Long-Term Mortality in Children With Ischemic Stroke: A Nationwide Register-Based Cohort Study

 But isn't all long term mortality 100%?

Long-Term Mortality in Children With Ischemic Stroke: A Nationwide Register-Based Cohort Study

Heléne E.K. Sundelin

,

Anna Walås

,

Jonas Söderling

,

Peter Bang

,

Jonas F. Ludvigsson

Originally published8 Dec 2021https://doi.org/10.1161/STROKEAHA.121.034797Stroke. 2021;0:STROKEAHA.121.034797

Abstract

Background and Purpose:

Ischemic stroke is a common cause of death in adults, however, mortality after pediatric ischemic stroke is not well explored. We investigate long-term and cause-specific mortality in children with ischemic stroke and their first-degree relatives.

Methods:

Through nationwide Swedish registers, we identified 1606 individuals <18 years old with ischemic stroke between 1969 and 2016 and their first-degree relatives (n=5714). Each individual with ischemic stroke was compared with 10 reference individuals (controls) matched for age, sex, and county of residence. Our main analysis examined 1327 children with ischemic stroke still alive 1 week after the event. First-degree relatives to children with ischemic stroke were compared with first-degree relatives to the reference individuals. Using a Cox proportional hazard regression model, the risk of overall and cause-specific mortality was computed in individuals with pediatric ischemic stroke and their first-degree relatives.

Results:

The mortality rate in the first 6 months was 40.1 (95% CI, 24.7–55.6) per 1000 person-years compared with 1.1/1000 in controls (95% CI, 0.3–1.9). The overall mortality risk was hazard ratio (HR)=10.8 (95% CI, 8.1–14.3) and remained elevated beyond 20 years (HR=3.9 [95% CI, 2.1–7.1]). Children with ischemic stroke were at increased risk of death from neurological diseases (HR=29.9 [95% CI, 12.7–70.3]), cardiovascular diseases (HR=6.2 [95% CI, 1.8–22.2]), cancers (HR=6.5 [95% CI, 2.6–15.9]) and endocrine, nutritional and metabolic diseases (HR=49.2 [95% CI, 5.7–420.8]). First-degree relatives to children with ischemic stroke had an increased mortality risk (HR=1.21 [95% CI, 1.05–1.39]), with the highest risk among siblings (HR=1.52 [95% CI, 1.09–2.11]) and relatives to individuals with ischemic stroke >28 days of age (HR=1.23 [95% CI, 1.06–1.42]) compared with the relatives of the controls.

Conclusions:

Long-term mortality increased after pediatric ischemic stroke, even 20 years later, with neurological diseases as the most frequent cause of death.

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Management of Spasticity After Traumatic Brain Injury in Children

The word management, not cure or results, already tells me this is useless.  No one wants a chronic condition managed, they want it cured.

Management of Spasticity After Traumatic Brain Injury in Children

Johannes M. N. Enslin^1,2*, Ursula K. Rohlwink^1,2,3 and Anthony Figaji^1,2

• ¹Paediatric Neurosurgery Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
• ²Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
• ³Neuroscience Institute, University of Cape Town, Cape Town, South Africa

Traumatic brain injury is a common cause of disability worldwide. In fact, trauma is the second most common cause of death and disability, still today. Traumatic brain injury affects nearly 475 000 children in the United States alone. Globally it is estimated that nearly 2 million people are affected by traumatic brain injuries every year. The mechanism of injury differs between countries in the developing world, where low velocity injuries and interpersonal violence dominates, and high-income countries where high velocity injuries are more common. Traumatic brain injury is not only associated with acute problems, but patients can suffer from longstanding consequences such as seizures, spasticity, cognitive and social issues, often long after the acute injury has resolved. Spasticity is common after traumatic brain injury in children and up to 38% of patients may develop spasticity in the first 12 months after cerebral injury from stroke or trauma. Management of spasticity in children after traumatic brain injury is often overlooked as there are more pressing issues to attend to in the early phase after injury. By the time the spasticity becomes a priority, often it is too late to make meaningful improvements without reverting to major corrective surgical techniques. There is also very little written on the topic of spasticity management after traumatic brain injury, especially in children. Most of the information we have is derived from stroke research. The focus of management strategies are largely medication use, physical therapy, and other physical rehabilitative strategies, with surgical management techniques used for long-term refractory cases only. With this manuscript, the authors aim to review our current understanding of the pathophysiology and management options, as well as prevention, of spasticity after traumatic brain injury in children.

How Well Does Stroke Thrombectomy Work for Children?

Since they don't tell you how many 100% recovered I can only assume it was a complete failure in that regard. But their tyranny of low expectations was so fucking low they declared success anyway.  They all need to be shot. 

How Well Does Stroke Thrombectomy Work for Children?

