Stroke is the leading cause of adult disability. One in three of us are at risk of stroke or dementia according to Framingham study. Western Health is one of the largest providers in stroke care for fellow Victorians. Our research work in acute stroke medicine has made significant inroads to providing better care for acute stroke patients.

In 2016, the Neurology department had four PhD students continuing their work in brain health related issues at our department in 2016. We had another research student completing her masters degree. Our group published 20 papers in high quality journals during the year 2016 with the START-EXTEND IA clinical trial being published in NEJM in early 2015 and cited by more than 1400 authors since then.

In 2017, we are keen to map the trajectories of stroke and other neurological disorders to promote better brain health through translational research on the back of five PhD students completing their projects at Western Health.

 

OUR RESEARCH

  • Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke Trial

Researchers: Prof Tissa Wijeratne, Elizabeth Mackey, Jennifer Goff, Dr Ben Stevenson et al Collaborators: Neuroscience Trials Australia / The Florey Institute of Neuroscience and Mental Health, in partnership with the University of California San Francisco

This trial is aimed at determining the safety and effectiveness of a combination of low-dose Aspirin and Clopidogrel (compared to Aspirin only), in reducing the risk of stroke, heart attacks, and other complications in TIA or minor ischemic stroke patients. This study will help us to optimise acute therapy in minor strokes and TIAs.

 

  • EXTEND-IA TNK: Extending the Time for Thrombolysis in Emergency Neurological Deficits – Intra Arterial using Intravenous Tenecteplase

Researchers: Prof Tissa Wijeratne, Dr Hans Tu, Elizabeth Mackey, Jennifer Goff, Dr Ben Stevenson et al

Collaborators: Neuroscience Trials Australia / The Florey Institute of Neuroscience and Mental Health, Royal Melbourne Hospital

This trial is aimed at investigating whether ischemic stroke patients selected for endovascular therapy will show improved reperfusion at initial angiogram, following treatment with IV Tenecteplase versus IV Alteplase. This study will help us to find a better clot buster therapy for acute ischemic stroke.

 

  • Cognitive Processing Following Cerebrovascular Events

Researchers: Prof Tissa Wijeratne, Prof Sheila Crewther, Dr Diana Perre, Deena Ebaid, Vinh Nguyen, Dr Ben Ong and Dr Essie Low

Collaborators: La Trobe University

This study aims to investigate the effects of a first TIA or stroke event on information processing, attention, and visual processing functions. This study will contribute to the field of rehabilitation post-stroke by identifying and optimizing better rehabilitation regimes. This will subsequently contribute to increased quality of life (QoL) for communities that suffer from impaired vascular integrity.

 

  • DIDO: Door-in-door-out times in stroke patients transferred for emergency clot retrieval

Researchers: Prof Tissa Wijeratne, Prof Helen Dewey, Dr Philip Choi, Dr Douglas Crompton, Dr Felix Ng, Dr Essie Low, Emily Andrew and Karen Smith

Collaborators: Eastern Health and Northern Health Neurology Departments, Ambulance Victoria

This is a retrospective study aimed at analysing endovascular clot retrieval (ECR) transfer workflow, with emphasis on door-in-door-out (DIDO) times. DIDO time is proposed as a new important clinical performance measure in modern stroke care, and may be used to evaluate the timeliness and quality of initial care at the initial Primary Stroke Centre. DIDO time is a key metric that may emerge as a quality benchmark to ascertain performance and improvement. This audit ultimately aims to identify and quantify delays in the transfer workflow which may be amendable to system optimisation and quality improvement efforts.

 

