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December 19, 2019

Comparative study of posterior and anterior circulation stroke in childhood
Results from the International Pediatric Stroke Study

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Barbara Goeggel Simonetti, MD, Mubeen F. Rafay, MBBS, MSc, Melissa Chung, MD, Warren D. Lo, MD, Lauren A. Beslow, MD, Lori L. Billinghurst, MD, Christine K. Fox, MD, Alberto Pagnamenta, MD, MSc, Maja Steinlin, MD, and Mark T. Mackay, MBBS, PhD for the IPSS Study GroupAuthors Info & Affiliations
January 28, 2020 issue
94 (4) e337-e344
https://doi.org/10.1212/WNL.0000000000008837
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Abstract

Objective

To compare risk factors, clinical presentation, and outcomes after posterior circulation arterial ischemic stroke (PCAIS) and anterior circulation arterial ischemic stroke (ACAIS) in neonates and children.

Methods

In this international multicenter observational study including neonates and children up to 18 years of age with arterial ischemic stroke (AIS), we compared clinical and radiologic features according to stroke location.

Results

Of 2,768 AIS cases, 507 (18%) were located in the posterior circulation, 1,931 (70%) in the anterior circulation, and 330 (12%) involved both. PCAIS was less frequent in neonates compared to children (8.8% vs 22%, p < 0.001). Children with PCAIS were older than children with ACAIS (median age 7.8 [interquartile range (IQR) 3.1–14] vs 5.1 [IQR 1.5–12] years, p < 0.001), and more often presented with headache (54% vs 32%, p < 0.001) and a lower Pediatric NIH Stroke Scale score (4 [IQR 2–8] vs 8 [IQR 3–13], p = 0.001). Cervicocephalic artery dissections (CCAD) were more frequent (20% vs 8.5%, p < 0.001), while cardioembolic strokes were less frequent (19% vs 32%, p < 0.001) in PCAIS. Case fatality rates were equal in both groups (2.9%). PCAIS survivors had a better outcome (normal neurologic examination at hospital discharge in 29% vs 21%, p = 0.002) than ACAIS survivors, although this trend was only observed in children and not in neonates.

Conclusion

PCAIS is less common than ACAIS in both neonates and children. Children with PCAIS are older and have a higher rate of CCAD, lower clinical stroke severity, and better outcome than children with ACAIS.

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Information & Authors

Information

Published In

Neurology®
Volume 94 • Number 4 • January 28, 2020
Pages: e337-e344
PubMed: 31857436

Copyright

© 2020 American Academy of Neurology.

Publication History

Received: March 11, 2019
Accepted: August 7, 2019
Published online: December 19, 2019
Published in print: January 28, 2020

Permissions

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Study Funding

This research was supported by The Auxilium Foundation.