Multicenter study suggests most recover with little disability

• by Crystal Phend, Senior Associate Editor, MedPage Today October 14, 2019

Stent retrievers and other endovascular thrombectomy treatments appeared as safe(but effective to 100% recovery?) for selected children as seen in adult trials, and also had good neurologic outcomes, in the Save ChildS Study.
Among 73 children treated at 27 centers in the U.S. and Europe, the most feared complication -- symptomatic intracerebral hemorrhage -- occurred in only one, for a 1.37% rate that was favorable compared with the 2.79% rate in the HERMES meta-analysis of adult trials.
No vascular complications, such as dissections or vessel rupture, were reported by Peter Sporns, MD, MHBA, of Universitätsklinikum Muenster in Germany, and colleagues in JAMA Neurology.
The only periprocedural complication was transient vasospasm on angiography in four patients (5%) that resolved without clinical sequelae. Malignant infarction followed by decompressive hemicraniectomy occurred in three children (4%). One patient with preexisting congenital heart disease died of cardiac arrest after complete recanalization.
"This study may support clinicians' practice of off-label thrombectomy in childhood stroke in the absence of high-level evidence," the researchers concluded.
Neurologic improvement also "showed a similar pattern as observed in the adult trials," as median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score improved from 14.0 at admission to 4.0 at day 7.
Median modified Rankin scale (mRS) score was 1.0 on the 6-point scale at both 6 and 24 months, with 80% having a favorable neurologic outcome (mRS ≤2) at discharge and more than 85% at the same point by 180 days.
None of the seven trials in the adult-trial meta-analysis reached much beyond 70% at 90 days on that measure.
However, an accompanying editorial expressed deep reservations about how much could be made of the findings, given the methods.
First, 24-month neurologic outcome data were missing for more than one-third of the children, "introducing the possibility of selection bias," wrote Christine Fox, MD, of the University of California San Francisco, and Nomazulu Dlamini, MBBS, PhD, of the Hospital for Sick Children in Toronto.
"Data for earlier outcomes were more complete, but because deficits may emerge over time in children, early outcomes may not provide the full picture," they wrote. "Cognitive and language deficits may initially go unrecognized in a toddler but become apparent as skills required for success in school grow increasingly complex."
And using historical data from the meta-analysis for comparison "has pitfalls," they added. "Given differences in the interpretation of outcome instruments and timing of outcome measures in the Save ChildS study compared with the HERMES trials, comparisons between these studies are of questionable value."
Clinical trials are unlikely to be done to support the guidelines suggesting mechanical thrombectomy with stent retrievers as reasonable to consider for some patients <18 years with large-vessel occlusion, Sporns' group noted.
The one trial that had started had to be abandoned for lack of recruitment.
Sporns' study included all patients ages ≤18 years diagnosed with arterial ischemic stroke who underwent endovascular recanalization from 2000 through 2018 at participating centers. Most treatment was with clot retrievers (82%), while distal thromboaspiration was used in 10%, along with a smattering of other tools. All patients immediately went to the pediatric ICU after endovascular treatment.
The researchers cautioned that, although all types of stroke sources were included, only seven patients had focal or bilateral cerebral arteriopathy. "Thus, an a priori selection bias of thrombectomy against children with potential inflammatory vasculopathy may be inherent to a seemingly low overall hemorrhagic risk," they wrote.
"Vascular fragility and risk of hemorrhage need to be considered and weighted carefully against a potential benefit of a recanalization treatment in this specific patient population," they noted. "Underlying abnormalities are often unknown at the time of admission; therefore, the emergency decision on whether to perform thrombectomy frequently has to be made without detailed knowledge about the cause of the stroke."

Sporns disclosed no relevant relationships with industry. Co-authors disclosed multiple relevant relationships with industry, including thrombectomy device makers, and holding relevant patents.
Fox and Dlamini disclosed no relevant relationships with industry.

• Primary Source

  JAMA Neurology

  Source Reference: Sporns PB, et al "Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study" JAMA Neurol 2019; doi: 10.1001/jamaneurol.2019.3403.

• Secondary Source

  JAMA Neurology

  Source Reference: Fox C and Dlamini N "Endovascular Therapy for Childhood Stroke -- Working Together to Reach Prime Time" JAMA Neuro 2019; doi: 10.1001/jamaneurol.2019.3412.

Stroke in Childhood: Clinical guideline for diagnosis, management and rehabilitation (2017) | RCPCH

I really dislike these types of guidelines when all they talk about is 'care'. Not how to get them 100% recovered. Survivors don't care about 'care', they want recovery.  GET THEM THERE!
Stroke in Childhood: Clinical guideline for diagnosis, management and rehabilitation (2017) | RCPCH

Stroke in Childhood 2017 is a nationally developed evidence-based clinical guideline for all UK paediatricians and healthcare professionals involved in the regulation or practice of the care of children and young people who have had or are suspected of having a stroke.

Join the conversation on Twitter at #childhealthmatters, #stroke, #makemaypurple to improve child health and stroke awareness.

Quick links:

Full clinical guideline
Guideline summary
Key recommendations
Parent/carer guideline
Additional resources

About

The updated Stroke in Childhood evidence-based clinical and parent guidelines were published in May 2017.
Funded by the Stroke Association, the clinical guideline was prepared by the Royal College of Paediatric and Child Health’s (RCPCH) multi-professional Stroke in Childhood Guideline Development Group (GDG), chaired by Dr Vijeya Ganesan. The GDG was represented by 27 stakeholder organisations and included lay representation from three parents of affected children and young people.
The clinical guideline is accompanied by a parent guideline, which aims to ensure that families understand what a stroke is, why they occur, and how children and young people affected by stroke should be treated and cared for.
Watch Stroke in Childhood: My Story, below, where a parent from the Stroke in Childhood Guideline Development Group talks of her experiences.


