Functional independence in 3,5 years old children with neonatal arterial ischemic stroke
Ms Magaly RAVELa, Ms Céline DEGANOb, Prof Vincent GAUTHERONc, Dr Stéphane CHABRIERd, Mr Cyrille RENAUDd
a Université Bordeaux Segalen, b Université Claude Bernard Lyon 1, c LPE, EA4338, Université Jean Monnet, Saint-Etienne, d Centre national de référence de l'AVC de l'enfant et Groupe de recherche sur la thrombose, EA3065, Université Jean Monnet, Saint-Etienne
Introduction : Perinatal ischemic stroke is one of the most common type of stroke in children and the most important cause of unilateral Cerebral Palsy. The object of the study was to find the factors related to lesser functional independence at 3,5 years old, in a population of children with neonatal arterial ischemic stroke.
Patients and methods : It was a french multicentric cohort study (AVCnn cohort), in a population of term born children with neonatal arterial ischemic stroke. 100 newborns were included between November 2003 and October 2006, in 39 french hospital centers. At 3,5 years old, their functional independence was assessed by the Wee-FIM scale. The Wee-FIM stars were compared to healthy children of same age in general population and with the following factors: cerebral palsy, epilepsy, stroke side and mother studies level.
Results: 80 children fulfilled the Wee-FIM scale at 3,5 years old. The motor condition at 7 years old was known in 69 children (42 boys and 27 girls): 23 had cerebral palsy and 7 were epileptic. The AVC was in the right hemisphere in 26% of cases and in the left hemisphere in 74% of cases. 70% of the mothers were graduated more than Bachelor Degree. Functional independence was weaker in the AVCnn cohort than in healthy children of same age in general population, except for alimentation. The most affected fields were bladder control, bath and shower transfers, expression and comprehension. Epilepsy seems to be the most pejorative factor on independence, and even more if associated to cerebral palsy. The most impacted fields were then: dressing, toilet use, sphincters control, and transfers. Stroke side and mother studies level were not associated to significant variation of functional independence.
Conclusion: There is a delay in all functional independence fields in children with neonatal arterial ischemic stroke. Functional independence, assessed by the Wee-FIM scale, seems to be most of all impacted by the presence of epilepsy.
Keywords : neonatal arterial ischemic stroke, Wee-FIM, functional independence