain. PEDI and PedsQL both differed significantly across the severity groups. PSOM-SCS displayed high concordance with mRS (agreement coefficient [AC2] = 0.88) and KOSCHI (AC2 = 0.79). The PSOM-SCS constitutes a valid tool for classifying overall neurological severity emphasizing function and encompassing the full range of severity in Pediatric Stroke.

  • additional validation study and french cross cultural adaptation of the Pediatric Stroke outcome measure summary of impressions psom soi
    Annals of Physical and Rehabilitation Medicine, 2019
    Co-Authors: M D Morard, Gabrielle Deveber, Mickael Dinomais, Kim Bull, P Rippert, M Chevignard, Stephane Chabrier, C Vuillerot
    Abstract:

    Abstract Background The Pediatric Stroke Outcome Measure-Summary of Impressions (PSOM-SOI) measures neurological function across right and left sensorimotor domains (Item A), language production (Item B), language comprehension (Item C), and cognition/behaviour (Item D). Objective This study was a cross-cultural adaptation into French of the PSOM-SOI and an assessment of its reliability and limitations of use. Material and Methods The translation and adaptation of the PSOM-SOI was followed by the assessment of its reliability in a cohort of 69 children with diagnosed acute neonatal arterial ischemic Stroke. Three independent raters retrospectively scored the PSOM-SOI based on data from in-person neurological examination and results of standardized tests performed at age 7 in the cohort database. Comparison 1 (C1) involved a less experienced rater and an experienced rater and comparison 2 (C2) involved 2 experienced raters. Inter-rater reliability (IRR) was measured with Kappa coefficients. Results The cross-cultural adaptation was easily performed, and no rater had difficulties using the French PSOM-SOI. The IRR was better in C1 than C2. For Item A, the agreement in C1 (κ = 0.47) and C2 (κ = 0.44) was moderate. The C1 agreement was substantial for Items B (κ = 0.71) and C (κ = 0.70); the C2 agreement was fair for Item B (κ = 0.23) and slight for Item C (κ = 0.16). For Item D, the agreement was moderate in C1 (κ = 0.52) and fair in C2 (κ = 0.35). In all but one comparison, agreement or minor disagreement (≤ 0.5 points) was obtained for more than 90% of the item scores. Regarding the total score, agreement for normal function (≤ 0.5) versus abnormal function (> 0.5) was achieved for 90% in C1 and 67% in C2. Conclusion The IRR of the French PSOM-SOI gave variable results depending on the item and rater's experience, but the extent of disagreements was minor for individual items and total score. Additional prospective validation studies using the French PSOM-Short Neurological Exam to score the PSOM-SOI are needed. A dichotomised total score (cut-off ≤ 0.5) could be used to define normal function versus poor outcome.

  • survey of practice patterns and preparedness for endovascular therapy in acute Pediatric Stroke
    Childs Nervous System, 2019
    Co-Authors: Jenny L Wilson, Michael J. Rivkin, Catherine Amlielefond, Gabrielle Deveber, Todd A Abruzzo, Darren B Orbach, Paola Pergami
    Abstract:

    Endovascular therapy benefits selected adults with acute Stroke while data are lacking for children. The purpose of this study was to assess physician practice and institutional preparedness for endovascular therapy in Pediatric Stroke. A link to an anonymous online survey was sent to members of the International Pediatric Stroke Study (IPSS) group about physician experience with endovascular therapy, likelihood of treatment for provided clinical vignettes, and institutional readiness for the delivery of endovascular therapy to children. Thirty-one Pediatric physicians with a mean of 11 years (SD 7.1) of experience responded. All but two would consider endovascular therapy in a child, and 20 (64.5%) had recommended endovascular therapy for a child in the preceding year. Most (n = 19, 67.9%) did not commit to an age minimum for endovascular therapy. Sixteen (57.1%) would consider treatment up to 24 h after symptom onset with 19 (67.9%) respondents reporting that their practice changed after the 2018 American Heart Association guidelines extended the time window for endovascular therapy in adults. Seventeen (60.7%) preferred imaging that included perfusion in children presenting beyond 6 h. Nineteen (70.4%) had institutional endovascular therapy criteria. Physicians in larger Pediatric groups had more “likely to treat” responses on the clinical vignettes than physicians working in smaller groups (11.7 vs. 6.1, p < 0.05). Pediatric Stroke physicians are largely willing to consider endovascular therapy with most changing their practice according to adult guidelines, though experience and selection criteria varied. These findings may help to inform consensus guidelines and clinical trial development.