 

Background

The first clinical guideline on stroke in childhood was published by the Royal College of Physicians (RCP) in 2004. These guidelines may no longer reflect the best and most up-to-date clinical practice, and as such required urgent updating to ensure utilisation of current evidence.
This 2017 iteration of the clinical guideline delivers an update and scope extension, and provides guidance on the identification, diagnosis, management and rehabilitation of children and young people (aged 29 days to 18 years at time of presentation) with arterial ischaemic stroke (AIS) and haemorrhagic stroke (HS).

Full clinical guideline 

This clinical guideline is the most comprehensive and up-to-date guidance on how stroke care should be provided, covering the whole pathway from identification, diagnosis and management of children and young people with AIS and HS until their transition to adult care.
The 2017 iteration is intended for use by all UK paediatricians and other healthcare professionals involved in the regulation or practice of the care of children and young people who have had or are suspected of having a stroke, as well as non-healthcare professionals involved with educational/social services. While sections may also be relevant to education and social care professionals, it is intended to inform clinical decision making.
RCPCH notes:
On 01.06.2017 an amendment was made to the recommendations under the acute diagnosis (clinical presentation) section on page 24 of the full clinical guideline. The third recommendation relating to urgent brain imaging was revised to read 'Reduced level of consciousness (age-appropriate Glasgow Coma Scale (GCS) less than 12 or AVPU (‘Alert, Voice, Pain, Unresponsive’) less than V) at presentation'.
Full clinical guideline (PDF, 197 pages, 15MB)
Appendices (PDF, 357 pages, 27MB)

Guidelines summary

Working with the Guidelines Team this summary provides a concise overview for GPs on the management of stroke in childhood.
Guidelines summary (weblink)

Key recommendations

The concise key recommendations guide contains 83 key recommendations identified by the RCPCH Stroke in Childhood GDG, which, if followed, will enhance the quality of stroke care in children and young people.
These recommendations have been extracted from the clinical guideline, which contains over 250 individual recommendations covering the diagnosis, management and rehabilitation of stroke in children and young people.
It is recommended that the concise key recommendations guide should not be read in isolation, and individuals should always consider the guideline in full.
Key recommendations (PDF, 9 pages, 114KB)
Full recommendations (PDF, 25 pages, 220KB)

Parent/carer guideline 

This lay version of the guideline provides information to parents, carers, and families of children and young people affected by stroke. The information is based on detailed clinical guidelines produced for healthcare professionals who are involved in the care of children and young people affected by stroke.
The information is designed to help the reader understand what a stroke is, why strokes occur, and how children and young people affected by stroke should be treated and cared for. It describes the usual journey from diagnosis to rehabilitation that a child or young person will follow after a stroke and will outline what you should expect at each stage of treatment and rehabilitation.
Parent/carer guideline (PDF, 30 pages, 4.2MB)
Welsh version (PDF, 31 pages, 4.1MB)

Additional resources

Posters

Want to raise awareness that stroke happens to children and young people?
Poster 1 (PDF, 1 page, 1.6MB)
Poster 2 (PDF, 1 page, 1MB)
Poster 3 (PDF, 1 page, 2.3MB)

Contact

If you have any questions in relation to the development of this guideline, please contact us on clinical.standards@rcpch.ac.uk. For media queries, please contact us on press.office@rcpch.ac.uk and see the press release.

Last published on 20 September 2017

Saliva Test May Help TBI Diagnosis in Kids

This would seem to be useful to tell if they are still problems needing resolution post-stroke.  But nothing will be done with this.
https://www.medpagetoday.com/pediatrics/generalpediatrics/69414?

Specific microRNAs linked to prolonged concussion symptoms

• by Molly Walker, Staff Writer, MedPage Today November 20, 2017

Action Points

• Changes in the composition of children's saliva, which have been found following traumatic brain injury, helped to identify patients with prolonged symptoms of concussion.
• Note that concentrations of five specific microRNAs identified participants with prolonged concussion symptoms with more than 85% accuracy -- more accurate than using symptoms 4 weeks after injury or parent report.

