Dr. Gabrielle deVeber says stroke is often unrecognized, untreated in children
OTTAWA, Oct. 3, 2019 /CNW/ - Research trailblazer Dr. Gabrielle deVeber urged better access to care and improved education for clinicians and the public around pediatric stroke ? a condition that affects at least 10,000 Canadian children - during the prestigious Hnatyshyn Lecture at the Canadian Stroke Congress here today.
More than 700 delegates to the Canadian Stroke Congress heard Dr. deVeber of Toronto's SickKids Hospital trace the Canadian origins of pediatric stroke research and the development of the first registry right here in Canada. Her work helped identify the incidence of strokes in babies, children and teens.
"Gabrielle deVeber has had a huge impact in many ways," says pediatric neurologist Dr. Adam Kirton, head of the Calgary Pediatric Stroke Program, a leading researcher and one of her former trainees. "But the single largest outcome may be how she has brought together people from around the world to impact the care of children with stroke and their families."
Childhood stroke often not diagnosed until it occurs again
The exclusion of pediatric stroke from stroke awareness campaigns means that stroke in children often goes unrecognized and untreated. A child with a weak wrist or who walks with a limp may be taken to get an x-ray and, when no break or strain is found, the investigation ends. It's not until the child has a subsequent stroke that the problem is identified. There are at least 500 children who have a stroke each year in Canada, many of whom live with mild and moderate deficits that last their lifetimes. "The burden of illness is significant and enduring," Dr. deVeber says.
She urged health professionals at the Congress to read and apply stroke best practices. The Canadian best practices stand alone in having integrated pediatric guidelines. She called for increased funding for research and the training of more health professionals in the field. Because the field is so small, only Calgary and Toronto have robust pediatric stroke programs in Canada. "We have graduated 20 pediatric neurologists in Canada since 1995 and many have gone to different parts of the world ? the Philippines, Germany and other parts of Europe, South America and Asia," she says. "We are left with a handful of pediatric neurologists who are trained to provide stroke care."
But, while challenges remain, Dr. deVeber also described enormous progress over 30 years. In the early 1990s, Dr. deVeber, a stroke neurologist at SickKids, partnered with her mentor, the late Dr. Maureen Andrew, a hematologist at McMaster University, to study clots in the brains of children ? how they formed, where they formed, what conditions led to the formation, and why they reoccur.
"We knew that, after the newborn period, there was recurrence and untreated children have two, three and sometimes many more strokes," Dr. deVeber says. "But in the early 1990s, we didn't know the best way to prevent and treat them." Their research focused on ischemic strokes ? the most common kind of strokes that result from blood clots. In children, underlying origins of the clots are different than in adults.
First pediatric stroke registry helped identify causes
Because there was no systematic research into pediatric stroke at the time, Drs deVeber and Andrew developed a program to follow children who came to McMaster and SickKids. They began a national pediatric stroke registry that enrolled patients for 10 years and then did five years of follow-up.
"We enrolled infants and children with stroke in Canada by collaborating with all 16 pediatric specialty hospitals in Canada...This allowed enrolment of more than a thousand children with stroke during the 1990s and we were able to get a good idea of the incidence of pediatric stroke because of our national health-care system," Dr. deVeber says. "There wasn't widespread awareness at the time and it was only when CT and MRI scans became feasible for children that more and more children with stroke were identified."
Finally, physicians were able to identify risk factors, incidence, treatments and to publish systematic research. Strokes in children most often result from focal inflammation in their arteries, congenital heart disease, infection, hematological disorders or, in the case of perinatal stroke, an embolism likely from the placenta.
The first registry closed in 2001 and, in 2002, Dr. deVeber led in the development of a larger international registry ? the International Pediatric Stroke Study ? with 200 collaborators in 40 countries. Since 2003, 6,000 patients with ischemic stroke have been enrolled and new discoveries have been made from the findings.
Advent of acute stroke care
Early recognition and system-wide approaches to pediatric stroke care are particularly urgent with the advent of neuroprotective and emergency treatment strategies that could benefit children. But expertise in the unique aspects of the infant and child's brain and pediatric stroke must be central in the team approach to optimize safety, she says. "Children are not 'little adults' when it comes to their blood, arteries, hearts and brains."
"This country can continue play a leadership role in pediatric stroke," Dr. deVeber says.
AMONG HIGHLIGHTS TODAY AT CONGRESS:
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Canadian Stroke Congress
Co-hosted by Heart & Stroke and the Canadian Stroke Consortium, the Canadian Stroke Congress is a uniquely Canadian forum for experts to share the latest research findings, exchange ideas, and make the connections which will change the future of stroke. It brings together researchers, neurologists, nurses, rehabilitation specialists, policy makers, health system decision makers ? and many others ? in an unprecedented opportunity to improve the brain health of Canadians. (strokecongress.ca)
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Canadian Stroke Consortium
The Canadian Stroke Consortium is the professional organization for stroke neurologists, leading continuing education, advocacy and research for healthcare professionals. (strokeconsortium.ca)
SOURCE Heart and Stroke Foundation
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