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Thursday, December 8, 2005
Babies and strokes: How to treat smallest victims
77/£ ASSOCIATED PRESS
WASHINGTON - It
looked 1ikf> a seizure when lit
tle 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 chil
dren could have strokes,”
says her mother, Amanda
Gonzaljes.
It’s a common misconcep
tion, yet several thousand
U S. children a year suffer
strokes—and some special
ists fear they’re on the rise.
Only now are efforts'\mder
way to detect strokes faster in
these smallest patients and
begin figuring out how to
treat them, to help rescue
their brains. ’
“It- gej^»^ort shrift,” corn-
plains' Dr. Raymond Pitetti,
assistant emergency medi
cine chief at Children’s
Hospital of Pittsburg who
developed a “stroke team” for
kids, to speed diagnosis after
counting an increase in vic
tims in his emeigency room.
“There are a lot of knowl
edge gaps,” agrees Dr. John
Lynch of the National
Institutes of Health, whose
research is pointing to possi
ble unrecognized genetic cul
prits.
Strokes are rare in chil
dren. Still, Lynch estimates
that about 1,000 infants a
year suffer a stroke during
the newborn period or before
birth—plus anywhere fix)m
3,000 to 5,000 children fix)m
age 1 month to 18 years.
The age difference is impor
tant, as newborn strokes
appear to be distinctly differ
ent fix)m those in older babies
and children, who are more
at risk for repeat brain
attacks.
Between 10 and 25 percent
of pediatric stroke sufferers
die.
Specialists once thought
most survivors eventually
would recover, because chil
dren’s brains are much more
“plastic” than adults’—
they’re more likely to reroute
themselves around damage.
But sobering research now
shows more than half will
have permanent motor or
cc^nitive disabilities.
“Kids in the end still do bet
ter than adults,” cautions Dr.
Amy Goldstein, a pediatric
neurologist at Children’s
Hospital of Pittsburgh, not
ing that “it’s hard to keep a 2-
year-old still,” while the
elderly may not be as moti
vated for necessary physical
therapy .
Worse, there’s very little
research on how to treat child
stroke. Neurologists cobble
together therapy based on
what works in adults,
althou^ what causes most
adult sfrokes—hardened,
clogged arteries—isn’t the
culprit for yomigsters, and
few are diagnosed fast
enough to try experimentally
the drug tPA that can restore
THE STOCK MARKET
New research is being
developed to fight alarming
infant stroke rates.
their elders’ blocked blood
flow.
Effoits are under way to
change that An international
study, led by Tbronto’s
Hospital for Sick Children, is
trying to pinpoint risk factors
and patients’ outcomes based
on how different hospitals
ceire for them, knowledge nec
essary to device new treat
ments.
While cardiac birth defects,
vascular abnormaUtiee, sick
le 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
NIITs Lynch, suggests many
of them haihor genetic muta
tions connected to blood clot
ting and metabolism, a possi
ble missing link.
And about 100 patients are
enrolled in a study of whether
Pitetti’s stroke team
improves their outcomes by
speeding diagnosis.
For now, pediatiic stroke
treatment centers on pi*e-
v^iting a I'epeat stroke and
minimizing damage fix)m tlie
first one.
Consider Alexzandi’a
Gonzales. Raced to the
Pittsburgh hospital July 24,
she suffered another stioke
three days later, on her birth
day Suigeons cut out a por-
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