Doctors seek better treatment for strokes in kids

WASHINGTON – It looked like a seizure when little Alexzandra Gonzales jerked and then went limp, barely breathing. A frantic race to the hospital led to a diagnosis her parents found hard to believe: Just days before her first birthday, she had had a stroke.

“We never knew that children could have strokes,” said her mother, Amanda Gonzales.

It’s a common misconception, yet several thousand U.S. children a year suffer strokes. Only now are efforts under way to detect strokes faster in these smallest patients and begin figuring out how to treat them, to help rescue their brains.

Strokes are rare in children. Still, Dr. John Lynch of the National Institutes of Health estimates that about 1,000 infants a year suffer a stroke during the newborn period or before birth – plus anywhere from 3,000 to 5,000 children from age 1 month to 18 years.

The age difference is important, as newborn strokes appear to be distinctly different from those in older babies and children, who are more at risk for repeat brain attacks.

Between 10 percent and 25 percent of pediatric stroke sufferers die.

Worse, there’s very little research on how to treat child stroke. Neurologists cobble together therapy based on what works in adults, although what causes most adult strokes – hardened, clogged arteries – isn’t the culprit for youngsters, and few are diagnosed fast enough to try experimentally the drug tPA that can restore their elders’ blocked blood flow.

Efforts are under way to change that. An international study, led by Toronto’s Hospital for Sick Children, is trying to pinpoint risk factors and patients’ outcomes based on how different hospitals care for them, knowledge necessary to create new treatments.

While cardiac birth defects, vascular abnormalities, sickle cell disease and certain infections can trigger child strokes, doctors never find a cause for about two-thirds of cases.

A second study, led by Lynch, suggests many of them harbor genetic mutations connected to blood clotting and metabolism, a possible missing link.

For now, pediatric stroke treatment centers on preventing a repeat stroke and minimizing damage from the first one.

Too often, children face a significant delay, doctors say. Hospitals frequently make stroke a diagnosis of last resort.

Parents might not recognize the symptoms of acute stroke, such as one-sided weakness, loss of speech and, in babies, seizures.

And if your baby seems to favor one side, insist on a neurology exam; it might be an undetected newborn stroke that requires physical therapy, added Dr. Amy Goldstein, a pediatric neurologist at Children’s Hospital of Pittsburgh.

“Moms need to trust their gut instinct,” she said. “Know this can happen.”

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