20 results on '"Mackay, Mark"'
Search Results
2. Paediatric stroke: the need for interdisciplinary models of care.
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Gordon A, Barnes C, and Mackay M
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- Adult, Age Factors, Child, Clinical Protocols standards, Early Diagnosis, Evidence-Based Medicine methods, Humans, Incidence, Infant, Newborn, Interdisciplinary Communication, Patient Care Team, Pediatrics standards, Practice Guidelines as Topic, Fibrinolytic Agents therapeutic use, Pediatrics methods, Stroke diagnosis, Stroke therapy
- Abstract
Stroke is an important cause of mortality and long-term morbidity in children. The aetiology of stroke in childhood differs from that of adults, with vasculopathies and congenital heart disease being the most commonly identified risk factors. Recognition and diagnosis are often delayed, limiting access to acute medical interventions such as thrombolysis. Optimal management of stroke in children is still not known and existing guidelines are at the level of expert consensus. Interdisciplinary childhood stroke programmes are required to meet the needs of this population and to contribute to the development of evidence-based therapies.
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- 2009
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3. Prolonged or recurrent acute seizures after pediatric arterial ischemic stroke are associated with increasing epilepsy risk
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Fox, Christine K, Mackay, Mark T, Dowling, Michael M, Pergami, Paola, Titomanlio, Luigi, Deveber, Gabrielle, and Investigators, the SIPS
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Biomedical and Clinical Sciences ,Clinical Sciences ,Neurosciences ,Brain Disorders ,Pediatric ,Neurodegenerative ,Clinical Research ,Stroke ,Epilepsy ,Management of diseases and conditions ,7.3 Management and decision making ,Adolescent ,Age Factors ,Brain Ischemia ,Child ,Child ,Preschool ,Female ,Follow-Up Studies ,Humans ,Infant ,Infant ,Newborn ,Male ,Online Systems ,Recurrence ,Risk Factors ,SIPS Investigators ,Medical and Health Sciences ,Pediatrics ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
AimTo determine epilepsy risk factors after pediatric stroke.MethodA cohort of children with arterial ischemic stroke (birth-18y) was enrolled at 21 centers and followed for 1 year. Acute seizures (≤7d after stroke) and active epilepsy (at least one unprovoked remote seizure plus maintenance anticonvulsant at 1y) were identified. Predictors were determined using logistic regression.ResultsAmong 114 patients (28 neonates and 86 children) enrolled, 26 neonates (93%) and 32 children (37%) had an acute seizure. Acute seizures lasted longer than 5 minutes in 23 patients (40%) and were frequently recurrent: 33 (57%) had 2 to 10 seizures and 11 (19%) had more than 10. Among 109 patients with 1-year follow-up, 11 (10%) had active epilepsy. For each year younger, active epilepsy was 20% more likely (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-0.99, p=0.041). Prolonged or recurrent acute seizures also increased epilepsy risk. Each additional 10 minutes of the longest acute seizure increased epilepsy risk fivefold (OR 4.7, 95% CI 1.7-13). Patients with more than 10 acute seizures had a 30-fold increased epilepsy risk (OR 30, 95% CI 2.9-305).InterpretationPediatric stroke survivors, especially younger children, have a high risk of epilepsy 1 year after stroke. Prolonged or recurrent acute seizures increase epilepsy risk in a dose-dependent manner.
