title: Immunotherapy for arterial ischaemic stroke in childhood: a systematic review.
abstract: BACKGROUND
  There is little evidence about either prevention or treatment of childhood arterial ischaemic stroke (AIS). However, drugs that regulate the immune and inflammatory response could theoretically prevent occurrence or recurrence of AIS. Additionally, as an acute treatment, they may limit the neurological damage caused by AIS. Here, we systematically review the evidence on the use of immunotherapy in childhood AIS.
  
  
  METHODS
  A systematic review of publications in databases Embase and Medline from inception. All types of evidence were included from trials, cohorts, case-control and cross-sectional studies and case reports.
  
  
  RESULTS
  34 reports were included: 32 observational studies and 2 trials. Immunotherapy was used in two key patient groups: arteriopathy and acute infection. The majority were cases of varicella and primary angiitis of the central nervous system. All three cohorts and 80% of the case studies were treated with steroids. Recurrence rates were low. Analytical studies weakly associated steroids with lower odds of new stroke and neurological deficits, and better cognitive outcomes in the context of Moyamoya disease and tuberculosis.
  
  
  CONCLUSIONS
  Immunotherapies are used in children with AIS, mainly as steroids for children with arteriopathy. However, there is currently little robust evidence to either encourage or discourage this practice. There is weak evidence consistent with the hypothesis that in certain children at risk, steroids may both reduce the risk of occurrent/recurrent stroke and enhance neurological outcomes. As the potential benefit is still uncertain, this indicates that a trial of steroids in childhood AIS may be justified.
authors.affiliation: School of Social and Community Medicine, University of Bristol and National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, Bristol, UK.
authors.forename: Hannah B
authors.identifier: http://orcid.org/0000-0002-1885-4771
authors.initials: HB
authors.lastname: Edwards
authors.affiliation: Department of Paediatric Neurology, University Hospitals Bristol NHS Foundation Trust, Level 6, Education and Research Centre, Bristol, UK.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Mallick
authors.affiliation: Department of Clinical Neurosciences, University College London and Great Ormond Street Hospital for Children Institute of Child Health, University College London, London, UK.
authors.forename: Finbar J K
authors.initials: FJK
authors.lastname: O'Callaghan
mesh_terms: D002545:Brain Ischemia / Q000150:complications*; D002494:Central Nervous System Infections / Q000150:complications; D002648:Child; D019317:Evidence-Based Medicine / Q000379:methods; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D020765:Intracranial Arterial Diseases / Q000150:complications; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000209:etiology / Q000628:therapy*
chemical_list: D005938:Glucocorticoids
keywords: Arterial Ischaemic Stroke; Evidence Based Medicine; Immunotherapy; Neurology; Steroids