Changes in the composition of children's saliva, which have been found following traumatic brain injury (TBI), helped to identify patients with prolonged symptoms of concussion, a small study found.
Specifically, concentrations of five specific microRNAs identified participants with prolonged concussion symptoms with more than 85% accuracy -- more accurate than using symptoms 4 weeks after injury or parent report, reported Jeremiah J. Johnson, of Pennsylvania State University in Hershey, and colleagues.
Notably, three of these microRNAs were linked with specific concussion symptoms -- memory difficulty, headaches, and fatigue, the authors wrote in JAMA Pediatrics.
They pointed out that more than 80% of concussions in children may result from mild traumatic brain injuries. One-third of these children experience prolonged concussion symptoms, but there is no objective tool to identify children at risk for these symptoms.
While clinical risk scores have a "modest ability" to determine risk of prolonged concussion symptoms, the authors cited feasibility problems in administering "multiple age-specific questionnaires" during a clinical encounter and suggested the potential use of biomarkers.
Johnson's group added that microRNAs were examined in prior studies of individuals with traumatic brain injury, but none of these studies focused solely on children.
An accompanying editorial by William P. Meehan III, MD, and Rebekah Mannix, MD, both of Boston Children's Hospital, characterized these findings as "novel" and "clinically relevant." They wrote that no single biomarker, or biomarker panel, has been an objective measure for either diagnosing or monitoring recovery from concussion, or determining who is at risk of prolonged recovery. They also noted that the ease and speed of collecting saliva samples is ideal for the pediatric patient population, as it can be used in diverse care settings.
"If validated in larger, multisite clinical trials, using this salivary microRNA panel to diagnose and manage concussions could be a major advancement to the field," Meehan and Mannix wrote. "Salivary microRNAs could also offer insights into the underlying biological mechanisms of injuries, potentially identifying specific targets to modify disease."
Johnson's group observed 52 patients, ages 7 to 21 years, who presented to evaluation of concussion within 2 weeks of initial head injury at a local medical center, based on prior research indicating that the symptoms and biomarkers return to baseline within 2 weeks of concussion, they explained.
Prolonged concussion symptoms were defined via a Sports Concussion Assessment Tool symptom score of ≥5, or a parent report 4 weeks after injury.
Participants had a mean age of 14 years, 42% were girls, and nearly all were white. There were 22 with acute concussion symptoms and 30 with prolonged concussion symptoms. Most participants were enrolled within 1 week of their concussion, the authors said, and about 40% had a concussion due to sports participation. Moreover, nearly half experienced a previous concussion. Also, nearly half of patients reported amnesia at the time of injury, while a quarter reported loss of consciousness.
Saliva was collected in patients in both groups and 437 microRNAs were identified in at least 22 of 30 samples. Fifteen of these microRNAs were associated with prolonged concussion symptoms. Of these, five identified patients with prolonged symptoms (area under the curve 0.856, 95% CI 0.822-0.890). The authors noted that "misclassified participants" had higher rates of sports participation and saliva collected sooner following injury, but "neither of these factors displayed statistical significance."
In fact, concentrations of five microRNAs exceeded the accuracy of symptom burden on child (AUC 0.649, 95% CI 0.388-0.887) and parent (AUC 0.562, 95% CI 0.219-0.734) for identifying patients with prolonged concussion symptoms.
The authors noted that validation of these microRNAs will need to be confirmed in an independent, larger cohort. They also said that while the study uses a validated tool to measure concussion symptoms, it does not provide functional measure, such as balance or processing speed.

The study was supported by the Children's Miracle Network group and Quadrant Biosciences.
Johnson disclosed no relevant relationships with industry. One co-author disclosed being a co-inventor of preliminary patents for microRNA biomarkers in disorders of the central nervous system, and a relevant relationship with Quadrant Biosciences.
Meehan and Mannix disclosed no relevant relationships with industry.

• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

• Primary Source

  JAMA Pedatrics

  Source Reference: Johnson JJ, et al "Association of salivary microRNA changes with prolonged concussion symptoms" JAMA Pediatr 2017; DOI:10.1001/jamapediatrics.2017.3884.

• Secondary Source

  JAMA Pediatrics

  Source Reference: Meehan III WP and Mannix R "Promise of salivary microRNA for assessing concussion" JAMA Pediatr 2017; DOI:10.1001/jamapediatrics.2017.3924.

Measuring upper limb function in children with hemiparesis with 3D inertial sensors

Every stroke survivor should have this to get objective measurements of stroke disability. With that we could assign stroke protocols with efficacy ratings to fix those disabilities. 

Measuring upper limb function in children with hemiparesis with 3D inertial sensors

• Authors
• Authors and affiliations

• Christopher J. NewmanEmail author
• Roselyn Bruchez
• Sylvie Roches
• Marine Jequier Gygax
• Cyntia Duc
• Farzin Dadashi
• Fabien Massé
• Kamiar Aminian

• Christopher J. Newman
  • 1
  Email author
• Roselyn Bruchez
  • 1
• Sylvie Roches
  • 1
• Marine Jequier Gygax
  • 1
• Cyntia Duc
  • 2
• Farzin Dadashi
  • 2
• Fabien Massé
  • 2
• Kamiar Aminian
  • 2

1. 1.Paediatric Neurology and Neurorehabilitation UnitLausanne University Hospital, Hôpital Nestlé–CHUVLausanneSwitzerland
2. 2.Laboratory of Movement Analysis and MeasurementEcole Polytechnique Fédérale de LausanneLausanneSwitzerland

Original Paper

First Online:

25 August 2017

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• 2 Downloads

Abstract

Purpose

Upper limb assessments in children with hemiparesis rely on clinical measurements, which despite standardization are prone to error. Recently, 3D movement analysis using optoelectronic setups has been used to measure upper limb movement, but generalization is hindered by time and cost. Body worn inertial sensors may provide a simple, cost-effective alternative.

Methods

We instrumented a subset of 30 participants in a mirror therapy clinical trial at baseline, post-treatment, and follow-up clinical assessments, with wireless inertial sensors positioned on the arms and trunk to monitor motion during reaching tasks.