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- 2017
4. Risk of Recurrent Arterial Ischemic Stroke in Childhood
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Fullerton, Heather J, Wintermark, Max, Hills, Nancy K, Dowling, Michael M, Tan, Marilyn, Rafay, Mubeen F, Elkind, Mitchell SV, Barkovich, A James, deVeber, Gabrielle A, Plumb, Patricia A, Benedict, Susan L, Bernard, Timothy J, Fox, Christine K, Friedman, Neil R, Lo, Warren D, Ichord, Rebecca N, Mackay, Mark T, Kirton, Adam, Hernandez-Chavez, Marta I, Humphreys, Peter, Jordan, Lori C, Sultan, Sally, Rivkin, Michael J, Titomanlio, Luigi, Kovacevic, Gordana S, Yager, Jerome Y, Amlie-Lefond, Catherine, Dlamini, Nomazulu, Condie, John, Yeh, Ann, Kneen, Rachel, Bjornson, Bruce, Pergami, Paola, Zou, Li Ping, Elbers, Jorina M, Abdalla, Abdalla, Chan, Anthony K, Farooq, Osman, Lim, Mingming J, Carpenter, Jessica L, Pavlakis, Steven, Wong, Virginia C, and Forsyth, Robert
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Paediatrics ,Biomedical and Clinical Sciences ,Brain Disorders ,Pediatric ,Stroke ,Prevention ,Neurosciences ,Atherosclerosis ,Adolescent ,Brain Ischemia ,Cerebral Arterial Diseases ,Child ,Child ,Preschool ,Cohort Studies ,Female ,Follow-Up Studies ,Humans ,Infant ,Internationality ,Male ,Prospective Studies ,Recurrence ,Risk Factors ,child ,pediatrics ,risk factor ,stroke ,vaccination ,VIPS Investigators ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Neurology & Neurosurgery ,Clinical sciences ,Allied health and rehabilitation science - Abstract
Background and purposePublished cohorts of children with arterial ischemic stroke (AIS) in the 1990s to early 2000s reported 5-year cumulative recurrence rates approaching 20%. Since then, utilization of antithrombotic agents for secondary stroke prevention in children has increased. We sought to determine rates and predictors of recurrent stroke in the current era.MethodsThe Vascular Effects of Infection in Pediatric Stroke (VIPS) study enrolled 355 children with AIS at 37 international centers from 2009 to 2014 and followed them prospectively for recurrent stroke. Index and recurrent strokes underwent central review and confirmation, as well as central classification of causes of stroke, including arteriopathies. Other predictors were measured via parental interview or chart review.ResultsOf the 355 children, 354 survived their acute index stroke, and 308 (87%) were treated with an antithrombotic medication. During a median follow-up of 2.0 years (interquartile range, 1.0-3.0), 40 children had a recurrent AIS, and none had a hemorrhagic stroke. The cumulative stroke recurrence rate was 6.8% (95% confidence interval, 4.6%-10%) at 1 month and 12% (8.5%-15%) at 1 year. The sole predictor of recurrence was the presence of an arteriopathy, which increased the risk of recurrence 5-fold when compared with an idiopathic AIS (hazard ratio, 5.0; 95% confidence interval, 1.8-14). The 1-year recurrence rate was 32% (95% confidence interval, 18%-51%) for moyamoya, 25% (12%-48%) for transient cerebral arteriopathy, and 19% (8.5%-40%) for arterial dissection.ConclusionsChildren with AIS, particularly those with arteriopathy, remain at high risk for recurrent AIS despite increased utilization of antithrombotic agents. Therapies directed at the arteriopathies themselves are needed.
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- 2016
5. Impact of stroke volume on motor outcome in neonatal arterial ischemic stroke
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Wiedemann, Andreas, Pastore-Wapp, Manuela, Slavova, Nedelina, Steiner, Leonie, Weisstanner, Christian, Regényi, Mária, Steinlin, Maja, Grunt, Sebastian, Mori, Andrea Capone, Bigi, Sandra, Datta, Alexandre, Fluss, Joël, Hackenberg, Annette, Keller, Elmar, MacKay, Mark T, Maier, Olive, Mercati, Danielle, Marcoz, Jean-Pierre, Poloni, Claudia, Ramelli, Gian Paolo, Schmitt-Mechelke, Thomas, Schmid, Regula, University of Zurich, and Grunt, Sebastian
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and Child Health ,2728 Neurology (clinical) ,10036 Medical Clinic ,Clinical Neurology ,610 Medicine & health ,2735 Pediatrics, Perinatology and Child Health ,General Medicine ,Pediatrics ,Perinatology - Published