PUBLICATIONS 2016-17

  1. Beyond Neglect: Preliminary Evidence of Retrospective Time Estimation Abnormalities in Non-Neglect Stroke and Transient Ischemic Attack Patients.Low E, Crewther SG, Perre DL, Ben Ong, Laycock R, Tu H, Wijeratne T.Sci Rep. 2016 Mar 4;6:22598. doi: 10.1038/srep22598
  2. Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 GBD 2015 Maternal Mortality Collaborators ( Wijeratne T) Lancet. 2016 Oct 8;388(10053):1775-1812. doi: 10.1016/S0140-6736(16)31470-2.
  3. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. GBD 2015 Child Mortality Collaborators (Wijeratne T) Lancet. 2016 Oct 8;388(10053):1725-1774. doi: 10.1016/S0140-6736(16)31575-6.
  4. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. GBD 2015 Risk Factors Collaborators ( Wijeratne T) Lancet. 2016 Oct 8;388(10053):1659-1724. doi: 10.1016/S0140-6736(16)31679-8.
  5. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. GBD 2015 DALYs and HALE Collaborators ( Wijeratne T) Lancet. 2016 Oct 8;388(10053):1603-1658. doi: 10.1016/S0140-6736(16)31460-X.
  6. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. GBD 2015 Mortality and Causes of Death Collaborators ( Wijeratne T) Lancet. 2016 Oct 8;388(10053):1459-1544. doi: 10.1016/S0140-6736(16)31012-1.
  7. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. GBD 2015 HIV Collaborators ( Wijeratne T). Lancet HIV. 2016 Aug;3(8):e361-87. doi: 10.1016/S2352-3018(16)30087-X.
  8. Migraine: Does aura require investigation? Vijiaratnam N, Barber D, Lim KZ, Paul E, Jiang M, Chosich B, Wijeratne T. Clin Neurol Neurosurg. 2016 Sep;148:110-4. doi: 10.1016/j.clineuro.2016.07.006.
  9. Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke. Anderson CS, Robinson T, Lindley RI, Arima H, Lavados PM, Lee TH, Broderick JP, Chen X, Chen G, Sharma VK, Kim JS, Thang NH, Cao Y, Parsons MW, Levi C, Huang Y, Olavarría VV, Demchuk AM, Bath PM, Donnan GA, Martins S, Pontes-Neto OM, Silva F, Ricci S, Roffe C, Pandian J, Billot L, Woodward M, Li Q, Wang X, Wang J,Wijeratne T, Chalmers J; ENCHANTED Investigators and Coordinators.. N Engl J Med. 2016 Jun 16;374(24):2313-23. doi: 10.1056/NEJMoa1515510.
  10. Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack. Johnston SC, Amarenco P, Albers GW, Denison H, Easton JD, Evans SR, Held P, Jonasson J, Minematsu K, Molina CA, Wang Y, Wijeratne T, Wong KS; SOCRATES Steering Committee and Investigators..N Engl J Med. 2016 Jul 7;375(1):35-43. doi: 10.1056/NEJMoa1603060.
  11. Prognostic Significance of Hyponatremia in Acute Intracerebral Hemorrhage: Pooled Analysis of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies.Carcel C, Sato S, Zheng D, Heeley E, Arima H, Yang J, Wu G, Chen G, Zhang S, Delcourt C, Lavados P, Robinson T, Lindley RI, Wang X, Chalmers J,Wijeratne T, Anderson CS; Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 Investigators.Crit Care Med. 2016 Jul;44(7):1388-94. doi: 10.1097/CCM.0000000000001628.
  12. Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage.Zheng D, Sato S, Arima H, Heeley E, Delcourt C, Wijeratne T, Cao Y, Chalmers J, Anderson CS; INTERACT2 Investigators. Am J Kidney Dis. 2016 Jul;68(1):94-102. doi: 10.1053/j.ajkd.2016.01.020.
  13. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack.Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, Guarino PD, Lovejoy AM, Peduzzi PN, Conwit R, Brass LM, Schwartz GG, Adams HP Jr, Berger L, Carolei A, Clark W, Coull B, Ford GA, Kleindorfer D, O’Leary JR, Parsons MW, Ringleb P, Sen S, Spence JD, Tanne D, Wang D, Wijeratne T, Winder TR; IRIS Trial Investigators.N Engl J Med. 2016 Apr 7;374(14):1321-31. doi: 10.1056/NEJMoa1506930.
  14. Low Ambient Temperature and Intracerebral Hemorrhage: The INTERACT2 Study.Zheng D, Arima H, Sato S, Gasparrini A, Heeley E, Delcourt C, Lo S, Huang Y, Wang J, Stapf C, Robinson T,Wijeratne T, Lavados P, Chalmers J, Anderson CS; INTERACT2 investigators..PLoS One. 2016 Feb 9;11(2):e0149040. doi: 10.1371/journal.pone.0149040.