Results

Inertial sensor measurements distinguished paretic and non-paretic limbs with significant differences (P < 0.01) in movement duration, power, range of angular velocity, elevation, and smoothness (normalized jerk index and spectral arc length). Inertial sensor measurements correlated with functional clinical tests (Melbourne Assessment 2); movement duration and complexity (Higuchi fractal dimension) showed moderate to strong negative correlations with clinical measures of amplitude, accuracy, and fluency.

Conclusion

Inertial sensor measurements reliably identify paresis and correlate with clinical measurements; they can therefore provide a complementary dimension of assessment in clinical practice and during clinical trials aimed at improving upper limb function.

Hand Robotic Therapy in Children with Hemiparesis

Demand your doctor followup and get this technology to help your hand recovery.  Reporting medical malpractice might get your stroke hospitals attention.
http://dl.umsu.ac.ir/handle/Hannan/155840#sthash.mogLN85N.dpbs

Please use this identifier to cite or link to this item: http://dl.umsu.ac.ir/handle/Hannan/155840

Title:	Hand Robotic Therapy in Children with Hemiparesis
Authors:	Bishop, Lauri Gordon, Andrew M. Kim, Heakyung
subject:	soluble urokinase plasminogen activator
Year:	2017
Publisher:
Abstract:	Objective: The aim of this study was to understand the impact of training with a hand robotic device on hand paresis and function in a population of children with hemiparesis.; Methods: Twelve children with hemiparesis (mean age, 9 [SD, 3.64] years) completed participation in this prospective, experimental, pilot study. Participants underwent clinical assessments at baseline and again 6 weeks later with instructions to not initiate new therapies. After these assessments, participants received 6 weeks of training with a hand robotic device, consisting of 1-hour sessions, 3 times weekly. Assessments were repeated on completion of training.; Results: Results showed significant improvements after training on the Assisting Hand Assessment (mean difference, 2.0 Assisting Hand Assessment units; P = 0.011) and on the upper-extremity component of the Fugl-Meyer scale (raw score mean difference, 4.334; P = 0.001). No significant improvements between pretest and posttest were noted on the Jebsen-Taylor Test of Hand Function, the Quality of Upper Extremity Skills Test, or the Pediatric Evaluation of Disability Inventory after intervention. Total active mobility of digits and grip strength also failed to demonstrate significant changes after training.; Interpretation: Participants tolerated training with the hand robotic device, and significant improvements in bimanual hand use, as well as impairment-based scales, were noted. Improvements were carried over into bimanual skills during play.; To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Understand key components of neuroplasticity; (2) Discuss the benefits of robotic therapy in the recovery of hand function in pediatric patients with hemiplegia; and (3) Appropriately incorporate robotic therapy into the treatment plan of pediatric patients with hemiplegia.; Level: Advanced ACCREDITATION:: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.;
URI:	http://dl.umsu.ac.ir/handle/Hannan/155840

The Mirror Illusion Increases Motor Cortex Excitability in Children With and Without Hemiparesis

Does your doctor have enough brains  and reading ability to have this as a stroke protocol for your recovery? The research has only been out there for years.
Ramachandran VS, Altschuler EL. The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain. 2009;132:1693-1710. , Google Scholar
http://journals.sagepub.com/doi/abs/10.1177/1545968316680483

Show all authors

Sebastian Grunt, MD, PhD, Christopher J. Newman, MD, Stefanie Saxer, MSc, Maja Steinlin, MD, Christian Weisstanner, MD, Alain Kaelin-Lang, MD, PhD

First Published December 13, 2016 research-article

 

Abstract

Background. Mirror therapy provides a visual illusion of a normal moving limb by using the mirror reflection of the unaffected arm instead of viewing the paretic limb and is used in rehabilitation to improve hand function. Little is known about the mechanism underlying its effect in children with hemiparesis.  
Objective. To investigate the effect of the mirror illusion (MI) on the excitability of the primary motor cortex (M1) in children and adolescents.  
Methods. Twelve patients with hemiparesis (10-20 years) and 8 typically developing subjects (8-17 years) participated. Corticospinal reorganization was classified as contralateral (projection from contralateral hemisphere to affected hand) or ipsilateral (projection from ipsilateral hemisphere to affected hand). M1 excitability of the hemisphere projecting to the affected (nondominant in typically developing subjects) hand was obtained during 2 different conditions using single-pulse transcranial magnetic stimulation (TMS). Each condition (without/with mirror) consisted of a unimanual and a bimanual task. Motor-evoked potentials (MEPs) were recorded from the abductor pollicis brevis and flexor digitorum superficialis muscles.
Results. MEP amplitudes were significantly increased during the mirror condition (P = .005) in typically developing subjects and in patients with contralateral reorganization. No significant effect of MI was found in subjects with ipsilateral reorganization. MI increased M1 excitability during active movements only. This increase was not correlated to hand function.  
Conclusion. MI increases the excitability of M1 in hemiparetic patients with contralateral corticospinal organization and in typically developing subjects. This finding provides neurophysiological evidence supporting the application of mirror therapy in selected children and adolescents with hemiparesis.

Cerebral perfusion and its relationship to post-concussion syndrome in mild traumatic brain injury: a prospective controlled cohort study

We will never know if this could help survivors since there is no followup to any research that might help survivors. I lay that failure at the feet of our fucking failures of stroke associations. 