Heather J. Fullerton - One of the best experts on this subject based on the ideXlab platform.

  • Building a Career as a Pediatric Stroke Neurologist
    Stroke, 2019
    Co-Authors: Heather J. Fullerton, Adam Kirton, Mark T Mackay, Lori C Jordan, Vijeya Ganesan, Maja Steinlin
    Abstract:

    Author(s): Fullerton, Heather J; Ganesan, Vijeya; Jordan, Lori C; Kirton, Adam; Mackay, Mark T; Steinlin, Maja

  • management of Stroke in neonates and children a scientific statement from the american heart association american Stroke association
    Stroke, 2019
    Co-Authors: Donna M Ferriero, Heather J. Fullerton, Timothy J. Bernard, Rebecca Ichord, Lori C Jordan, Gabrielle Deveber, Lori Billinghurst, Stephen R Daniels, Michael R Debaun, Patricia Massicotte
    Abstract:

    Purpose- Much has transpired since the last scientific statement on Pediatric Stroke was published 10 years ago. Although Stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and Stroke. Methods- Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results- Annualized Pediatric Stroke incidence rates, including both neonatal and later childhood Stroke and both ischemic and hemorrhagic Stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood Stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to Pediatric Stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood Stroke are discussed in each section. Conclusions- Here we provide updates on perinatal and childhood Stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic Stroke, and updates in regard to areas of childhood Stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field.

  • focal cerebral arteriopathy of childhood novel severity score and natural history
    Stroke, 2018
    Co-Authors: Heather J. Fullerton, Timothy J. Bernard, Neil R. Friedman, Nicholas V. Stence, Rebecca Ichord, Catherine Amlielefond, Mark T Mackay, Nancy K Hills, Bin Jiang, Mubeen F Rafay
    Abstract:

    Background and Purpose- Focal cerebral arteriopathy (FCA)-a common cause of arterial ischemic Stroke in previously healthy children-often progresses over days to weeks, increasing the risk of recurrent Stroke. We developed a novel severity scoring system designed to quantify FCA progression and correlate with clinical outcomes. Methods- The VIPS study (Vascular Effects of Infection in Pediatric Stroke) prospectively enrolled 355 children with arterial ischemic Stroke (2010-2014), including 41 with centrally confirmed FCA. Two neuroradiologists independently reviewed FCA cerebrovascular imaging, assigning a graded severity score of zero (no involvement) to 4 (occlusion) to individual arterial segments. The FCA severity score (FCASS) was the unweighted sum. In an iterative process, we modeled scores derived from different combinations of arterial segments to identify the model that optimized correlation with clinical outcome, simplicity, and reliability. Results- The optimal FCASS summed scores from 5 arterial segments: supraclinoid internal carotid artery, A1, A2, M1, and M2. The median (interquartile range) baseline FCASS was 4 (2-6). Of 33 children with follow-up imaging, the maximum FCASS (at any time point) was 7 (5-9). Twenty-four (73%) had FCA progression on follow-up with their maximum FCASS at a median of 8 (5-35.5) days postStroke; their median FCASS increase was 4 (2.5-6). FCASS did not correlate with recurrent arterial ischemic Stroke. Maximum (but not baseline) FCASS correlated with 1-year Pediatric Stroke outcome measures ( P=0.037). Conclusions- Our novel scoring system for FCA severity correlates with neurological outcomes in the VIPS cohort and provides a tool for FCA treatment trials under development.

  • socioeconomic determinants of outcome after childhood arterial ischemic Stroke
    Neurology, 2018
    Co-Authors: Lori C Jordan, Heather J. Fullerton, Rebecca Ichord, Gabrielle Deveber, Nancy K Hills, Paola Pergami, Christine K Fox, Vips Investigators
    Abstract:

    Objective To determine whether lower socioeconomic status (SES) is associated with worse 1-year neurologic outcomes and reduced access to rehabilitation services in children with arterial ischemic Stroke (AIS). Methods From 2010 to 2014, the Vascular effects of Infection in Pediatric Stroke (VIPS) observational study prospectively enrolled and confirmed 355 children (age 29 days–18 years) with AIS at 37 international centers. SES markers measured via parental interview included annual household income (US dollars) at the time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure scores were categorized as 0 to 1, 1.5 to 3, 3.5 to 6, and 6.5 to 10. Univariate and multivariable ordinal logistic regression models examined potential predictors of outcome. Results At 12 ± 3 months after Stroke, 320 children had documented outcome measurements, including 15 who had died. In univariate analysis, very low income ( Conclusions In a large, multinational, prospective cohort of children with AIS, low income was associated with worse neurologic outcomes compared to higher income levels. This difference was not explained by Stroke type, neurologic comorbidities, or reported use of rehabilitation services. The root causes of this disparity are not clear and warrant further investigation.

  • Pediatric Stroke Imaging.
    Pediatric Neurology, 2018
    Co-Authors: Alexander Khalaf, Michael, Heather J. Fullerton, Max Wintermark
    Abstract:

    Abstract Background Pediatric Stroke is a distinct clinical entity as compared with that in adults due to its unique and diverse set of etiologies. Furthermore, the role and application of diagnostic imaging has specific constraints and considerations. The intention of this article is to review these concepts in a thorough manner to offer a Pediatric Stroke imaging framework that providers can employ when taking care of these patients. Methods A comprehensive primary and secondary literature review was performed with specific attention to the common causes of Pediatric Stroke, appropriate use of neuroimaging, specific imaging findings, and developing techniques which may improve our ability to accurately diagnose these patients. Results Findings from this literature review were synthesized and summarized in order to thoroughly review the aforementioned concepts and outline the current consensus-based approach to diagnostic imaging in Pediatric Stroke. Furthermore, imaging findings drawn from patients seen in our institution are demonstrated to familiarize readers with Pediatric Stroke neuroimaging. Conclusions The challenges posed by Pediatric Stroke can be mitigated, in part, by the thoughtful application of diagnostic imaging, with the ultimate hope of improving outcomes for these vulnerable patients.

Timothy J. Bernard - One of the best experts on this subject based on the ideXlab platform.

  • Predicting Recovery and Outcome after Pediatric Stroke: Results from the International Pediatric Stroke Study.
    Annals of Neurology, 2020
    Co-Authors: Ryan J. Felling, Timothy J. Bernard, Michael J. Rivkin, Mubeen F Rafay, Jessica L Carpenter, Nomazulu Dlamini, Sahar M A Hassanein, Lori C Jordan, Michael J Noetzel, Kevin A Shapiro
    Abstract:

    OBJECTIVE To characterize predictors of recovery and outcome following Pediatric arterial ischemic Stroke, hypothesizing that age influences recovery after Stroke. METHODS We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic Stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change. RESULTS Our population consisted of 587 patients, including 174 with neonatal Stroke and 413 with childhood Stroke, with recurrent Stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p

  • predicting recovery and outcome after Pediatric Stroke results from the international Pediatric Stroke study
    Annals of Neurology, 2020
    Co-Authors: Ryan J. Felling, Timothy J. Bernard, Michael J. Rivkin, Mubeen F Rafay, Jessica L Carpenter, Nomazulu Dlamini, Sahar M A Hassanein, Lori C Jordan, Michael J Noetzel, Kevin A Shapiro
    Abstract:

    OBJECTIVE To characterize predictors of recovery and outcome following Pediatric arterial ischemic Stroke, hypothesizing that age influences recovery after Stroke. METHODS We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic Stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change. RESULTS Our population consisted of 587 patients, including 174 with neonatal Stroke and 413 with childhood Stroke, with recurrent Stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p < 0.05), underlying chronic disorder (OR = 2.23, p < 0.05), and involvement of both small and large vascular territories (OR = 2.84, p < 0.05). Recovery patterns differed, with emerging deficits more common in children <1 year of age (p < 0.05). INTERPRETATION Outcomes after Pediatric Stroke are generally favorable, but moderate to severe neurological impairments are still common. Age between 28 days and 1 year appears to be a particularly vulnerable period. Understanding the timing and predictors of recovery will allow us to better counsel families and target therapies to improve outcomes after Pediatric Stroke. ANN NEUROL 2020;87:840-852.

  • management of Stroke in neonates and children a scientific statement from the american heart association american Stroke association
    Stroke, 2019
    Co-Authors: Donna M Ferriero, Heather J. Fullerton, Timothy J. Bernard, Rebecca Ichord, Lori C Jordan, Gabrielle Deveber, Lori Billinghurst, Stephen R Daniels, Michael R Debaun, Patricia Massicotte
    Abstract:

    Purpose- Much has transpired since the last scientific statement on Pediatric Stroke was published 10 years ago. Although Stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and Stroke. Methods- Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results- Annualized Pediatric Stroke incidence rates, including both neonatal and later childhood Stroke and both ischemic and hemorrhagic Stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood Stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to Pediatric Stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood Stroke are discussed in each section. Conclusions- Here we provide updates on perinatal and childhood Stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic Stroke, and updates in regard to areas of childhood Stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field.

  • focal cerebral arteriopathy of childhood novel severity score and natural history
    Stroke, 2018
    Co-Authors: Heather J. Fullerton, Timothy J. Bernard, Neil R. Friedman, Nicholas V. Stence, Rebecca Ichord, Catherine Amlielefond, Mark T Mackay, Nancy K Hills, Bin Jiang, Mubeen F Rafay
    Abstract:

    Background and Purpose- Focal cerebral arteriopathy (FCA)-a common cause of arterial ischemic Stroke in previously healthy children-often progresses over days to weeks, increasing the risk of recurrent Stroke. We developed a novel severity scoring system designed to quantify FCA progression and correlate with clinical outcomes. Methods- The VIPS study (Vascular Effects of Infection in Pediatric Stroke) prospectively enrolled 355 children with arterial ischemic Stroke (2010-2014), including 41 with centrally confirmed FCA. Two neuroradiologists independently reviewed FCA cerebrovascular imaging, assigning a graded severity score of zero (no involvement) to 4 (occlusion) to individual arterial segments. The FCA severity score (FCASS) was the unweighted sum. In an iterative process, we modeled scores derived from different combinations of arterial segments to identify the model that optimized correlation with clinical outcome, simplicity, and reliability. Results- The optimal FCASS summed scores from 5 arterial segments: supraclinoid internal carotid artery, A1, A2, M1, and M2. The median (interquartile range) baseline FCASS was 4 (2-6). Of 33 children with follow-up imaging, the maximum FCASS (at any time point) was 7 (5-9). Twenty-four (73%) had FCA progression on follow-up with their maximum FCASS at a median of 8 (5-35.5) days postStroke; their median FCASS increase was 4 (2.5-6). FCASS did not correlate with recurrent arterial ischemic Stroke. Maximum (but not baseline) FCASS correlated with 1-year Pediatric Stroke outcome measures ( P=0.037). Conclusions- Our novel scoring system for FCA severity correlates with neurological outcomes in the VIPS cohort and provides a tool for FCA treatment trials under development.

  • Abstract TMP102: Predicting Recovery and Outcome After Pediatric Stroke
    Stroke, 2018
    Co-Authors: Ryan J. Felling, Timothy J. Bernard, Michael J. Rivkin, Mubeen F Rafay, Jessica L Carpenter, Nomazulu Dlamini, Sahar M A Hassanein, Lori C Jordan, Michael J Noetzel, Kevin A Shapiro
    Abstract:

    We aimed to characterize the timing of recovery and predictors of outcome following Pediatric Stroke, with the hypothesis that the recovery pattern after Stroke is influenced by age. While the immature brain is often presumed to have an increased capacity for neuroplasticity, there is little direct data examining how recovery differs in children of different ages. We reviewed data for children with arterial ischemic Stroke (AIS) who were enrolled in the International Pediatric Stroke Study, a prospective registry of children with Stroke. Inclusion criteria included a diagnosis of AIS and the availability of outcome at two years after the index Stroke event. A subset of these patients who had multiple assessments over time were used to study longitudinal patterns of recovery. We investigated demographic, clinical, and radiologic associations with both early outcome at discharge and long term outcome at two years using multinomial logistic regression. Categorical outcomes at each timepoint were defined by Pediatric Stroke Outcome Measure (PSOM). We studied longitudinal recovery using time-to-event (survival) analysis. 614 out of 4,294 patients met our inclusion criteria. 202 patients had perinatal AIS while 412 had childhood AIS. Perinatal AIS was associated with significant worsening between discharge and two years, as neurologic impairment became more apparent, but with better outcomes at both timepoints compared with childhood AIS (moderate/severe: 14% vs 49% at discharge, 47% vs 54% at 2 years). Predictors of severe deficits in univariate analyses included age at Stroke (perinatal vs. childhood), hemiparesis or decreased consciousness at presentation, anterior circulation, and large vessel involvement. In longitudinal analysis, improvement in PSOM occurred for a longer time after Stroke onset in younger children compared to older children. Although age has a strong influence on recovery after Pediatric Stroke, all children had the capacity to demonstrate recovery over extended periods of time. Understanding the timing and predictors of recovery will allow us to better target therapies to the appropriate windows of opportunity, thereby improving outcomes after Pediatric Stroke.

Lori C Jordan - One of the best experts on this subject based on the ideXlab platform.

  • Predicting Recovery and Outcome after Pediatric Stroke: Results from the International Pediatric Stroke Study.
    Annals of Neurology, 2020
    Co-Authors: Ryan J. Felling, Timothy J. Bernard, Michael J. Rivkin, Mubeen F Rafay, Jessica L Carpenter, Nomazulu Dlamini, Sahar M A Hassanein, Lori C Jordan, Michael J Noetzel, Kevin A Shapiro
    Abstract:

    OBJECTIVE To characterize predictors of recovery and outcome following Pediatric arterial ischemic Stroke, hypothesizing that age influences recovery after Stroke. METHODS We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic Stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change. RESULTS Our population consisted of 587 patients, including 174 with neonatal Stroke and 413 with childhood Stroke, with recurrent Stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p

  • predicting recovery and outcome after Pediatric Stroke results from the international Pediatric Stroke study
    Annals of Neurology, 2020
    Co-Authors: Ryan J. Felling, Timothy J. Bernard, Michael J. Rivkin, Mubeen F Rafay, Jessica L Carpenter, Nomazulu Dlamini, Sahar M A Hassanein, Lori C Jordan, Michael J Noetzel, Kevin A Shapiro
    Abstract:

    OBJECTIVE To characterize predictors of recovery and outcome following Pediatric arterial ischemic Stroke, hypothesizing that age influences recovery after Stroke. METHODS We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic Stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change. RESULTS Our population consisted of 587 patients, including 174 with neonatal Stroke and 413 with childhood Stroke, with recurrent Stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p < 0.05), underlying chronic disorder (OR = 2.23, p < 0.05), and involvement of both small and large vascular territories (OR = 2.84, p < 0.05). Recovery patterns differed, with emerging deficits more common in children <1 year of age (p < 0.05). INTERPRETATION Outcomes after Pediatric Stroke are generally favorable, but moderate to severe neurological impairments are still common. Age between 28 days and 1 year appears to be a particularly vulnerable period. Understanding the timing and predictors of recovery will allow us to better counsel families and target therapies to improve outcomes after Pediatric Stroke. ANN NEUROL 2020;87:840-852.

  • Building a Career as a Pediatric Stroke Neurologist
    Stroke, 2019
    Co-Authors: Heather J. Fullerton, Adam Kirton, Mark T Mackay, Lori C Jordan, Vijeya Ganesan, Maja Steinlin
    Abstract:

    Author(s): Fullerton, Heather J; Ganesan, Vijeya; Jordan, Lori C; Kirton, Adam; Mackay, Mark T; Steinlin, Maja

  • management of Stroke in neonates and children a scientific statement from the american heart association american Stroke association
    Stroke, 2019
    Co-Authors: Donna M Ferriero, Heather J. Fullerton, Timothy J. Bernard, Rebecca Ichord, Lori C Jordan, Gabrielle Deveber, Lori Billinghurst, Stephen R Daniels, Michael R Debaun, Patricia Massicotte
    Abstract:

    Purpose- Much has transpired since the last scientific statement on Pediatric Stroke was published 10 years ago. Although Stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and Stroke. Methods- Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results- Annualized Pediatric Stroke incidence rates, including both neonatal and later childhood Stroke and both ischemic and hemorrhagic Stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood Stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to Pediatric Stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood Stroke are discussed in each section. Conclusions- Here we provide updates on perinatal and childhood Stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic Stroke, and updates in regard to areas of childhood Stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field.

