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Steroid use could help prevent childhood stroke

Trialled use of steroids to prevent childhood stroke is justified, concludes an extensive review of recent reports.
Stroke

Trialled use of steroids to prevent childhood stroke is justified, concludes an extensive review of recent reports.

Although there is little evidence about the prevention or treatment of arterial ischaemic stroke (AIS) in children, drugs that regulate the immune and inflammatory response could prevent occurrence or recurrence.

This Archives of Disease in Childhood report concerns immunotherapy among patients with arteriopathy or acute infection. Drawing on 32 observational studies and two trials in the Embase and Medline databases, the report considers relevant case reports, trials, cohorts and cross-sectional studies.

The authors found that steroids were used in 80% of the case studies and recurrence rates were low.

They also identified an association between patient use of steroids and

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Trialled use of steroids to prevent childhood stroke is justified, concludes an extensive review of recent reports.

Stroke
Picture: iStock

Although there is little evidence about the prevention or treatment of arterial ischaemic stroke (AIS) in children, drugs that regulate the immune and inflammatory response could prevent occurrence or recurrence.

This Archives of Disease in Childhood report concerns immunotherapy among patients with arteriopathy or acute infection. Drawing on 32 observational studies and two trials in the Embase and Medline databases, the report considers relevant case reports, trials, cohorts and cross-sectional studies.

The authors found that steroids were used in 80% of the case studies and recurrence rates were low.

They also identified an association between patient use of steroids and lower risk of new stroke or neurological deficits.

Among patients with Moyamoya disease, in which blood flow in arteries in the brain are constricted, and tuberculosis, steroid use appeared to produce better cognitive outcomes.

Lead author Hannah Edwards of Bristol University concludes: ‘Immunotherapies are used in children with AIS, mainly as steroids for children with arteriopathy. However, there is currently little robust evidence to encourage or discourage this practice.’

AIS occurs in babies, children and teenagers as well as adults. In babies, warning signs can be inexplicable seizures and a preference to use only one side of the body.

A trial of steroids in childhood AIS ‘may be justified’, conclude the authors, to bolster the current bank of ‘weak evidence’.

Reference
  • Edwards HB, Mallick AA, O'Callaghan FJ (2016) Immunotherapy for arterial ischaemic stroke in childhood: a systematic review. Archives of Disease in Childhood. doi: 10.1136/archdischild-2016-311034

About the author

Time Harrison is a freelance writer

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