- 2020
6. Paediatric Code Stroke.
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Long, Elliot, Saw, Jarel T S, Davis, Conor, Morgan, Cam, Sheridan, Bennett, Monagle, Paul, Ryan, Monique M, Macdonald‐Laurs, Emma, and Mackay, Mark T
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STROKE ,MEDICAL personnel ,PEDIATRICS ,MAGNETIC resonance angiography - Published
- 2022
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7. Mortality after pediatric arterial ischemic stroke
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Beslow, Lauren A., Dowling, Michael M., Hassanein, Sahar M.A., Lynch, John K., Zafeiriou, Dimitrios, Sun, Lisa R., Kopyta, Ilona, Titomanlio, Luigi, Kolk, Anneli, Chan, Anthony, Biller, Jose, Grabowski, Eric F., Abdalla, Abdalla A., Mackay, Mark T., DeVeber, Gabrielle, Ashwal, Steve, Ferriero, Donna, Fullerton, Heather, Ichord, Rebecca, Kirkham, Fenella, O'Callaghan, Finbar, Pavlakis, Steve, Sebire, Guillaume, Willan, Andrew, Kirton, Adam, Goldenberg, Neil, Saengpattrachai, Montri, Crosswell, Hal, Rivkin, Michael, Bjornson, Bruce, Tatishvili, Nana, Brankovic-Sreckovic, Vesna, Bernard, Timothy, Armstrong, Jennifer, Humphreys, Peter, Heyer, Geoffrey, Fryer, Robert, Yeh, Ann, Billinghurst, Lori, Khoury, Chaouki, Abraham, Lisa, Whelan, Harry, Nowak-Gottl, Ulrike, Wainwright, Mark, Condie, John, Carpenter, Jessica, Holzhauer, Susanne, Guang, Yang, Zou, Li Ping, Taylor, J. Michael, and Pediatrics
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Heart Defects, Congenital ,Male ,Pediatrics ,medicine.medical_specialty ,Multivariate analysis ,Heart disease ,Infarction ,Disease ,Brain Ischemia ,Brain ischemia ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,030225 pediatrics ,medicine ,Humans ,Hospital Mortality ,Registries ,Child ,Stroke ,business.industry ,Infant, Newborn ,Infant ,Odds ratio ,Hispanic or Latino ,medicine.disease ,Confidence interval ,United States ,Hospitalization ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Multivariate Analysis ,Female ,business ,030217 neurology & neurosurgery - Abstract
OBJECTIVES: Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we identify predictors of in-hospital mortality after pediatric arterial ischemic stroke (AIS). METHODS: Neonates (0–28 days) and children (29 days– RESULTS: Fourteen of 915 neonates (1.5%) and 70 of 2273 children (3.1%) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6%) were stroke-related, with remaining deaths attributed to medical disease. In multivariable analysis, congenital heart disease (odds ratio [OR]: 3.88; 95% confidence interval [CI]: 1.23–12.29; P = .021), posterior plus anterior circulation stroke (OR: 5.36; 95% CI: 1.70–16.85; P = .004), and stroke presentation without seizures (OR: 3.95; 95% CI: 1.26–12.37; P = .019) were associated with in-hospital mortality for neonates. Hispanic ethnicity (OR: 3.12; 95% CI: 1.56–6.24; P = .001), congenital heart disease (OR: 3.14; 95% CI: 1.75–5.61; P < .001), and posterior plus anterior circulation stroke (OR: 2.71; 95% CI: 1.40–5.25; P = .003) were associated with in-hospital mortality for children. CONCLUSIONS: In-hospital mortality occurred in 2.6% of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival.
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- 2018
8. Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?
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Babl Franz E, Yock-Corrales Adriana, Mosley Ian T, and Mackay Mark T
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Stroke ,stroke recognition tools ,FAST ,ROSIER ,child ,emergency department ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Stroke recognition tools have been shown to improve diagnostic accuracy in adults. Development of a similar tool in children is needed to reduce lag time to diagnosis. A critical first step is to determine whether adult stoke scales can be applied in childhood stroke. Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS) Methods Children aged 1 month to < 18 years with radiologically confirmed acute AIS who presented to a tertiary emergency department (ED) (2003 to 2008) were identified retrospectively. Signs, symptoms, risk factors and initial management were extracted. Two adult stroke recognition tools; ROSIER (Recognition of Stroke in the Emergency Room) and FAST (Face Arm Speech Test) scales were applied retrospectively to all patients to determine test sensitivity. Results 47 children with AIS were identified. 34 had anterior, 12 had posterior and 1 child had anterior and posterior circulation infarcts. Median age was 9 years and 51% were male. Median time from symptom onset to ED presentation was 21 hours but one third of children presented within 6 hours. The most common presenting stroke symptoms were arm (63%), face (62%), leg weakness (57%), speech disturbance (46%) and headache (46%). The most common signs were arm (61%), face (70%) or leg weakness (57%) and dysarthria (34%). 36 (78%) of children had at least one positive variable on FAST and 38 (81%) had a positive score of ≥1 on the ROSIER scale. Positive scores were less likely in children with posterior circulation stroke. Conclusion The presenting features of pediatric stroke appear similar to adult strokes. Two adult stroke recognition tools have fair to good sensitivity in radiologically confirmed childhood AIS but require further development and modification. Specificity of the tools also needs to be determined in a prospective cohort of children with stroke and non-stroke brain attacks.
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- 2011
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9. Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke.
