Evidence based medicine in childhood arterial ischemic stroke: New insights and challenges

Abstract

Arterial Ischemic Stroke (AIS) is a frequent disease that rarely occurs during childhood. However, its consequences are expected to be lifelong and involve thousands of children worldwide. In the past twenty years, significant advances have been made in the understanding of its epidemiology. However, as it is often the case with pediatric pathology, interventions and treatments is mainly consensus based and derived from the experience of research in the field of adult AIS. Despite all those efforts, classification and nosology of childhood AIS remain unclear, which does not permit to stratify patients in respect of causes and risk factors. We have been able in 2012 to publish a preliminary work that proposes a new classification of childhood AIS, dividing patients into symptomatic and cryptogenic categories (Darteyre et al. Neurology 2012). We have shown that this simple classification displays homogeneous subgroups of patients in regard to stroke causes, mortality, recurrences and long–term neurological impairments. We have pushed forward those results into a PhD project, in order to determinate if secondary prevention trials could be now feasible in this field. We will mainly present our results and how they fit in the actual reflections surrounding childhood AIS.