Seizures are symptoms of strokes in foetuses and babies

Noticing that her daughter, Noelle, didn't reach with her right hand, Judy Bergman assumed the infant was left-handed. But an MRI taken when Noelle was 7 months old confirmed that she had suffered a stroke, most likely before she was born. "I had never heard of a child having a stroke," said the Grayslake mother of two, recalling her shock.

She remembers thinking: "What is the future going to hold? What are her challenges going to be?"The American Heart Association last month issued guidelines to physicians for the first time on the diagnosis and treatment of stroke in infants and children. The group said that strokes are far more common in children than previously thought and that the causes, risks and symptoms differ greatly from those in adults.The guidelines were developed because early diagnosis and therapy are critical to helping children recover the best they can.

'Challenges'Childhood strokes are not increasing in prevalence, doctors emphasized. Instead, improved knowledge has led to greater recognition of it. For example, doctors now believe that cerebral palsy and intracranial bleeding are different forms of strokes.

And though a stroke can be devastating medically, researchers are finding that children have greater potential to recover and adapt than adults because of the plasticity of their brains, said Susan Levine, a professor of psychology at the University of Chicago.For example, a stroke that injures the left hemisphere of the adult brain typically causes problems with speech.

Children, on the other hand, continue to acquire language skills, although language development is usually delayed, Levine said."Up until age 13, there is the ability to transfer language processing from the left to the right hemisphere of the brain," said Dr. Deborah Gaebler-Spira, director of the cerebral palsy program at the Rehabilitation Institute of Chicago. "So our anticipation of recovery of certain very distinct brain functions is much more optimistic for children."

Most children suffer strokes on one side of their brains (Noelle's was in the left hemisphere). The most common risk factors are sickle cell disease and birth defects of the heart.At least half of children who have strokes are left with residual impairment or disability, said Dr. Jose Biller, guidelines co-author and chairman of neurology at Loyola University Chicago Stritch School of Medicine.

As part of a research project funded by the National Institutes of Health, for five years Levine has been studying a group of 40 children as young as 14 months who have had a stroke and 60 children who have not. The researchers videotaped interactions between the children and their parents.So far their research suggests that for children who have had a stroke, "there are slight delays in getting language off the ground, but their progress is pretty similar to the typically developing children," Levine said.

The researchers will continue to follow the children to determine if they have difficulty developing the more complex language skills needed to succeed in school.About 10 in every 100,000 children in the U.S. suffer a stroke in a given year. The risk is greatest in the first year of life, particularly in the first two months.Only people older than 65 have a higher stroke risk than babies younger than a month, said Dr. E. Steve Roach, chairman of the task force that developed the American Heart Association guidelines. Roach is neurologist in chief at Nationwide Children's Hospital in Columbus, Ohio.

SeizuresIn newborns and babies affected in utero, the first symptoms of a stroke often are seizures that involve a single limb. Such seizures are so common that stroke is believed to account for about 10 percent of seizures in full-term newborns, Roach said.Bergman mentioned Noelle's preference for her left hand to the child's doctor during a routine exam.

The MRI diagnosed the stroke. (Children generally do not show a hand preference before age 2.)Noelle, now 5, has been undergoing physical and occupational therapy, and recently completed speech therapy. Casts, and later braces, were placed on her legs to increase her range of motion and correct her gait.

Her biggest challenge now is improving her limited use of her right hand.Said Bergman: "When we started on this journey I was shocked. I was heartbroken. ... Now I think because I see how well she's doing, I know truly in my heart, she will be able to do anything she wants to do."