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Medley, Tanya L., Mackay, Mark T., Cheung, Michael, Monagle, Paul, Mandelstam, Simone, Stojanovski, Belinda, Dale, Russell C., Fahey, Michael, Sinclair, Adriane, Walsh, Peter, Wray, Alison, Miteff, Christina, Andrews, Ian, Ware, Tyson, Pridmore, Clair, and Troedson, Christopher
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CHILD mortality , *STROKE , *CONGENITAL heart disease , *CHILDREN , *MAGNETIC resonance imaging - Abstract
Stroke is among the top 10 causes of death in children and survivors carry resulting disabilities for decades, at substantial cost to themselves and their families. Children are not currently able to access reperfusion therapies, due to limited evidence supporting safety and efficacy and long diagnostic delays. The Australian Clinical Consensus Guideline for the Diagnosis and Acute Management of Childhood Stroke was developed to minimize unwarranted variations in care and document best evidence on the risk factors, etiologies, and conditions mimicking stroke that differ from adults. Clinical questions were formulated to inform systematic database searches from 2007 to 2017, limited to English and pediatric studies. SIGN methodology and the National Health and Medical Research Council system were used to screen and classify the evidence. The Grades of Recommendation, Assessment, Development, and Evaluation system (GRADE) was used to grade evidence as strong or weak. The Guideline provides more than 60 evidence-based recommendations to assist prehospital and acute care clinicians in the rapid identification of childhood stroke, choice of initial investigation, to confirm diagnosis, determine etiology, selection of the most appropriate interventions to salvage brain at risk, and prevent recurrence. Recommendations include advice regarding the management of intracranial pressure and congenital heart disease. Implementation of the Guideline will require reorganization of prehospital and emergency care systems, including the development of regional stroke networks, pediatric Code Stroke, rapid magnetic resonance imaging and accreditation of primary pediatric stroke centers with the capacity to offer reperfusion therapies. The Guideline will allow auditing to benchmark timelines of care, access to acute interventions, and outcomes. It will also facilitate the development of an Australian childhood stroke registry, with data linkage to international registries, to allow for accurate data collection on stroke incidence, treatment, and outcomes. [ABSTRACT FROM AUTHOR]
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- 2019
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10. Children with post-stroke epilepsy have poorer outcomes one year after stroke.
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Fox, Christine K., Jordan, Lori C., Beslow, Lauren A., Armstrong, Jennifer, Mackay, Mark T., and deVeber, Gabrielle
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STROKE ,CHILDHOOD epilepsy ,PEDIATRICS ,CONFIDENCE intervals ,ANTICONVULSANTS - Abstract
Background Epilepsy is a common complication of pediatric stroke. Aim In this study, we aim to measure the association between epilepsy and neurologic outcome after childhood arterial ischemic stroke. Methods Prospective cohort study of children (29 days–19 years) enrolled after an acute arterial ischemic stroke at 21 international pediatric stroke centers and followed to identify epilepsy. One year post-stroke, outcomes were scored using the examination-based Pediatric Stroke Outcome Measure (range = 0–10); higher values reflect greater disability. Ordinal logistic regression was used to measure the association of Pediatric Stroke Outcome Measure scores (categorized as 0–1, 1.5–3, 3.5–6, 6.5–10) with epilepsy. Results Investigators enrolled 86 children (median age = 6.1 years, interquartile range (IQR) = 1.4–12.2 years) with acute stroke. At 1 year, 18/80 (23%) remained on an anticonvulsant including 8/80 (10%) with epilepsy. Among the 70 with Pediatric Stroke Outcome Measure scored, the median was 0.5 (IQR = 0–1.5) for children without epilepsy (n = 63), and 6 (IQR = 0.5–10) for children with epilepsy (n = 7). In univariable analyses, poorer 1-year outcome was associated with middle cerebral artery stroke, cortical infarcts, hemorrhagic transformation, hospital disposition not to home, and epilepsy. In multivariable analysis, middle cerebral artery stroke (odds ratio (OR) = 4.9, 95% confidence intervals (CI) = 1.1–21.3) and epilepsy (OR = 24.1, CI = 1.5–380) remained associated with poorer outcome. Conclusions Children who developed epilepsy during the first year post-stroke had poorer neurologic outcomes than those without epilepsy. [ABSTRACT FROM AUTHOR]
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- 2018
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11. Early predictors of psychosocial functioning 5 years after paediatric stroke.
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Greenham, Mardee, Anderson, Vicki, Cooper, Anna, Hearps, Stephen, Ditchfield, Michael, Coleman, Lee, Hunt, Rod W, Mackay, Mark T, Monagle, Paul, and Gordon, Anne L
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PEDIATRICS ,STROKE ,PSYCHOSOCIAL factors ,COGNITIVE ability ,EARLY medical intervention ,PSYCHOLOGY ,CEREBRAL ischemia treatment ,STROKE diagnosis ,STROKE treatment ,CEREBRAL ischemia ,LONGITUDINAL method ,MENTAL health ,PROGNOSIS ,SOCIAL skills ,TIME ,TREATMENT effectiveness ,DIAGNOSIS - Abstract
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- 2017
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12. Planning interventional trials in childhood arterial ischaemic stroke using a Delphi consensus process.
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Steinlin, Maja, O'callaghan, Finbar, and Mackay, Mark T
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STROKE diagnosis ,RANDOMIZED controlled trials ,JUVENILE diseases ,DELPHI method ,PEDIATRICS ,CEREBRAL ischemia treatment ,STROKE treatment ,CEREBRAL ischemia ,CLINICAL trials ,CONSENSUS (Social sciences) ,INTERNET ,MEDICAL protocols ,STROKE - Abstract
Aim: There is a paucity of data from randomized controlled treatment trials in childhood arterial ischaemic stroke. Our objectives were to identify and plan a trial through use of a Delphi consensus process.Method: The Delphi panel consisted of Australian, New Zealand, and European paediatric neurologists with interests in childhood stroke. Four rounds were conducted using a REDCap (Research Electronic Data Capture) Web-based application: the first consisted of open-ended questions; the second evaluated agreement for the most important trial; the third and fourth reached consensus on design.Results: Forty-seven out of 66 neurologists answered the first round. Eight areas of research for important and feasible trials were identified. In the second round, 43 paediatric neurologists ranked the three highest rated trials: (1) aspirin versus aspirin plus steroids in focal arteriopathy (n=31); (2) heparin versus aspirin (n=6); and (3) heparin versus aspirin versus modern anticoagulation (n=6). The third and fourth surveys reached consensus among 43 out of 44 respondents on design of the highest ranked trial, and allowed agreement on inclusion/exclusion criteria, clinical/neuroimaging data, and treatment protocols.Conclusion: The Delphi consensus process is an efficient method of identifying and planning paediatric stroke trials. An international, multicentre trial is now in preparation. [ABSTRACT FROM AUTHOR]- Published
- 2017
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13. Seizures in Children With Cerebral Palsy and White Matter Injury.
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Cooper, Monica S., Mackay, Mark T., Fahey, Michael, Reddihough, Dinah, Reid, Susan M., Williams, Katrina, and Harvey, A. Simon
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BRAIN disease treatment , *CEREBRAL palsy treatment , *DIAGNOSIS of epilepsy , *HEMORRHAGE complications , *INFANTILE spasms , *BRAIN diseases , *CEREBRAL palsy , *CEREBROVASCULAR disease , *CHI-squared test , *SEIZURES (Medicine) , *ELECTROENCEPHALOGRAPHY , *EPILEPSY , *FISHER exact test , *PREMATURE infants , *INTERVIEWING , *MAGNETIC resonance imaging , *MEDICAL cooperation , *PEDIATRICS , *RESEARCH , *RESEARCH funding , *SPASMS , *DATA analysis software , *DESCRIPTIVE statistics , *KAPLAN-Meier estimator , *MANN Whitney U Test , *DISEASE complications , *DIAGNOSIS - Abstract
OBJECTIVE: The goal of this study was to describe the prevalence, syndromes, and evolution of seizure disorders in children with cerebral palsy (CP) due to white matter injury (WMI). METHODS: For this population-based cohort study, brain MRI scans and medical records were reviewed in children in the Victorian Cerebral Palsy Register born between 1999 and 2006 recorded as having WMI. Children were excluded if they had features of an undiagnosed syndrome, associated cortical malformation or injury, or no medical contact in the preceding year. Included were 166 children with CP and isolated WMI due to presumed vascular insufficiency or hemorrhage; 87 were born preterm. Seizure and CP details were obtained from medical records and interviews, and EEG recordings were reviewed. RESULTS: Forty-one children (25%) had seizures beyond the neonatal period. Four children had West syndrome, which resolved with treatment. Thirteen children had febrile seizures that they outgrew. Thirty children had focal epilepsy with seizure manifestations and EEG discharges typical of early-onset childhood occipital epilepsy or childhood epilepsy with centrotemporal spikes; 23 have outgrown these seizures. Two children had idiopathic generalized epilepsy; it was ongoing in 1 child. Fourteen children had evolution from 1 epileptic syndrome to another. At last follow-up (median age, 12.7 years; minimum age, 9.7 years), 80% had not had a seizure for >2 years. CONCLUSIONS: The electroclinical features of seizure disorders associated with CP and WMI are those of the age-limited, epileptic syndromes of childhood, with favorable outcome in the majority. The findings have important implications for counseling and drug treatment. [ABSTRACT FROM AUTHOR]
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- 2017
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14. Social competence following neonatal and childhood stroke.