Authors

Affiliations & Disclosures

Barbara Goeggel Simonetti, MD
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1)Swiss National Science Foundation (SNSF), Grant Nr: SPUM Grants 140340, 33CM30. 2012.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) Swiss Heart Foundation. 2013. (2) Fondazione Neuroscienze Ticino (3) Swiss Society of Hypertension
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Mubeen F. Rafay, MBBS, MSc
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
Member, National Institute of Neurological Disorders and Stroke (NINDS) and National Institute of Health (NIH) Stroke Common Data Elements NINDS v2.0, Stroke Long Term Therapies Working Subgroup
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
I am a member of the International Advisory board for the Journal of Pakistan Medical Association Editorial board, Member, Annals of Abbasi Shaheed Hospital and Karachi Medical and Dental College, Pakistan, and the World Journal of Neurology and review committee for the Journal of Pediatric Neurology. I receive no compensation for these services.
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
Research Grant to support my research from the Manitoba Institute of Child Health.
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
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NONE
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Melissa Chung, MD
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1)NIH, RO1 NS096714-01A1, site PI, 2017 - present
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Warren D. Lo, MD
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
I am on the editorial board of Neurology since 2019.
Patents:
1.
NONE
Publishing Royalties:
1.
Pediatric Stroke and Cerebrovascular Disorders, published 2011
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
1U01NS106655-01A1 Ramey, and Lo MPI Virginia Tech / National Institutes of Health (NIH) 4/1/2018 – 3/31/2023 Infant ACQUIRE 5 U54 NS 065705-10 REVISED M. Lawton (UCSF PI) University of California San Francisco / National Institutes of Health (NIH) 9/30/2014 – 7/31/2019 Brain Vascular Malformation Clinical Research Network (BVMC) Role: Co-investigator U24NS107205 S. Kolb (OSU PI) W. Lo NCH Site PI Ohio State University/NINDS 7/1/2018 – 6/30/2019 Network of Excellence in Neuroscience Clinical Trial Center (82146816) J. Heathcock (OSU PI) Ohio State University Office of Sponsored Programs / Patient Centered Outcomes Research Institute (PCORI) 9/15/2016 – 8/15/2019 A Comparison: High Intense periodic vs. Every week therapy in children with cerebral palsy (ACHIEVE) Role: Co-investigator R01 NS 06820 -05 H. Fullerton (UCSF PI) University of California San Francisco / National Institutes of Health (NIH) 9/1/2017 – 6/30/2019 VIPS II - The Vascular effects of Infection in Pediatric Stroke 2017 Role: Co-investigator R01 HD 083384 -01 J. Heathcock (OSU PI) Ohio State University Office of Sponsored Programs / National Institutes of Health (NIH) 4/1/2016 – 1/31/2020 Frequency: Dosing for Rehabilitation Delivery in children with Cerebral Palsy Role: Co-investigator 1R01HD074574-01A1 A. Darragh (OSU PI) Ohio State University Office of Sponsored Programs / Virginia Polytechnic Institute/ NICHD/NIH 03/01/2014 – 6/30/2019 Multisite RCT of 3 Neurorehabilitation Therapies for Infants with Asymmetrical CP Role: Co-investigator PENDING C. Fox (UCSF PI) University of California San Francisco/National Institutes of Health 9/1/2019 – 8/31/2024 Seizures and Children's OUTcomes after Stroke (SCOUTS) Role: Co-Investigator
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Lauren A. Beslow, MD
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
I am on the DSMB for the NIH funded trial, Primary Prevention of Stroke in Children With SCD in Sub-Saharan Africa II (SPRING).
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
I am on the Editorial Board of Stroke from 2019-Present.
Patents:
1.
NONE
Publishing Royalties:
1.
Up to Date article entitled, "Hemorrhagic Stroke in Children" - originally published circ 2016
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Biogen
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Lori L. Billinghurst, MD
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
1. NIH/NINDS, HEAL-EEG (Neurophysiologic measures of Epo treatment for hypoxic-ischemic encephalopathy (HIE)), Site PI, 2018-2019
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Christine K. Fox, MD
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
Data Safety Monitoring Board, NIH-NHLBI
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
UpToDate contributor, Wolters Kluwer Health
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
1. NIH-NINDS, R01 NS1104094, Co-Investigator, 2017-2019
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
1. Pediatric Epilepsy Research Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Alberto Pagnamenta, MD, MSc
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Maja Steinlin, MD
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
Schweizerische Muskelgesellschaft TCS advisory board Switzerland
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Cerebellum European Journal of Paediatric Neurology
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Schweizerische Herzstiftung Batzebär Universtiät Bern Novartis Research Foundation Neuropsychiatrische Forschungsstiftung Swiss National Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Mark T. Mackay, MBBS, PhD
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Frontiers in Neurology, associate editor, 2017 onwards
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
National Health and Medical Research Council. Grant ID APP1065794. Chief investigator (2014-2016).
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Murdoch Children’s Research Institute, Australia The Brain Foundation, Australia The National Stroke Foundation, Australia. The Ian Potter Foundation, Australia
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
for the IPSS Study Group
From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
View all articles by this author

Notes

Correspondence Dr. Goeggel Simonetti [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Coinvestigators are listed at links.lww.com/WNL/B34.

Author Contributions

B.G.S. designed/conceptualized the study, analyzed/interpreted the data, drafted the manuscript, and collected data. M.F.R. designed/conceptualized the study, interpreted the data, collected data, and reviewed and edited the manuscript for content. M.C., W.D.L., L.A.B., L.L.B., C.K.F.: data collection, critical review of the manuscript, editing manuscript for content. A.P. analyzed/interpreted the data and reviewed the manuscript, editing manuscript for content. M.T.M., M.S.: initiated, designed, conceptualized, and supervised the study, analyzed/interpreted the data, revised the manuscript, and collected data. All authors agreed on submission of the present version of the manuscript.

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