Abstract NS15: Behavioral Outcomes in Pediatric Stroke: Emotional Changes and Depression in the Pediatric NIH Stroke Scale Cohort

Background and Purpose: Stroke affects 2-13/100,000 children annually and ranks among the top ten causes of childhood death with long-term deficits in 40-60% of survivors. Parents report behavioral changes, such as short temper, irritability, or symptoms of depression. Using data collected in the multicenter study to validate the Pediatric NIH Stroke Scale, we report the prevalence and factors associated with emotional changes and depression following childhood stroke. Methods: Children 2-18 years old with arterial ischemic stroke were prospectively enrolled over 34 months at 15 sites with daily PedNIH Stroke Scale examination. Outcomes were assessed by Pediatric Stroke Outcome Measure (PSOM) at 3 and 12 months. Parents reported the presence or absence of emotional changes or depression. Hemispheric localization and vascular distribution was determined by MRI. Associations were evaluated by logistic regression. Results: 105 children were enrolled (mean age 10.4y, 63% male). Emotional changes were reported in 39/93 (42%) at 3m and 28/78 (36%) at 12m. Depressive symptoms were reported in 13/93 (14%) and 11/80 (14%) at 3 and 12m, respectively. Among those with data at both timepoints, emotional changes present at 3m resolved at 12m for 9/30 (30%) and 6/41 (15%) of those initially without changes at 3m, developed emotional changes at 12m. Symptoms of depression resolved at 12m in 7/12 (58%) with symptoms at 3m, while 5/60 (8.3%) of those without symptoms at 3m reported depressive symptoms at 12m. In multivariate analyses, only PSOM, and not gender, hemispheric lateralization, vascular distribution, or PedNIHSS were predictive of emotional changes or depressive symptoms. Conclusions: Behavioral changes affect a large proportion of children after stroke. In multivariate analysis, parent-reported emotional changes and depression correlated with physician scored severity (PSOM). Behavioral assessment of pediatric stroke survivors and parental education is needed as children encounter emotional struggles in recovery. These potentially treatable behavioral changes could impede therapy and inhibit maximal recovery.