NISAN - the National Institute for Stroke and Applied Neurosciences

Permanent link for this collection

https://hdl.handle.net/10292/10244

Institute Director: Professor Valery Feigin

Deputy Director: Associate Professor Alice Theadom

The National Institute for Stroke and Applied Neurosciences (NISAN) conducts epidemiological studies and clinical trials to improve health and outcomes in people with major neurological disorders. Current research programmes focus on:

Stroke
Traumatic brain injury
Neuromuscular disorders

Research with this aim is unique in New Zealand and NISAN is a hub for information sharing and developing a cohesive network between existing research and clinical groups with interests in:

Neuroepidemiology
Public health
Neurorehabilitation
Neuropsychology
Biostatistics

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Now showing 1 - 9 of 9

Association of Early Blood-Based Biomarkers and Six-Month Functional Outcomes in Conventional Severity Categories of Traumatic Brain Injury: Capturing the Continuous Spectrum of Injury
(Elsevier BV, 2024) Wilson, L; Newcombe, VFJ; Whitehouse, DP; Mondello, S; Maas, AIR; Menon, DK; Ackerlund, C; Amrein, K; Andelic, N; Andreassen, L; Anke, A; Antoni, A; Audibert, G; Azouvi, P; Azzolini, ML; Bartels, R; Barzó, P; Beauvais, R; Beer, R; