Health and development in the 12 months following arterial ischaemic stroke in children

© 2012 Dr. Anne Louise GordonBackground: The breadth of consequences of stroke in children is poorly understood, impacting the targeting of health resources and appropriate measurement of intervention outcomes. Clinical experience suggests children experience functionally disabling consequences following a stroke that change over time. There is limited understanding of the clinical course following diagnosis and factors that impact long-term functional outcome. Aim: This study aimed to: 1) Prospectively measure and describe neurological, language, cognitive and motor abilities of children from acute presentation to 12 months following diagnosis of arterial ischaemic stroke 2) Measure the children’s activity limitations in daily life activities, quality of life, and parent health at 6 and 12 months 3) Explore the relationship between brain capacity markers, cognitive capacity markers, age at injury and environmental factors over a 12 month period 4) Identify factors predictive of functional outcome at 12 months. Method: A prospective single-centre study was undertaken to evaluate the clinical course of 27 children following diagnosis of first arterial ischaemic stroke. The children were evaluated during the acute phase, and at 1, 3, 6 and 12 months following diagnosis across domains of health including neurological function, language, motor, cognitive, social-emotional, adaptive behaviours and quality of life. Family functioning and parent health was also measured and the concerns of the children and parents elicited. Outcomes were explored for the neonatal group (n=6) compared to the older children (aged > 30 days at diagnosis), and the cohort overall. Findings: Neonates had few neurological or detectable health consequences in the first 6 months following diagnosis, however motor impairments and limitations in functional daily abilities were evident by 12 months. In the older age group, a wider range of sequelae was evident. Motor impairments were the most prevalent consequence, and made the most rapid recovery in the first 6 months. Fine motor difficulties emerged over time. Social, behavioural and communication limitations were evident by 12 months. None of the children aged older than 30 days at diagnosis returned to their pre-morbid levels of functional daily ability by 12 months. The health-related quality of life of the older children was impacted, particularly psychosocial health. Parent health was impaired, and burden on the family was sustained through the first 12 months following diagnosis. Functional outcome at 12 months was predicted by the presence or absence of a speech deficit at the time of symptom onset, and one month fine motor or cognitive abilities. Socio-economic status also contributed to functional outcome. Conclusions: The consequences of stroke in children are diverse, can appear over the months following diagnosis, and may continue to emerge beyond the 12 month surveillance period of this study. Measures of impairment only detect a limited range of sequelae. Activity limitations, and participation and quality of life restrictions are prevalent. The impact of the stroke can also extend to the broader family. Health resources need to be targeted to long-term surveillance of this population, to address changing needs in daily life (including home, school and community activities) and parent and family health. Further prospective multi-centre studies of larger populations will enable prognostication of outcome, and the exploration of the individual and environmental mechanisms that contribute to variations in clinical course and outcome