  • socioeconomic determinants of outcome after childhood arterial ischemic Stroke
    Neurology, 2018
    Co-Authors: Lori C Jordan, Heather J. Fullerton, Rebecca Ichord, Gabrielle Deveber, Nancy K Hills, Paola Pergami, Christine K Fox, Vips Investigators
    Abstract:

    Objective To determine whether lower socioeconomic status (SES) is associated with worse 1-year neurologic outcomes and reduced access to rehabilitation services in children with arterial ischemic Stroke (AIS). Methods From 2010 to 2014, the Vascular effects of Infection in Pediatric Stroke (VIPS) observational study prospectively enrolled and confirmed 355 children (age 29 days–18 years) with AIS at 37 international centers. SES markers measured via parental interview included annual household income (US dollars) at the time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure scores were categorized as 0 to 1, 1.5 to 3, 3.5 to 6, and 6.5 to 10. Univariate and multivariable ordinal logistic regression models examined potential predictors of outcome. Results At 12 ± 3 months after Stroke, 320 children had documented outcome measurements, including 15 who had died. In univariate analysis, very low income ( Conclusions In a large, multinational, prospective cohort of children with AIS, low income was associated with worse neurologic outcomes compared to higher income levels. This difference was not explained by Stroke type, neurologic comorbidities, or reported use of rehabilitation services. The root causes of this disparity are not clear and warrant further investigation.

Michael J. Rivkin - One of the best experts on this subject based on the ideXlab platform.

  • Predicting Recovery and Outcome after Pediatric Stroke: Results from the International Pediatric Stroke Study.
    Annals of Neurology, 2020
    Co-Authors: Ryan J. Felling, Timothy J. Bernard, Michael J. Rivkin, Mubeen F Rafay, Jessica L Carpenter, Nomazulu Dlamini, Sahar M A Hassanein, Lori C Jordan, Michael J Noetzel, Kevin A Shapiro
    Abstract:

    OBJECTIVE To characterize predictors of recovery and outcome following Pediatric arterial ischemic Stroke, hypothesizing that age influences recovery after Stroke. METHODS We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic Stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change. RESULTS Our population consisted of 587 patients, including 174 with neonatal Stroke and 413 with childhood Stroke, with recurrent Stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p

  • predicting recovery and outcome after Pediatric Stroke results from the international Pediatric Stroke study
    Annals of Neurology, 2020
    Co-Authors: Ryan J. Felling, Timothy J. Bernard, Michael J. Rivkin, Mubeen F Rafay, Jessica L Carpenter, Nomazulu Dlamini, Sahar M A Hassanein, Lori C Jordan, Michael J Noetzel, Kevin A Shapiro
    Abstract:

    OBJECTIVE To characterize predictors of recovery and outcome following Pediatric arterial ischemic Stroke, hypothesizing that age influences recovery after Stroke. METHODS We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic Stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change. RESULTS Our population consisted of 587 patients, including 174 with neonatal Stroke and 413 with childhood Stroke, with recurrent Stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p < 0.05), underlying chronic disorder (OR = 2.23, p < 0.05), and involvement of both small and large vascular territories (OR = 2.84, p < 0.05). Recovery patterns differed, with emerging deficits more common in children <1 year of age (p < 0.05). INTERPRETATION Outcomes after Pediatric Stroke are generally favorable, but moderate to severe neurological impairments are still common. Age between 28 days and 1 year appears to be a particularly vulnerable period. Understanding the timing and predictors of recovery will allow us to better counsel families and target therapies to improve outcomes after Pediatric Stroke. ANN NEUROL 2020;87:840-852.