Cerebral perfusion and its relationship to post-concussion syndrome in mild traumatic brain injury: a prospective controlled cohort study

 

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Platform Presentations

CACN Chair’s Select Abstracts

A.03 Cerebral perfusion and its relationship to post-concussion syndrome in mild traumatic brain injury: a prospective controlled cohort study

KM Barlow^a1, LD Marcil^a1, D Dewey^a1, H Carlson^a1, FP MacMaster^a1, BL Brooks^a1 and RM Lebel^a1

^a1 (Calgary)

Abstract

Background: Persistent post-concussive symptoms (PCS) have been linked to increased cortical network activation and decreased cerebrovascular reactivity. Decreased cerebral perfusion could help explain PCS and may be a biomarker to track recovery.  
Methods: Children (ages 8 to 18 years) symptomatic with PCS at one month post-injury were studied. Children who recovered following a mTBI (asymptomatic group) and healthy children acted as controls. Pseudocontinuous arterial spin labeling MRI was used to quantify cerebral blood flow (CBF). All subjects were imaged at approximately 40 days post-injury. Symptomatic group underwent repeat neuroimaging 4-5 weeks later.  
Results: Seventy-two participants (14.1 years; 95% CIs: 13.5, 14.8) underwent neuroimaging at 40 days post-injury. Global CBF was significantly higher in the symptomatic group compared to healthy controls, and lower in the asymptomatic group (F(2,57) 9.734 p<0.001). Symptomatic children had increased CBF in the frontal and occipital regions, and asymptomatic children had decreased CBF in the temporal regions compared to healthy controls. CBF decreased in symptomatic children over time. CBF was a predictor of cognition (R²=0.235;p=0.001).
Conclusions: Cerebral perfusion is altered in children with mTBI and is associated with recovery trajectory. Asymptomatic children had decreased CBF suggesting cerebral recovery is ongoing. Further longitudinal studies are required to determine if these perfusion patterns continue to change over time.

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Children's daily exposure to polychlorinated biphenyls from dietary supplements containing fish oils

You have zero idea what is in the supplements you take. All because of the stupidity of our Congress passing the Dietary Supplement Health and Education Act of 1994 (DSHEA): (DSHEA) defined dietary supplements as a category of food, which put them under different regulations than drugs. They are considered safe until proven otherwise. Caveat Emptor.
http://www.ncbi.nlm.nih.gov/pubmed/23281830

Ashley JT¹, Ward JS, Anderson CS, Schafer MW, Zaoudeh L, Horwitz RJ, Velinsky DJ.

Author information

Abstract

In children, omega-3 polyunsaturated fatty acids (PUFAs) may elicit a suite of health benefits including enhancement of cognitive development. Subsequently, dietary supplements containing omega-3 PUFAs have become increasingly popular. Often, the largest source of beneficial PUFAs in these supplements is fish oil, which may contain significant levels of contaminants such as polychlorinated biphenyls (PCBs). The objectives of this study were to evaluate congener-specific PCB concentrations in 13 over-the-counter children's dietary supplements containing fish oils/powders and assess potential PCB exposures through ingestion of these products on a daily basis. Every supplement analysed contained PCBs, with a mean concentration of 9 ± 8 ng PCBs/g supplement. When following serving size suggestions, mean daily exposure values ranged from 2.5 to 50.3 ng PCBs/day. Daily exposures for children's supplements were significantly lower than those previously reported for adult supplements and may be explained, in part, by the variability in the amount of fish oil (and PUFA content) in a serving size. Based on this study, factors such as fish oil purification methods (e.g., molecular distillation) and the trophic level of the fish species used to make the fish oil cannot be used as indicators of PCB levels within children's supplements. Fish supplements may decrease or increase daily PCB exposure compared with ingestion of fresh fish. However, eating fish high in omega-3 PUFAs and low in PCBs may reduce PCB exposure compared with daily supplementation with fish oils for some products studied.

PMID:

23281830

[PubMed - indexed for MEDLINE]

Mirror therapy in children with hemiparesis: a randomized observer-blinded trial

How many more research articles repeating the same things on this subject need to be written before our stroke leaderships steps up and declares that there already is a written protocol on this and to stop writing on this. Well never, since we have NO stroke leadership and NO stroke rehabilitation protocols. You are fucking screwed and what stroke leadership there is doesn't care.
Mirror training has been considered useful since at least 1999. I've written 29 posts on mirror therapy since 2012. But since nobody is listening to me, nothing has been done about writing a fucking simple stroke protocol on this. Do not do this on your own, way too dangerous.
http://onlinelibrary.wiley.com/doi/10.1111/dmcn.13117/abstract;jsessionid=4A0AFD868FACC0761722EA16D70FBA5A.f04t03?userIsAuthenticated=false&deniedAccessCustomisedMessage=

1. Roselyn Bruchez^1,†,
2. Marine Jequier Gygax^1,†,
3. Sylvie Roches¹,
4. Joel Fluss²,
5. David Jacquier¹,
6. Pierluigi Ballabeni³,
7. Sebastian Grunt⁴ and
8. Christopher J Newman^1,*

Article first published online: 5 APR 2016

DOI: 10.1111/dmcn.13117

© 2016 Mac Keith Press

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Developmental Medicine & Child Neurology

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Aim

To determine the efficacy of mirror therapy in children with hemiparesis.

