alexa Maintenance Treatment of Childhood Primary Angiitis of
ISSN: 2161-0665

Pediatrics & Therapeutics
Open Access

Like us on:
OMICS International organises 3000+ Global Conferenceseries Events every year across USA, Europe & Asia with support from 1000 more scientific Societies and Publishes 700+ Open Access Journals which contains over 50000 eminent personalities, reputed scientists as editorial board members.

Open Access Journals gaining more Readers and Citations

700 Journals and 15,000,000 Readers Each Journal is getting 25,000+ Readers

This Readership is 10 times more when compared to other Subscription Journals (Source: Google Analytics)

Case Report

Maintenance Treatment of Childhood Primary Angiitis of Central Nervous System with Aspirin and Azathioprine

Muhammad Akbar Malik1*, Naseer Ahmad2 and Hamza Malik3

1The Brain Associates, 218 D Model Town Lahore, Pakistan

2Department of Neurosciences, Children’s Hospital Lahore, Pakistan

3Department of Pediatric CMH Lahore, Pakistan

*Corresponding Author:
Muhammad Akbar Malik
The Brain Associates
218 D Model Town Lahore, Pakistan
Tel: 00924235869467, 00966508142686
E-mail: [email protected]

Received Date: August 22, 2013; Accepted Date: October 16, 2013; Published Date: October 21, 2013

Citation: Malik MA, Ahmad N, Malik H (2013) Maintenance Treatment of Childhood Primary Angiitis of Central Nervous System with Aspirin and Azathioprine. Pediat Therapeut 3:174. doi: 10.4172/2161-0665.1000174

Copyright: © 2013 Malik MA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Abstract

Objectives: We aimed to assess the efficacy and safety of Aspirin and Azathioprine in prevention of recurrence of childhood primary angiitis of central nervous system (cPACNS) after induction therapy with intravenous pulse Methylprednisolone/ Immunoglobulin, and describe long-term neurological outcomes in a cohort of children with this disorder. Study type: Case series Methods: The cohort comprised of consecutive patients diagnosed as having childhood primary angiitis of central nervous system (cPACNS), based on clinical and vascular imaging findings, including identification of arterial stenosis on conventional angiography or Magnetic Resonance (MR) angiography. Over the period of 2 years, 68 children with cPACNS were admitted, who presented within 14 days of onset of the symptoms. Patients with ischemic infarcts were initially treated in conjunction with Heparin/ Oral Anticoagulant and IV Methylprednisolone and/or Immunoglobulin, and this was followed by long term use of Aspirin and Azathioprine. Patient were followed in the out patients clinics and were systemically assessed for clinical presentation, hospital course, adverse effects of anticoagulants, aspirin and Azathioprine. The primary outcomes were 1) morbidity and mortality, 2) Paediatric Stroke Outcome Measure (PSOM) scores after the median follow-up of 34 months. Statistical analysis: Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 12.0 (Chicago, IL). Frequencies were calculated for categorical data including gender, final outcome and complications of anticoagulation therapy. Mean with 95% SD was calculated for nominal variables including age. Fisher’s exact test or chi squared test were used, where appropriate to determine any significant difference in outcome with different presenting features, taking p<0.05 as significant. Results: From January 2008, to December 2010, 94 patients with cPACNS were enrolled, 68 of whom met the inclusion criteria and were given induction therapy. The median age at diagnosis was 8.5 years (range 1•6-16 years). 56 patients (boys 35/56, 62%, girls 21/56, 38%) completed induction therapy (with acute mortality of 12/68, 18.5%) and received maintenance therapy with aspirin (n=40) or aspirin and azathioprine (n=16). At the median follow-up of 34 months, of the total 56 patients is; total 30 (30/56, 53.5%) had relapse/flare: first relapse within 24 months after discharge 35.7%: 20 (20/56, 35.7%) died, 15 (15/56, 26.7%) in association with relapse of cPACNS, 5 (5/56, 9%) died due to other causes:14 (14/56, 25%) were receiving Aspirin only: 11 (11/56, 19.6%) were off any medication : 7 (7/56, 12.3%) were receiving both Azathioprine and Aspirin and 4 (4/56, 7.2%) were lost in follow-up. The Neurological findings among 32 patients available to be assessed at last follow up by Paediatric Stroke Outcome Measurement (PSOM) were; normal 8 (8/32, 25%); minor disabilities 10 (10/32, 31.25%; moderate disabilities 10 (10/32, 31.25%) and severe disabilities 4 (4/32, 12.5%). No serious side effects were documented due to low dose aspirin and azathioprine therapy. Conclusion: The spectrum of cPACNS in children includes both progressive and non-progressive forms. Recurrence of cPACNS was high within six months after discharge with high mortality, more among the patients treated with Aspirin than with Azathioprine in conjunction with Aspirin, after initial treatment with IV Methylprednisolone / Immunoglobulin and heparin/ oral anticoagulants.

Keywords

Share This Page

Additional Info

Loading
Loading Please wait..
 
Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

[email protected]

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

[email protected]

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords