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About Sickkids
About SickKids

December 29, 2005

Clinical trials needed for paediatric stroke

TORONTO (December 29, 2005) — Researchers at The Hospital for Sick Children (SickKids), Stollery Children's Hospital and Chedoke McMaster have advised that randomized clinical trials are urgently needed to equip diagnosing physicians with the most effective treatment options for paediatric stroke. This research is published in the January 2006 issue of the journal Stroke.

“There is a lot of uncertainty for clinicians when identifying the best treatment options for different types of paediatric stroke, as there is little to no evidence from clinical trials to support treatment decisions,” said Dr. Gabrielle deVeber, the study's principal investigator, a paediatric neurologist and scientist at SickKids and an associate professor of Paediatrics at the University of Toronto. “By compiling data on the largest number of children with stroke and the clinicians treating them, we were able to identify the most significant treatment issues facing physicians when dealing with paediatric stroke.”

From January 1995 to January 1, 2005 physicians worldwide consulted the 1-800-NOCLOTS toll-free paediatric stroke telephone consultation service. The consultation service, run out of SickKids in Toronto , Stollery Children's Hospital in Edmonton and the Children's Hospital at Chedoke McMaster in Hamilton provided telephone support and treatment suggestions to physicians dealing with paediatric stroke. The paediatric neurologists and haematologists operating the line documented caller and patient characteristics, antithrombotic treatments and caller's questions for entry into a computerized database.

“While we were collecting data, physicians were also provided with patient-specific support by a consultation service through the use of an annually updated published paediatric stroke protocol,” said Dr. deVeber, who is also director of the Children's Stroke Program at SickKids.

Stroke consults were completed on 1,065 children from birth to 18 years of age during the nine-year study. The majority of the calls were from the United States and 54 per cent of the consult patients were male and 16 per cent were newborns. Children were diagnosed with arterial ischemic stoke (AIS), where a blockage in the arteries or veins inhibits the supply of blood flow to the brain, or cerebral sinovenous thrombosis (CSVT), a type of stroke that occurs in children due to blood clots blocking the brain's venous flow.

Dr. deVeber previously discovered that sinovenous thrombosis accounts for 20 per cent of all ischemic strokes in children. The incidence of this disorder in the childhood population is at least one per 200,000 children and 1 in 10,000 newborns per year. The other 80 per cent of ischemic strokes are arterial.

“Based on our findings with the consults, it is clear that research is urgently needed in paediatric stroke to provide treatment guidance for clinical settings,” added Dr. deVeber. “It is very important that this research investigate the unique challenges and potential treatment options for the different types of stroke, and that newborns be evaluated separately from older infants and children.”

Strokes are usually associated with the very old, not the very young. Data obtained from adult stroke trials are not directly applicable to infants and children though because of age-related differences in the coagulation, vascular, and neurological systems as well as major differences in the risk factors and outcomes from stroke.

Strokes occur in children more frequently than brain tumours, at a rate of three per 100,000 children in Canada annually. In the past five years, SickKids has treated 500 children with stroke and sees three to five new cases a week. In addition, a weekly stroke clinic follows over 600 children with stroke.

Childhood stroke symptoms are similar to those of adult stroke and include a severe headache, sudden weakness of one side of the body, speech difficulties, eye movement problems and numbness. When symptoms of stroke occur in children they should be seen urgently as CT or MRI scans and critical medical treatment may be needed to prevent further damage to the brain.

Other members of the research team were Dr. Patricia Massicotte, Dr. Stefan Kuhle and Lesley Mitchell of Stollery Children's Hospital, Dr. Anthony K. Chan of Children's Hospital at Chedoke, and Dr. Maureen Andrew and Margaret Adams of SickKids.

This research was supported by the Heart and Stroke Foundation of Canada, the Canadian Institutes of Health Research, Baxter BioScience and SickKids Foundation.

The Hospital for Sick Children, affiliated with the University of Toronto , is Canada 's most research-intensive hospital and the largest centre dedicated to improving children's health in the country. Its mission is to provide the best in family-centred, compassionate care, to lead in scientific and clinical advancement, and to prepare the next generation of leaders in child health. For more information, please visit www.sickkids.ca.

For more information, please contact:

Public Affairs
The Hospital for Sick Children
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Toronto, ON
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Canada
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