Method

The design was an observer-blinded parallel-group randomized controlled trial (International Standard Randomised Controlled Trial Number 48748291). Randomization was computer-generated, 1:1 allocation to mirror therapy or comparison groups. The settings were home-based intervention and tertiary centre assessments. Participants were 90 children with hemiparesis aged 7 to 17 years. Intervention was 15 minutes per day of simultaneous arm training, 5 days a week, for 5 weeks. The mirror therapy group used a mirror; those in the comparison group looked at their paretic limb. Assessments comprised measures of upper limb strength, function (Melbourne Assessment 2), daily performance (ABILHAND-Kids), and sensory function at weeks 0 (T₀), 5 (T₁), and 10 (T₂).

Results

There were no significant differences in outcomes and their progression over time between the mirror therapy and comparison groups. Post-hoc intention-to-treat analyses showed significant improvements in both groups for grasp strength (T₀−T₁+12.6%), pinch strength (T₀−T₂+9.1%), upper limb function in terms of accuracy (T₀−T₂+2.7%) and fluency (T₀−T₂+5.0%), as well as daily performance (T₀−T₂+16.6%). Per protocol analyses showed additional improvements in dexterity (T₀−T₂+4.0%).

Interpretation

The use of the mirror illusion during therapy had no significant effect on treatment outcomes. However, 5 weeks of daily simultaneous arm training significantly improved paretic upper limb strength, function, and daily use. These two sentences contradict each other, how did they separate the results from the separate therapies?

Robotic exoskeleton maps sense-deficits in young stroke patients

No idea why this couldn't be used in adults. My proprioception is not very good.
http://www.cbc.ca/news/canada/calgary/robotic-sense-position-uofc-study-strokes-children-1.3520197?cmp=rss

Researchers at the University of Calgary are using robotics technology to try to come up with more effective treatments for children who have had strokes.
The robotic device measures a patient's position sense — what doctors call proprioception — the unconscious perception of where the body is while in motion or at rest.

The KINARM supports a patient's arms with its exoskeleton while it measures their movement as they play video games or do other tasks. (CBC)

"Someone whose position sense has been affected might have difficulty knowing where their hand or arm is in space, adding to their difficulty in using their affected, weaker limb," said one of the study's senior researchers, Dr. Kirton of the Cumming School of Medicine's departments of pediatrics and clinical neurosciences.
"We can try to make a hand stronger but, if your brain doesn't know where the hand is, this may not translate into meaningful function in daily life."
PhD candidate Andrea Kuczynski is doing ongoing research using the KINARM (Kinesiological Instrument for Normal and Altered Reaching Movements) robotic device.
During the test the children sit in the KINARM machine with their arms supported by its exoskeleton, which measured movement as they played video games and did other tasks. All the children also had MRIs, which gave researchers a detailed picture of their brain structures.

KINARM could be rehabilitation tool 

"So basically they slide me in there, position my arm, so it like maps out, so they can see it on the screen, and like how I move," said Max Challoner, a 12-year-old participant in the study.
He had a stroke shortly after he was born that left him with mild physical impairments on his right side.
Years later, testing showed that Max might have a sensory processing disorder.
But the KINARM testing has shown Max's right side moves nearly as well as his left. That's a relief for his mother, Wendy Saunders.
"That's something that we don't need to worry about," she said. "Just knowing that takes away a lot of the other anxieties we have about his future."
Max says he was just happy to take part in the study. "It feels nice actually, helping people in such a way that it could potentially help them learn how they function," he said.
Kuczynski tested 40 children who had perinatal strokes and compared the results to a healthy control group.
Perinatal stroke affects about 1,000 children in Alberta. The perinatal period lasts from the 20th week of gestation to shortly after birth.
Different types of perinatal strokes cause different brain injuries. Cerebral palsy is a common secondary outcome that affects muscle movement and motor skills.
"In the future, the KINARM could be used as a tool for rehabilitation. Once we have an understanding of how an individual's position sense has been affected, we can begin to focus and personalize rehabilitation," Kuczynski said.
The study was published in a recent edition of Neurorehabilitation and Neural Repair.