  15. Determinants and Prognostic Significance of Hematoma Sedimentation Levels in Acute Intracerebral Hemorrhage.Sato S, Delcourt C, Zhang S, Arima H, Heeley E, Zheng D, Al-Shahi Salman R, Stapf C, Tzourio C, Robinson T, Lindley RI,Wijeratne T, Chalmers J, Anderson CS; INTERACT2 Investigators..Cerebrovasc Dis. 2016;41(1-2):80-6. doi: 10.1159/000442532.
  16. Eliciting and responding to patient histories of abuse and trauma: challenges for medical education.Matta G, Woodward-Kron RE, Petty S, Salzberg MR.Med J Aust. 2016 Sep 19;205(6):248-9.
  17. The antiepileptic medications carbamazepine and phenytoin inhibit native sodium currents in murine osteoblasts.Petty SJ, Milligan CJ, Todaro M, Richards KL, Kularathna PK, Pagel CN, French CR, Hill-Yardin EL, O’Brien TJ, Wark JD, Mackie EJ, Petrou S.Epilepsia. 2016 Sep;57(9):1398-405. doi: 10.1111/epi.13474.
  18. Osteoporosis Associated with Epilepsy and the Use of Anti-Epileptics-a Review.Petty SJ, Wilding H, Wark JD.Curr Osteoporos Rep. 2016 Apr;14(2):54-65. doi: 10.1007/s11914-016-0302-7. Review.
  19. Monotherapy with Levetiracetam Versus Older AEDs: A Randomized Comparative Trial of Effects on Bone Health.Hakami T, O’Brien TJ, Petty SJ, Sakellarides M, Christie J, Kantor S, Todaro M, Gorelik A, Seibel MJ, Yerra R, Wark JD.Calcif Tissue Int. 2016 Jun;98(6):556-65. doi: 10.1007/s00223-016-0109-7.
  20. Relationship between Sleep Duration and Risk Factors for Stroke. Phua CS, Jayaram L, Wijeratne T. Front Neurol. 2017 Aug 8;8:392.
  21. Subacute Cerebellar Degeneration due to a Paraneoplastic Phenomenon Associated with Metastatic Merkel Cell Carcinoma: A Case Report. Sharobeam A, Ray J, Dong J, Chong V. Case Rep Oncol. 2017 Aug 16;10(2):764-768.
  22. Motor speech signature of behavioral variant frontotemporal dementia: Refining the phenotype. 
Vogel AP, Poole ML, Pemberton H, Caverlé MWJ, Boonstra FMC, Low E, Darby D, Brodtmann A. Neurology. 2017 Aug 22;89(8):837-844.
  23. Student-run clinics: The future of outpatient neurology practice? 
Wijeratne T, Low E, Crewther S. Neurology: Clinical Practice. 2017 Aug 28.
  24. Compromised Motor Dexterity Confounds Processing Speed Task Outcomes in Stroke Patients. 
Low E, Crewther SG, Ong B, Perre D, Wijeratne T. Front Neurol. 2017 Sep 21;8:484.
  25. Teaching Video NeuroImages: My weeping patient: Avoiding the pitfalls of a functional diagnosis. 
Peters J, Vijiaratnam N, Wijeratne T. Neurology. 2017 Oct 17;89(16):e202.
  26. Smartphone electrographic monitoring for atrial fibrillation in acute ischemic stroke and transient ischemic attack. 
Tu HT, Chen Z, Swift C, Churilov L, Guo R, Liu X, Jannes J, Mok V, Freedman B, Davis SM, Yan B. Int J Stroke. 2017 Oct;12(7):786-789.
  27. Treatment advances in Parkinson disease: Same script different cast? 
Vijiaratnam N, Evans AH. J Clin Neurosci. 2018 Jan;47:354-355.
  28. Neurological and Sleep Disturbances in Bronchiectasis. 
Phua CS, Wijeratne T, Wong C, Jayaram L. J Clin Med. 2017 Nov 30;6(12). pii: E114. doi: 10.3390/jcm6120114. Review.
  29. Pain sensitivity in Parkinson’s disease: Systematic review and meta-analysis. 
Sung S, Vijiaratnam N, Chan DWC, Farrell M, Evans AH. Parkinsonism Relat Disord. 2017 Dec 29. pii: S1353-8020(17)30870-2.
  30. Success rate of elective lumbar puncture at a major Melbourne neurology unit. 
Williams P, Tait G, Wijeratne T. Surg Neurol Int. 2018 Jan 16;9:12.
  31. Botulinum toxin in patients with Meige’s syndrome. 
Vijiaratnam N, Wijeratne T. Neurol India. 2018 Jan-Feb;66(1):38-39.
  32. Adult food borne botulism in Australia: The only 2 cases from the last 15years. Ramachandran P, Chan E, Poon M, Tu HTH, Davis JM, Eisen D, Marriott M. (2017). Journal of Clinical Neuroscience, 41, 86-87.
  33. Deconstruction of interhospital transfer workflow in large vessel occlusion: Real-world data in the thrombectomy era. Ng FC, Low E, Andrew E, Smith K, Campbell BCV, Hand PJ, Crompton DE, Wijeratne T, Dewey HM, Choi PM. (2017). Stroke, 48(7), 1976-1979.
  34. Neural markers associated with the temporal deployment of attention: A systematic review of non-motor psychophysical measures post-stroke. Low E, Laycock R, Crewther S (2017). Journal of Human Neuroscience, 11 (31), 1-15.