Expert opinion on emerging drugs in childhood arterial ischemic stroke.

INTRODUCTION: Vascular stroke syndromes in childhood (arterial ischemic stroke (AIS), cerebral sinovenous thrombosis and non-traumatic intracranial hemorrhage) are increasingly recognized as important causes of mortality and morbidity, with significant personal and societal economic costs. The disease mechanisms underlying childhood AIS differ significantly from adults; in particular, atheroma plays an extremely minor role in children. However, to date, treatment principles in children have been based on extrapolation from adult data, usually by consensus expert opinion. AREAS COVERED: This review article summarizes the current pharmacological treatments of childhood AIS, the evidence supporting these and proposes future treatment targets directed at underlying disease mechanisms. This is categorized into acute management, secondary prevention, emerging treatments and future treatments. EXPERT OPINION: There is a paucity of robust data supporting current treatment approaches in childhood AIS. There are currently no recommended acute treatments; the role of thrombolysis in children remains to be determined. Aspirin, heparin and warfarin are used as secondary prevention therapies, but have not been shown to be superior to placebo. Non-atheromatous arteriopathy is now recognized as an important risk factor for recurrent AIS in children; further understanding of its etiology and pathophysiology could lead to identification of future therapeutic targets.