Outline. Calgary Pediatric Stroke Program. Parent Information and Networking Session

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1 Calgary Pediatric Stroke Program Parent Information and Networking Session Perinatal Stroke Adam Kirton MD MSc FRCPC Pediatric Neurologist Alberta Children s Hospital Sonia Rothenmund RN, BN, CNN(C) Pediatric stroke nurse Sue Jones and Vicki Jones March of Dimes, Stroke Recovery Canada Outline Brief overview of perinatal stroke Review the structure of the CPSP Clinical care Research Education and support March of Dimes Feedback and future directions

2 Calgary Pediatric Stroke Program (CPSP) Clinical Services Pediatric Stroke Clinic Perinatal Stroke Clinic (APSP) Clinical consult service (24/7/365) International consult service Research Staff Dr. Adam Kirton Sonia Rothenmund Dr. Alexsandra Mineyko Jacquie Hodge Amy Hampson Resident and student research Education and Support ACH Pediatric Neurologists Related disciplines: Hematology, neurosurgery, neuropsychology, neuroradiology, adult stroke, physiatry, rehabilitation therapy Pediatric Cerebrovascular Disease Perinatal Stroke Arterial ischemic stroke Neonatal AIS Arterial PPIS PVI Neonatal CSVT Neonatal HS Childhood Stroke AIS, CSVT, HS Other cerebrovascular diseases

3 Perinatal stroke Common Under-diagnosed Poorly understood Preventable? Treatable? Poor outcomes Raju et al, Pediatrics 2007 Littlest folks have different strokes Epidemiology Risk factors Pathophysiology Diagnosis Treatments Outcomes Research Epidemiology Age at Event N=933 children with AIS % 23% % 9% 7% 6% 5% 6% 6% 0 // Neonate 1mo-1yr 2-3yrs 4-5yrs 6-7yrs 8-9yrs 10-11yrs 12-13yrs 14-15yrs deveber and Kirton for CPISR, Child Neurology Society 2006

4 Stroke Classification in Children Stroke Venous Ischemic Arterial Hemorrhagic Intraparenchymal Subarachnoid Intraventricular Subdural Epidural CSVT AIS Perinatal Ischemic Stroke Syndromes Symptomatic v. Asymptomatic Prenatal v. Perinatal Arterial v. Venous Symptomatic Neonatal AIS Presumed Perinatal Ischemic Stroke (PPIS) Arterial Presumed Perinatal Ischemic Stroke (APPIS) Periventricular Venous Infarction (PVI) Kirton and deveber, Stroke Reviews 2006 Term newborn. Normal pregnancy, delivery. Seizures at 12 hours. Neonatal Arterial Ischemic Stroke (NAIS)

5 6 month old with decreased use of right arm. ARTERIAL PRESUMED PERINATAL ISCHEMIC STROKE (APPIS) Kirton and deveber, Stroke Review month old with decreased use of right arm. PERIVENTRICULAR VENOUS INFARCTION (PVI) Kirton and Wei, Neurology 2010

6 Universal healthcare Defined population Two tertiary care pediatric centres Collaborator expertise Largest population-based perinatal stroke cohort n > 500 syndromic diagnosis original neuroimaging comprehensive risk factor analysis treatment trials Preliminary Case Identification 2009/08/24 Perinatal Stroke Treatment Physical: OT, PT, ortho Language: ST Learning: Neuropsyc Behavioural: Psychology Seizures Support Family centered Education

7 Summary Perinatal stroke is common Several factors determine type of perinatal stroke Timing before birth or around birth Symptoms seizures at birth or weakness in infancy Blood vessel artery or vein MRI makes the diagnosis Outcomes are variable Calgary Pediatric Stroke Program (CPSP) Clinical Services Pediatric Stroke Clinic Perinatal Stroke Clinic (APSP) Clinical consult service (24/7/365) International consult service Research Staff Dr. Adam Kirton Sonia Rothenmund Dr. Alexsandra Mineyko Jacquie Hodge Amy Hampson Resident and student research Education and Support ACH Pediatric Neurologists Related disciplines: Hematology, neurosurgery, neuropsychology, neuroradiology, adult stroke, physiatry, rehabilitation therapy Calgary Pediatric Stroke Program Research Perinatal Stroke: APSP Epidemiology, risk factors Role of the placenta Acute biomarkers PLASTIC CHAMPS trial Transcranial Magnetic Stimulation ACH Pediatric TMS Laboratory Mapping plastic reorganization Therapeutic brain stimulation Imaging injury, adaptation in pediatric stroke Corticospinal Wallerian Degeneration Cerebellar and cerebral diaschisis International Pediatric Stroke Study (IPSS) Neonatal AIS study Dyslipidemia in pediatric stroke A B Vasculopathy and infection in pediatric stroke (VIPS study) Thrombolysis in Pediatric Stroke (TIPS trial) Pediatric NIH Stroke Scale validation (NIH) SSS decompression in neonatal CSVT Fibromuscular dysplasia and childhood AIS

8 Calgary Pediatric Stroke Program (CPSP) Clinical Services Pediatric Stroke Clinic Perinatal Stroke Clinic (APSP) Clinical consult service (24/7/365) International consult service Research Staff Dr. Adam Kirton Sonia Rothenmund Dr. Alexsandra Mineyko Jacquie Hodge Amy Hampson Resident and student research Education and Support ACH Pediatric Neurologists Related disciplines: Hematology, neurosurgery, neuropsychology, neuroradiology, adult stroke, physiatry, rehabilitation therapy

9 Parent Focus Groups Reported Challenges for Parents: Guilt, worry, fear, grief Personality vs. Stroke (e.g. sleep issues, school performance) Future planning about what to expect Dealing with questions in between clinic visits Accessing programs, organizations and funding options Help in overcoming challenges Access to information Brochures, information sessions, Mapping out of available resources Education for schools Website Answers to typical questions List of resources Parent forum Parent support group Therapy treatment List of options while waiting to be seen Common therapies parents can do at home Research Updates Community pediatrician with interest in managing pediatric stroke Children and Siblings Challenges Acceptance and fitting in Eduation Coping skills and dealing with questions Overcoming these challenges Support groups Helping schools understand about pediatric stroke Educational resources for children

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