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tPA being tried in Paediatric Stroke Patients. The International Stroke Conference Reports.

International Stroke Conference

Sunday, 11 February 2007

Sixteen children have been administered Activase (alteplase,

tPA) since 2003 for the treatment of acute ischemic stroke, according to reports from the International Paediatric Stroke Study, presented at the International Stroke Conference (ISC) in San Francisco

"Children are increasingly receiving Tissue plasminogen activator for stroke, often outside of the established time intervals for safe use in adults," said Catherine Amlie-Lefond, MD, assistant professor of neurology at the Medical College of Wisconsin, Milwaukee.

Reports on 360 children between January 2003 and July 2006 were received by the International Paediatric Stroke Study, who has been gathering information on childhood stroke since 2003. Of the 16 children who were treated, 3 had normal neurological outcomes, 12 had neurological and/or cognitive deficits and 1 child died. "The child that died had suffered a stroke that, in itself, was life threatening,"

In her presentation on Feb7 Dr. Amlie-Lefond said, "Safety and dosing studies of tPA in childhood stroke are urgently needed to provide a basis for age-appropriate guidelines,""Physicians are ready to intervene and recognize the impact of childhood stroke, but they have no guidelines."

It was noted that there are differences in the cause of stroke and "critical physiologic differences between the blood-clotting system of children compared with adults, suggesting that the dosing guidelines for tPA in adults may not be optimal for children."

American Stroke Association

"The potential for giving tPA in acute adult stroke has revolutionized stroke treatment for adults and facilitated the development of critical stroke pathways that help rapidly identify stroke victims and optimize their care,"

The drug was given to the children by the intravenous route in 7 cases; while it was administered through the intra-arterial route in 9 cases with the interval from the onset of symptoms to administration of tPA ranged from 20 minutes to 120 hours, Dr. Amlie-Lefond said.

"There are cases in which doctors will use desperate measures to treat children in desperate conditions," said Donna Ferriero, MD, chief of child neurology, University of California, San Francisco, California.

Dr. Ferrier moderated a press briefing at which researchers, including Dr. Almie-Lefond, presented several studies dealing with stroke in children.

The symposium is sponsored by the American Stroke Association, a division of the Dallas, Texas based American Heart Association.

The report showed generally poorer outcomes than in adults and included

    * 12 cases of neurologic or cognitive deficit or both (including all nine who received intra-arterial tPA).
    * One death in a child that was deemed probably unrelated to tPA.
    * One amputation secondary to femoral artery thrombosis in a child given intra-arterial tPA.
    * Two cerebral hemorrhages.

Prior studies have shown a 10% mortality rate from childhood arterial ischemic stroke and long-term deficits in 60%.

Source :American Stroke Association meeting. Amlie-Lefond C, et al "Thrombolysis in Children with Arterial Ischemic Stroke: Initial Results from the International Pediatric Stroke Study" ASA meeting 2007; Abstract 138.