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Published on: April 21, 2017
Expert opinion on emerging drugs in childhood arterial ischemic stroke
1Great Ormond Street Hospital, Department of Neurology, London, UK.
Insights
Childhood arterial ischemic stroke (AIS) treatments lack robust evidence, with no recommended acute options. Future research should focus on non-atheromatous arteriopathy to identify effective therapies for pediatric stroke.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Pediatric Stroke
Background:
- Childhood vascular stroke syndromes, including arterial ischemic stroke (AIS), are significant causes of mortality and morbidity.
- Disease mechanisms in pediatric AIS differ from adults, with atheroma playing a minimal role.
- Current treatment strategies are often extrapolated from adult data, lacking specific pediatric evidence.
Purpose of the Study:
- To review current pharmacological treatments for childhood AIS.
- To evaluate the evidence supporting existing treatments.
- To propose future treatment targets based on underlying disease mechanisms.
Main Methods:
- Systematic review of pharmacological treatments for childhood AIS.
- Categorization of treatments into acute management, secondary prevention, and future therapies.
- Analysis of evidence supporting current and emerging treatment approaches.
Main Results:
- A significant paucity of robust data supports current childhood AIS treatment approaches.
- No recommended acute treatments exist for pediatric AIS; thrombolysis efficacy is undetermined.
- Secondary prevention therapies (aspirin, heparin, warfarin) lack proven superiority over placebo.
Conclusions:
- Non-atheromatous arteriopathy is a key risk factor for recurrent AIS in children.
- Understanding the etiology and pathophysiology of non-atheromatous arteriopathy is crucial for developing future therapies.
- Further research is needed to establish evidence-based treatment guidelines for pediatric AIS.
Introduction:
Vascular stroke syndromes in childhood (arterial ischemic stroke (AIS), cerebral sinovenous thrombosis and non-traumatic intracranial hemorrhage) are increasingly recognized as important causes of mortality and morbidity, with significant personal and societal economic costs. The disease mechanisms underlying childhood AIS differ significantly from adults; in particular, atheroma plays an extremely minor role in children. However, to date, treatment principles in children have been based on extrapolation from adult data, usually by consensus expert opinion.
Areas Covered:
This review article summarizes the current pharmacological treatments of childhood AIS, the evidence supporting these and proposes future treatment targets directed at underlying disease mechanisms. This is categorized into acute management, secondary prevention, emerging treatments and future treatments.
Expert Opinion:
There is a paucity of robust data supporting current treatment approaches in childhood AIS. There are currently no recommended acute treatments; the role of thrombolysis in children remains to be determined. Aspirin, heparin and warfarin are used as secondary prevention therapies, but have not been shown to be superior to placebo. Non-atheromatous arteriopathy is now recognized as an important risk factor for recurrent AIS in children; further understanding of its etiology and pathophysiology could lead to identification of future therapeutic targets.
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