  • prevalence of symptoms of anxiety depression and post traumatic stress disorder in parents and children following Pediatric Stroke
    Journal of Child Neurology, 2020
    Co-Authors: Michael J. Rivkin, Laura L Lehman, Kristin Maletsky, Jeanette Beaute, Kshitiz Rakesh, Kush Kapur, Christine Mrakotsky
    Abstract:

    Post-traumatic stress disorder (PTSD), anxiety, and depression are seen in parents and children following critical illness. Whether this exists in parents and children following Pediatric Stroke has not been thoroughly studied. We examined emotional outcomes in 54 mothers, 27 fathers, and 17 children with Stroke. Parents of children 0-18 years and children 7-18 years who were within 2 years of Stroke occurrence were asked to complete questionnaires to determine their emotional outcomes. Of participating mothers, 28% reported PTSD, 26% depression, and 4% anxiety; in fathers, 15% reported PTSD, 24% depression, and none reported anxiety. Further, children reported significant emotional difficulty, with 24% having depression, 14% anxiety, and 6% PTSD by self-report ratings. Maternal PTSD, anxiety and depression, and paternal anxiety were all negatively associated with the child's functional outcome. Clinically significant anxiety (based on clinical thresholds) was not found in fathers; however, continuous scores were still analyzed for association between subclinical anxiety and functional outcome, which revealed a statistically significant association between more reported symptoms and higher Recovery and Recurrence Questionnaire scores. Prevalence of PTSD and depression are greater in parents compared to the general population in this preliminary study.

  • survey of practice patterns and preparedness for endovascular therapy in acute Pediatric Stroke
    Childs Nervous System, 2019
    Co-Authors: Jenny L Wilson, Michael J. Rivkin, Catherine Amlielefond, Gabrielle Deveber, Todd A Abruzzo, Darren B Orbach, Paola Pergami
    Abstract:

    Endovascular therapy benefits selected adults with acute Stroke while data are lacking for children. The purpose of this study was to assess physician practice and institutional preparedness for endovascular therapy in Pediatric Stroke. A link to an anonymous online survey was sent to members of the International Pediatric Stroke Study (IPSS) group about physician experience with endovascular therapy, likelihood of treatment for provided clinical vignettes, and institutional readiness for the delivery of endovascular therapy to children. Thirty-one Pediatric physicians with a mean of 11 years (SD 7.1) of experience responded. All but two would consider endovascular therapy in a child, and 20 (64.5%) had recommended endovascular therapy for a child in the preceding year. Most (n = 19, 67.9%) did not commit to an age minimum for endovascular therapy. Sixteen (57.1%) would consider treatment up to 24 h after symptom onset with 19 (67.9%) respondents reporting that their practice changed after the 2018 American Heart Association guidelines extended the time window for endovascular therapy in adults. Seventeen (60.7%) preferred imaging that included perfusion in children presenting beyond 6 h. Nineteen (70.4%) had institutional endovascular therapy criteria. Physicians in larger Pediatric groups had more “likely to treat” responses on the clinical vignettes than physicians working in smaller groups (11.7 vs. 6.1, p < 0.05). Pediatric Stroke physicians are largely willing to consider endovascular therapy with most changing their practice according to adult guidelines, though experience and selection criteria varied. These findings may help to inform consensus guidelines and clinical trial development.

  • characteristics and outcome in children with craniectomy following acute ischemic Stroke in the international Pediatric Stroke study
    Journal of Child Neurology, 2019
    Co-Authors: Laura L Lehman, Michael M. Dowling, Ryan J. Felling, Gabrielle Deveber, Kristin P. Guilliams, Paola Pergami, Melissa Chung, Michael J. Rivkin
    Abstract:

    The outcome of children with acute ischemic Stroke treated with craniectomy has not been thoroughly examined. In adults, hemicraniectomy after middle cerebral artery territory Stroke and posterior decompression after posterior circulation Stroke has been shown to improve outcome. Pediatric cases of hemicraniectomy for middle cerebral artery Stroke and posterior decompression following posterior circulation Stroke suggest relatively good outcome. There are no published data in adults or children with craniectomy after cerebral sinovenous thrombosis. Our aim was to determine the outcome of children with acute ischemic Stroke treated with craniectomy in the International Pediatric Stroke Study (IPSS). We included children enrolled who had a craniectomy following Stroke presentation. Of 4294 patients in IPSS, 38 children (1%) were found to have craniectomy following an ischemic Stroke. Of 38 craniectomy cases, 29 had anterior circulation Strokes, 5 had posterior circulation Strokes, and 4 had cerebral sinovenous thromboses. The mortality rate was 8%. Overall, children who have craniectomies have significant neurologic deficits. Prospective studies are needed to examine long-term morbidity following craniectomy.