Immunotherapy for arterial ischaemic stroke in childhood: a systematic review

• Published in: Archives of disease in childhood 2017-05, Vol.102 (5), p.410-415
• Main Authors: Edwards, Hannah B, Mallick, Andrew A, O'Callaghan, Finbar J K
• Format: Article
• Language: English
• Subjects: Adults; Anatomy; Attrition (Research Studies); Brain Ischemia - complications; Care and treatment; Cell adhesion & migration; Central nervous system; Central Nervous System Infections - complications; Child; Children; Evidence; Evidence-Based Medicine - methods; Glucocorticoids - therapeutic use; Health aspects; Humans; Hypotheses; Immunology; Immunotherapy; Immunotherapy - methods; Infections; Intracranial Arterial Diseases - complications; Mortality; Observational studies; Patients; Prevention; Secondary Prevention - methods; Steroids; Stroke; Stroke (Disease); Stroke - etiology; Stroke - therapy; Studies
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2016-311034

BackgroundThere is little evidence about either prevention or treatment of childhood arterial ischaemic stroke (AIS). However, drugs that regulate the immune and inflammatory response could theoretically prevent occurrence or recurrence of AIS. Additionally, as an acute treatment, they may limit the neurological damage caused by AIS. Here, we systematically review the evidence on the use of immunotherapy in childhood AIS.DesignA systematic review of publications in databases Embase and Medline from inception. All types of evidence were included from trials, cohorts, case–control and cross-sectional studies and case reports.Results34 reports were included: 32 observational studies and 2 trials. Immunotherapy was used in two key patient groups: arteriopathy and acute infection. The majority were cases of varicella and primary angiitis of the central nervous system. All three cohorts and 80% of the case studies were treated with steroids. Recurrence rates were low. Analytical studies weakly associated steroids with lower odds of new stroke and neurological deficits, and better cognitive outcomes in the context of Moyamoya disease and tuberculosis.ConclusionsImmunotherapies are used in children with AIS, mainly as steroids for children with arteriopathy. However, there is currently little robust evidence to either encourage or discourage this practice. There is weak evidence consistent with the hypothesis that in certain children at risk, steroids may both reduce the risk of occurrent/recurrent stroke and enhance neurological outcomes. As the potential benefit is still uncertain, this indicates that a trial of steroids in childhood AIS may be justified.