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Lo, Warren, Gordon, Anne, Hajek, Christine, Gomes, Alison, Greenham, Mardee, Perkins, Elizabeth, Zumberge, Nicholas, Anderson, Vicki, Yeates, Keith Owen, and Mackay, Mark T.
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STROKE ,SOCIAL skills ,PERINATAL care ,COGNITIVE ability ,PEDIATRICS ,SOCIAL participation - Abstract
Background Social functioning encompasses a range of important skills that an individual uses to interact with the social world. Previous studies suggest that social functioning (outcomes) may be impaired after childhood stroke, but research is limited. Aims We examined the following: (1) the effect of ischemic stroke upon social outcomes in children; (2) the correlation of cognitive abilities and problem behaviors with social outcomes; and (3) the role of infarct characteristics as predictors of social outcomes. Methods We conducted an observational case-controlled study to compare children with neonatal or childhood onset stroke and controls with chronic asthma. Neurological deficits were measured with the Pediatric Stroke Outcome Measure. Cognitive abilities, problem behavior, adaptive behavior, and social outcomes were assessed with standardized measures. Results Overall stroke cases were impaired in several areas of adaptive behaviors but not in cognitive ability, problem behaviors, or social outcomes. Children with more severe neurological deficits had impairments in a range of adaptive behaviors, social adjustment, and social participation. Impaired cognitive ability and more problem behaviors correlated with impaired social adjustment, particularly in stroke cases. Larger infarcts correlated with greater neurological impairment, lower IQ, and poorer social participation. Conclusions Stroke can result in impaired adaptive and social functioning without apparent deficits in IQ or behavior. Infarct size, residual neurological deficits, impaired cognitive ability, and problem behaviors increase the risk for poor social adjustment and participation. These findings can help the clinician anticipate impaired social functioning after pediatric stroke, which is important because age-specific treatments are available. [ABSTRACT FROM AUTHOR]
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- 2014
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15. Evaluation of Serum Carnitine Levels for Pediatric Patients Receiving Carnitine-Free and Carnitine-Supplemented Parenteral Nutrition.
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Winther, Brian, Jackson, Daniel, Mulroy, Cecilia, and MacKay, Mark
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PARENTERAL feeding ,BLOOD sugar analysis ,MITOCHONDRIAL physiology ,CARNITINE ,CARRIER proteins ,CHILDREN'S hospitals ,DIETARY supplements ,FATTY acids ,HOSPITALS ,PEDIATRICS ,PHARMACOLOGY ,RETROSPECTIVE studies ,THERAPEUTICS - Published
- 2014
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16. The ketogenic diet in refractory childhood epilepsy.
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Mackay, Mark T., Bicknell-Royle, Jillian, Nation, Judy, Humphrey, Maureen, and Harvey, A. Simon
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CHILDHOOD epilepsy , *PEDIATRIC neurology , *KETOGENIC diet , *DIET in disease , *EPILEPSY , *PEDIATRICS - Abstract
Objective : To report the efficacy and tolerability of the ketogenic diet (KD) in refractory paediatric epilepsy. Methods : Twenty-six consecutive children were treated with the classical KD from 1996 to 2001. The epilepsy syndromes included symptomatic generalized epilepsy (15), idiopathic generalized epilepsy (4), symptomatic partial epilepsy (1) and unclassified epilepsy (6). One child was lost to follow up. Results : Median age at initiation of the KD was 6.1 years. Median duration of the treatment was 9 months. Twelve children (48%) were treated for >12 months; one still remains on the KD. Four children (16%) became seizure-free. Five children (20%) had 50–99% reduction in seizures, seven (28%) had <50% reduction in seizures and eight (36%) had no improvement. Age, seizure-type and aetiology did not predict response. The medications were decreased in 33% of the children. The KD was discontinued in 64% of the children because of poor efficacy and in 12% because of side-effects. Problems during initiation of the KD included asymptomatic hypoglycaemia (24%) and vomiting (12%). Later complications included poor growth (20%), hyperlipidaemia (16%), hypercalcuria (8%), hypocarnitaemia (8%), constipation (8%), pancreatitis (4%) and decreased bone density (4%). There were no deaths. A 3-month trial of the KD costs $A3879. The first 12 months cost $A7275 with a cost of $A4528 each year, thereafter. Conclusions : The KD is an effective treatment for some children with refractory epilepsy, being generally well tolerated and rarely associated with side-effects. Response is not necessarily predicted by age, syndrome or aetiology. A prospective study of the KD is presently underway. [ABSTRACT FROM AUTHOR]
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- 2005
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17. Facial Function in Bell Palsy in a Cohort of Children Randomized to Prednisolone or Placebo 12 Months After Diagnosis.
