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Evaluation of hyperhomocysteinaemia in children with stroke
E Cardo1, M A Vilaseca, J Campistol
1Servei de Neuropediatria, Hospital Sant Joan de Déu-Hospital Clínic, Barcelona, Spain.
Insights
Children with stroke or on anti-epileptic drugs show higher homocysteine levels. Screening for hyperhomocysteinaemia is recommended in pediatric stroke cases, with folate supplementation potentially beneficial.
Area of Science:
- Pediatric Neurology
- Vascular Medicine
- Clinical Biochemistry
Background:
- Hyperhomocysteinaemia is a known risk factor for arterial vascular disease and thrombosis in adults.
- The association between hyperhomocysteinaemia and stroke in children is less understood.
- Anti-epileptic drugs, particularly those with antifolate properties, are used in some children who experience stroke.
Purpose of the Study:
- To investigate the association between hyperhomocysteinaemia and stroke in children.
- To examine the potential interaction between anti-epileptic drug treatment and hyperhomocysteinaemia in pediatric stroke patients.
Main Methods:
- Plasma total homocysteine levels were measured in children with stroke (n=68), children on anti-epileptic drugs without stroke (n=100), and compared to reference values (n=195).
- High-performance liquid chromatography with fluorescence detection was used for homocysteine quantification.
- Hyperhomocysteinaemia was defined as homocysteine levels above the 95th percentile of reference values.
Main Results:
- Children with stroke and those on anti-epileptic drugs exhibited significantly higher total homocysteine values compared to reference groups, except in adolescents.
- 36% of pediatric stroke patients and 28% of children on anti-epileptic treatment showed hyperhomocysteinaemia.
- Total homocysteine levels in children with both stroke and anti-epileptic treatment were comparable to untreated stroke patients.
Conclusions:
- Systematic screening for hyperhomocysteinaemia is recommended in the etiological investigation of pediatric stroke.
- Anti-epileptic drug treatment may contribute to mild hyperhomocysteinaemia in some children with stroke.
- Dietary folate supplementation may benefit children with stroke and those undergoing anti-epileptic treatment.
Abstract:
Hyperhomocysteinaemia is associated with an increased risk of arterial vascular disease and thrombosis in adults. Our aim was to study the association of hyperhomocysteinaemia and stroke in children. Since some patients who had suffered a stroke developed seizures and received treatment with anti-epileptic (antifolate) drugs, we also examined the possible interaction between anti-epileptic drugs and hyperhomocysteinaemia. Plasma total homocysteine was measured in 68 children with stroke (23 of the 68 were taking anti-epileptic drugs) and 100 children undergoing anti-epileptic treatment but without history of stroke, and we compared the values with our reference values for similar ages (n = 195). Total homocysteine was determined by high profile liquid chromatography with fluorescence detection. Hyperhomocysteinaemia was defined as a homocysteine concentration above the 95th percentile for the reference values. Significant differences were found in total homocysteine values of children with stroke and those taking anti-epileptic drugs compared with our reference values for similar ages, except for the adolescent group. Total homocysteine values above the 95th percentile for the reference values were found in 36% of patients with stroke and 28% of children on anti-epileptic treatment. Total homocysteine concentrations in the 23 patients with both stroke and anti-epileptic drug treatment were similar to those of untreated patients with stroke in all age groups. In summary, systematic screening for hyperhomocysteinaemia should be included in the protocol to investigate the aetiology of stroke, even in paediatrics. Anti-epileptic treatment in children with stroke may be responsible for the mild hyperhomocysteinaemia observed in some of them. A dietary supplement of folate may be of benefit in children with stroke and in patients taking anti-epileptic drugs.