Research Training Fellowship: Dr D Eleftheriou

Published on 3 June 2009

Stroke in children – research brings new hope

Each year, Action Medical Research awards these prestigious grants to help the brightest and best doctors and scientists develop their career in medical research. Dr Eleftheriou’s grant of £191,375 will fund her three-year study into strokes in children – a potentially devastating problem that is surprisingly common.

Introduction

Each year in the UK, hundreds of children suffer a stroke, often with devastating results – two thirds of survivors develop long-term problems, such as movement or learning difficulties, and up to a one third go on to have another stroke.^1-5

Dr Despina Eleftheriou is a talented researcher who became determined to improve the lives of young stroke victims after caring for children at London’s Great Ormond Street Hospital. She hopes to boost understanding of what causes strokes and develop new blood tests to help predict which children are at risk of suffering further strokes, with the ultimate aim of developing better treatments.

She said: "Action Medical Research has given me a once-in-a-lifetime opportunity to make a real difference to the lives of children who have suffered a stroke - with a prospect of changing treatment strategies all round the world."

The problem

Stroke in childhood

Strokes are often thought of as a problem facing the elderly, but hundreds of children have a stroke each year in the UK.^1-3 Around half of these children have another medical condition, such as heart disease or sickle cell disease, which puts them at increased risk.^6-7 For the remainder, their stroke comes totally out of the blue.

A stroke is a sudden brain attack: blood supply to part of the brain is cut off, meaning brain cells can be damaged or destroyed.

The effects of a stroke can be devastating – for the children and their families. ‘In the long term, around two thirds of children who survive a stroke have residual movement difficulties, around a third have difficulties with emotion and behaviour, and the child’s ability to think and learn may be affected in a variety of ways,’ explains Dr Eleftheriou.⁴ The most badly affected children can lose their lives.

Sadly, some children also suffer a recurrence. ‘Nearly a third of children will have a further stroke and the uncertainty about whether this will occur, and anxieties about how to prevent this, have a major impact on the child and family,’ says Dr Eleftheriou.⁵

The research

What causes strokes in children and can they be predicted?

Dr Eleftheriou aims to improve understanding of what causes strokes during childhood. ‘In this project, we aim to investigate whether inflammation and/or injury of the blood vessels in the brain could play a part in causing strokes in children,’ she explains. A key area of focus is how the disease processes involved in inflammation and injury progress in children who go on to suffer more than one stroke.

Dr Eleftheriou is also investigating whether it is possible to predict which children are likely to suffer a further stroke by analysing the levels of particular substances in their bloodstream. These substances, called ‘biomarkers’, are produced when blood vessels in the brain are damaged and they may circulate in the bloodstream.

At least 60 babies and children who have suffered a stroke are taking part in the study, along with healthy children for comparison.

‘I am grateful for the great opportunity I have been given to study the role of inflammation in childhood stroke,’ says Dr Eleftheriou. ‘Action Medical Research aims to deliver an extensive portfolio of life-changing research in childhood disease and disability, making it an ideal charity to fund my project.’

Who benefits

Paving the way for better treatment

By boosting understanding of what causes stroke in children, this research could lead to better treatments. ‘This research has the potential to transform the bleak outlook that children who have suffered a stroke can face’, explains Dr Eleftheriou. ‘If inflammation is shown to play a role in causing strokes, then drugs called immunosuppressants, which are already used to treat inflammation in other conditions, may help prevent further strokes in affected children.’

Dr Eleftheriou also hopes the new blood tests she is developing will enable better predictions of which children are likely to have another stroke, so that treatment can be targeted to children who need it most. This is important because some immunosuppressants have many side effects, meaning they should be given only to children who are most at risk of further strokes.

Investing in talent

This fellowship also represents a major step forward for Dr Eleftheriou. She already has a deep understanding of how long-term illness affects children and their families, after working as a doctor at Great Ormond Street Hospital. Now she is determined to seize this opportunity to learn cutting-edge research skills, so that she can dedicate her career to developing life-changing new treatments.

References

1. Callaghan F, Williams A, Davis A, Kirkham F. Incidence of childhood stroke in the UK: Data from the British Paediatric Surveillance Unit and the Strategic Health Authority. Arch Dis Child 2003; 88(Suppl 1):A35-A36.
2. Pappachan J, Kirkham FJ. Cerebrovascular disease and stroke. Arch Dis Child 2008;93:890-8.
3. Paediatric Stroke Working Group. Stroke in childhood. Clinical guidelines for diagnosis, management and rehabilitation. Clinical Effectiveness and Evaluation Unit. Royal College of Physicians, November 2004.
4. Ganesan V, Hogan A, Shack N, Gordon A, Isaacs E, Kirkham FJ. Outcome after ischaemic stroke in childhood. Dev Med Child Neurol 42:455– 461, 2000.
5. Ganesan V, Prengler M, Wade A, Kirkham FJ. Clinical and radiological recurrence after childhood arterial ischemic stroke. Circulation. 2006;114:2170-7.
6. Amlei-Lefond C, Sebire G, Fullerton HJ. Recent developments in childhood arterial ischaemic stroke. Lancet Neurol 2008 May;7 (5): 425-35
7. Ganesan V, Prengler M, McShane MA, Wade AM, Kirkham FJ. Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol 2003; 53: 167–73.