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Babl, Franz E., Herd, David, Borland, Meredith L., Kochar, Amit, Lawton, Ben, Hort, Jason, West, Adam, George, Shane, Oakley, Ed, Wilson, Catherine L., Hopper, Sandy M., Cheek, John A., Hearps, Stephen, Mackay, Mark T., Dalziel, Stuart R., and Lee, Katherine J.
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BELL'S palsy , *FACIAL paralysis , *DIAGNOSIS , *PREDNISOLONE , *MOTOR neurons , *PLACEBOS - Abstract
Information on the medium-term recovery of children with Bell palsy or acute idiopathic lower motor neuron facial paralysis is limited. We followed up children aged 6 months to <18 years with Bell palsy for 12 months after completion of a randomized trial on the use of prednisolone. We assessed facial function using the clinician-administered House-Brackmann scale and the modified parent-administered House-Brackmann scale. One hundred eighty-seven children were randomized to prednisolone (n = 93) or placebo (n = 94). At six months, the proportion of patients who had recovered facial function based on the clinician-administered House-Brackmann scale was 98% (n = 78 of 80) in the prednisolone group and 93% (n = 76 of 82) in the placebo group. The proportion of patients who had recovered facial function based on the modified parent-administered House-Brackmann scale was 94% (n = 75 of 80) vs 89% (n = 72 of 81) at six months (OR 1.88; 95% CI 0.60, 5.86) and 96% (n = 75 of 78) vs 92% (n = 73 of 79) at 12 months (OR 3.12; 95% CI 0.61, 15.98). Although the vast majority had complete recovery of facial function at six months, there were some children without full recovery of facial function at 12 months, regardless of prednisolone use. [ABSTRACT FROM AUTHOR]
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- 2024
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18. Trajectories of Motor Recovery in the First Year After Pediatric Arterial Ischemic Stroke.
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Cooper, Anna N., Anderson, Vicki, Hearps, Stephen, Greenham, Mardee, Ditchfield, Michael, Coleman, Lee, Hunt, Rod W., Mackay, Mark T., Monagle, Paul, and Gordon, Anne L.
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ISCHEMIA diagnosis , *MOTOR ability , *STROKE diagnosis , *AGE distribution , *AGE factors in disease , *CEREBRAL arteries , *ISCHEMIA , *LONGITUDINAL method , *PEDIATRICS , *STROKE , *INDIVIDUALIZED medicine , *STROKE rehabilitation , *DESCRIPTIVE statistics , *DISEASE complications - Abstract
BACKGROUND: Neuromotor impairments are common after pediatric stroke, but little is known about functional motor outcomes. We evaluated motor function and how it changed over the first 12 months after diagnosis. We also examined differences in outcome according to age at diagnosis and whether fine motor (FM) or gross motor (GM) function at 12 months was associated with adaptive behavior. METHODS: This prospective, longitudinal study recruited children (N = 64) from The Royal Children's Hospital, Melbourne who were diagnosed with acute arterial ischemic stroke (AIS) between December 2007 and November 2013. Motor assessments were completed at 3 time points after the diagnosis of AIS (1, 6, and 12 months). Children were grouped as follows: neonates (n = 27), preschool-aged (n = 19), and school-aged (n = 18). RESULTS: A larger lesion size was associated with poorer GM outcomes at 12 months (P = .016). Neonatal AIS was associated with better FM and GM function initially but with a reduction in z scores over time. For the preschool- and school-aged groups, FM remained relatively stable over time. For GM outcomes, the preschool- and the school-aged age groups displayed similar profiles, with gradual recovery over time. Overall, poor FM and GM outcomes at 12 months were associated with poorer adaptive behavior scores. CONCLUSIONS: Motor outcomes and the trajectory of recovery post-AIS differed according to a child's age at stroke onset. These findings indicate that an individualized approach to surveillance and intervention may be needed that is informed in part by age at diagnosis. [ABSTRACT FROM AUTHOR]
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- 2017
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19. Stroke in Children With Cardiac Disease: Report From the International Pediatric Stroke Study Group Symposium.
