The Cerebrovascular Disorders and Stroke Program at Boston Children's Hospital is one of a few specialized programs in the Unites States dedicated to understanding, preventing and treating childhood strokes. We are one of the most active pediatric stroke research centers in the world—both clinically and in the laboratory—working continually to improve treatments. Our multidisciplinary team at Boston Children’s Hospital is one of a small group of pediatric primary stroke centers in North America, working to establish a 24/7 standardized care program for children with stroke.
Collaborative clinical studies
Boston Children’s participates in three major multi-center studies of pediatric stroke:
Michael Rivkin, MD, discusses research underway to treat pediatric strokes with clot-busting drugs, similar to those used to treat adult strokes.
The current standard of care for adults, if the stroke is caught early, is to give intravenous tissue plasminogen activator (tPA) to dissolve any blood clot that might be causing the stroke. The five-year international Thrombolysis in Pediatric Stroke (TIPS) study is investigating intravenous tPA for children with acute ischemic stroke. Boston Children’s and other pediatric primary stroke centers are enrolling children 2 to 17 years old, who present within 4.5 hours of stroke onset, to test the safety of three alternative intravenous doses of tPA. A recent study found that providing TIPS training to pediatric centers increased their readiness to treat children with acute stroke.
International Pediatric Stroke Study
Led by Michael Rivkin, MD, Laura Lehman, MD, and Cameron Trenor, MD, this collaborative research project is collecting standardized data on the diagnosis, investigation, treatment and outcome of children with stroke, to better understand stroke conditions in newborns and older children. The information is shared in an international data repository used to help practitioners around the world better understand stroke in children. Ultimately, the study's data will lead to clinical trials.
Infection and stroke
The Vascular Effects of Infection in Pediatric Stroke (VIPS) Study
This NIH-funded multicenter study, led by Michael Rivkin, MD, is exploring the hypothesis that infection can lead to arterial ischemic stroke in children by injuring the blood vessels, and that the resulting arterial damage and biochemical markers of inflammation can predict additional stroke.
Ongoing clinical studies at Boston Children’s
Transient ischemic attacks in children
Laura Lehman, MD
, one of the full-time attending staff neurologists in the Cerebrovascular Disorders and Stroke Program, is actively researching TIAs in children and their relationship with subsequent stroke. She has presented her work
at the International Stroke Conference.
Cerebrovascular surgery/intervention database
Malformations of the blood vessels are a common cause of stroke in children. Darren Orbach, MD, PhD
, and Edward Smith, MD
, maintain a comprehensive, dynamic database of patients with cerebrovascular disease—representing the largest pediatric experience in the world—allowing them to conduct research evaluating interventions and patient outcomes over time. For more information, visit their research page
and view their selected papers
Michael Rivkin, MD, and Amy Danehy, MD
, are investigating non-invasive perfusion magnetic resonance imaging as a method to look at the brain's blood supply and circulation in neonates and older children who are having or have had a stroke. Such imaging avoids the need to inject dye for use as intravascular contrast, does not require an IV and poses no risk of damaging or rupturing a blood vessel. Read some results of this research
Restoring thumb control after hemiplegic stroke
This study, co-led by Annette Correia, OT
, of the Occupational Therapy Service, is testing a specially designed, powered orthotic device called IOTA
that is designed to help children with stroke and other conditions regain use of their thumbs.
Treatment of seizures in newborns after brain injury
A pilot study is testing bumetanide to treat seizures caused by focal or multi-focal stroke, intracranial hemorrhage or hypoxic-ischemic encephalopathy that are not controlled by phenobarbital.
Blood clot formation
Research by Cameron Trenor, MD, aims to understand the mechanism of small artery blood clot formation, similar to what occurs in some stroke patients. He is also interested in vascular anomalies, which can lead to stroke or bleeding around or within the brain.
Cognitive outcomes after stroke in childhood
Christine Mrakotsky, PhD, is studying children with extensive neuropsychological evaluations to determine the ways in which stroke affects children’s developing cognition.
Basic laboratory research may eventually improve our treatment of stroke and help children recover from its effects.
Biomarkers of cerebrovascular disease
Neurosurgeon Edward Smith, MD, is beginning to identify telltale proteins in the urine of patients with cerebrovascular disorders, such as moyamoya disease
and arteriovenous malformations
. These easy-to-measure “biomarkers” may help in diagnosing and monitoring CVD, reducing the need for children to visit the hospital for follow-up imaging studies. Read more
Darren Orbach, MD, PhD, is conducting basic research around the development of a high-speed MR technique for directly imaging rapid neuronal activity. The high-speed MR technique is currently being used to help further the understanding of the pathophysiology of various epilepsy syndromes.