Colds, Flu May Temporarily Increase Stroke Risk in Kids

Not sure what you could do about this anyway.
http://dgnews.docguide.com/colds-flu-may-temporarily-increase-stroke-risk-kids?
Colds, the flu, and other minor infections may temporarily increase stroke risk in children, according to a study published in the September 30, 2015, online issue of the journal Neurology.
The study also found routine childhood vaccines may decrease the risk of stroke.
“Parents should be reassured that while the risk was increased, the overall risk of stroke among children is still extremely low,” said José Biller, MD, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois. “It is possible that changes in the body as a result of these infections, such as inflammation and dehydration, could tip the balance in a child who is already at a higher risk for stroke. Parents should not be alarmed if their child has a cold that it will lead to a stroke.”
For the study, researchers reviewed the medical charts and conducted parent interviews of 355 children aged younger than 18 years diagnosed with a stroke and 354 children of similar age who never had a stroke. The researchers looked at whether the children had been exposed to infection and also their vaccine history.
Of the participants, 18% of the children with stroke had an infection the week before the stroke occurred and 3% of the children who did not have a stroke had an infection the week before the interview with researchers. The children with a stroke were 6 times more likely to have an infection in the previous week than those who did not have a stroke.
The researchers found that the risk of stroke was increased only for infections in the prior week, indicating that the effect of infection on stroke risk is short-lived. Infections that occurred a month or 6 months prior were not associated with an increased risk.
Children who were poorly vaccinated were at a higher risk of stroke than those who had most or all of their routine vaccinations. Children who had received some, few, or none of their routine vaccinations were 7 times more likely to have a stroke than those who received most or all of their vaccines. Eight percent of the children with strokes were poorly vaccinated, compared with 1% of those who did not have strokes.
“If our results hold up in further studies, controlling infections like colds and flu through hand-washing and vaccines may be a strategy for preventing stroke in children,” said co-author Heather J. Fullerton, MD, University of California San Francisco’s Benioff Children’s Hospital, San Francisco, California.
She noted that the study expands on an earlier study by her group with similar findings. The current study has a larger sample size, broader geographic representation, prospective enrolment, and central review of brain imaging to confirm the stroke cases.
SOURCE: American Academy of Neurology

Students: Design a Brain Experiment

Students: Design a Brain Experiment

The Dana Foundation is asking U.S. high school students to submit their most creative brain experiment ideas to the fourth annual Design a Brain Experiment Competition. Submissions must test an idea about the brain, anything from examining the effects of art on the adolescent brain to exploring alternative treatments for Alzheimer's disease. Students should not complete their experiments, so be creative!

 

I'm sure you can promote some ideas to your grandchildren.

Parental Stroke Increases Stroke Risk in Children

But have they even correlated the same type of stroke to parent/child? I would have to tell my daughter not to do any type of twisting injury to the neck. Thats stupid, she just needs to make sure that she doesn't allow plaque buildup in arteries.
Maybe by;

1.Watermelon juice reverses hardening of the arteries

2.Statins Tame Plaque Inflammation

3 .Peptide Inhibitor of NF-κB Translocation Ameliorates Experimental Atherosclerosis

4. All About Monocyte Migrations

5. Targeting Arterial Plaque

 

http://www.tele-management.ca/2013/08/parental-stroke-increases-stroke-risk-in-children-2/
After heart disease and cancer, stroke is the third leading cause of death in the United States. In addition to modifiable risk factors such as high blood pressure, cigarette smoking, and obesity, non-modifiable risk factors such as increasing age, male gender, and previous history of stroke or heart attack contribute to the risk of stroke. Data from the Framingham Heart Study demonstrates that parental stroke before the age of 65 triples the risk of stroke among children.
Previous research has varied in its findings regarding the relationship between family history of stroke and stroke risk. Using data from the Framingham Heart Study, researchers from Boston University and their colleagues analyzed data on 3443 individuals with no history of stroke whose parents had a known stroke status by the age of 65. Among this study group, a total of 106 parental strokes were documented by the age of 65 and 128 strokes were documented among the offspring. Statistical analysis revealed that the risk of stroke was increased by as much as three times in individuals who had at least one parent with stroke by the age of 65.
While previous studies have been inconsistent in verifying the importance of family history of stroke as a risk factor for stroke, the current findings are based on long term in-person observation across multiple generations of family members. While further research is needed to identify and understand the genes responsible for stroke risk, it does seem that obtaining a family history is an important component of estimating an individual’s risk for stroke.

Association of Parental Stroke With Brain Injury and Cognitive Measures in Offspring

If I'm reading this correctly my daughter has aged 3-7 years cognitively just because I had a stroke. She'll be surprised since she's going for a triple major in college. I only had a double major.
http://stroke.ahajournals.org/content/early/2013/01/29/STROKEAHA.112.680520.abstract

Abstract

Background and Purpose—Parental stroke has been related to an increased risk of stroke in the offspring. This study examines whether parental stroke is also associated with increased vascular brain injury and poorer cognitive performance among offspring free of clinical stroke.

Methods—Multivariable regression analyses were used to relate parental stroke to cross-sectional and change in brain magnetic resonance imaging measures and cognitive function among the offspring, with and without adjustment for vascular risk factors.

Results—Stroke- and dementia-free Framingham Offspring (n=1297, age, 61±9 years, 54% women) were studied. Parental stroke by age 65 years was associated with a higher baseline white matter hyperintensity volume (β=0.17±0.08; P=0.027) and with lower visual memory performance (β= −0.80±0.34; P=0.017). During a 6-year follow-up, parental stroke was also associated with increase in white matter hyperintensity volume (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.03–3.38) and decline in executive function (Trails B–A; OR, 1.81; 95% CI, 1.06–3.09). The associations with white matter hyperintensity volume and visual memory attenuated after additional adjustment for concomitant vascular risk factors.

Conclusions—Parental stroke by age 65 years is associated with increased vascular brain injury and lower memory in offspring equivalent to 3 and 7 years of brain aging, respectively. This may be partly attributed to inheritance of vascular risk factors.