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Sinclair, Adriane J., Fox, Christine K., Ichord, Rebecca N., Almond, Christopher S., Bernard, Timothy J., Beslow, Lauren A., Chan, Anthony K.C., Cheung, Michael, deVeber, Gabrielle, Dowling, Michael M., Friedman, Neil, Giglia, Therese M., Guilliams, Kristin P., Humpl, Tilman, Licht, Daniel J., Mackay, Mark T., and Jordan, Lori C.
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HEART diseases , *PEDIATRICS , *STROKE prevention , *DISEASE incidence , *COMPUTED tomography , *ULTRASONIC imaging - Abstract
Background Cardiac disease is a leading cause of stroke in children, yet limited data support the current stroke prevention and treatment recommendations. A multidisciplinary panel of clinicians was convened in February 2014 by the International Pediatric Stroke Study group to identify knowledge gaps and prioritize clinical research efforts for children with cardiac disease and stroke. Results Significant knowledge gaps exist, including a lack of data on stroke incidence, predictors, primary and secondary stroke prevention, hyperacute treatment, and outcome in children with cardiac disease. Commonly used diagnostic techniques including brain computed tomography and ultrasound have low rates of stroke detection, and diagnosis is frequently delayed. The challenges of research studies in this population include epidemiologic barriers to research such as small patient numbers, heterogeneity of cardiac disease, and coexistence of multiple risk factors. Based on stroke burden and study feasibility, studies involving mechanical circulatory support, single ventricle patients, early stroke detection strategies, and understanding secondary stroke risk factors and prevention are the highest research priorities over the next 5-10 years. The development of large-scale multicenter and multispecialty collaborative research is a critical next step. The designation of centers of expertise will assist in clinical care and research. Conclusions There is an urgent need for additional research to improve the quality of evidence in guideline recommendations for cardiogenic stroke in children. Although significant barriers to clinical research exist, multicenter and multispecialty collaboration is an important step toward advancing clinical care and research for children with cardiac disease and stroke. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
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20. Role of the sodium channel SCN9A in genetic epilepsy with febrile seizures plus and Dravet syndrome
- Author
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Saul A. Mullen, Deepak Gill, Mark T Mackay, Jacinta M McMahon, Sanyjay Sisodiya, Michael Harbord, Lynette G. Sadleir, Bree L. Hodgson, Elaine C. Wirrell, Samuel F. Berkovic, Richard Webster, Susannah T. Bellows, Andrew Bleasel, John C. Mulley, Eva Andermann, Leanne M. Dibbens, Xenia Iona, Ingrid E. Scheffer, Kevin Farrell, Sara Kivity, Mulley, John, Hodgson, Bree, McMahon, Jacinta M, Iona, Xenia, Bellows, Susannah, Mullen, Saul A, Farrell, Kevin, Mackay, Mark, Sadleir, Lynette, Bleasel, Andrew, Gill, Deepak, Webster, Richard, Wirrell, Elaine C, Harbord, Michael, Sisodiya, Sanyjay, Andermann, Eva, Kivity, Sara, Berkovic, Samuel F, Scheffer, Ingrid E, and Dibbens, Leanne Michelle
- Subjects
Pediatrics ,medicine.medical_specialty ,Genotype ,Epilepsies, Myoclonic ,genetic epilepsy with febrile seizures plus ,Seizures, Febrile ,Sodium Channels ,Genetic epilepsy ,Dravet syndrome ,SCN1B ,Febrile seizure ,Genetic predisposition ,Medicine ,febrile seizures ,susceptibility gene ,Humans ,Genetic Predisposition to Disease ,SCN1A ,Genetics ,genetic modifier ,SCN9A ,business.industry ,Sodium channel ,NAV1.7 Voltage-Gated Sodium Channel ,Genetic variants ,clinical heterogeneity ,medicine.disease ,Pedigree ,Neurology ,Mutation ,Neurology (clinical) ,business ,genetic susceptibility - Abstract
Mutations of the SCN1A subunit of the sodium channel is a cause of genetic epilepsy with febrile seizures plus (GEFS+) in multiplex families and accounts for 70–80% of Dravet syndrome (DS). DS cases without SCN1A mutation inherited have predicted SCN9A susceptibility variants, which may contribute to complex inheritance for these unexplained cases of DS. Compared with controls, DS cases were significantly enriched for rare SCN9A genetic variants. None of the multiplex febrile seizure or GEFS+ families could be explained by highly penetrant SCN9A mutations. Refereed/Peer-reviewed
- Published
- 2013
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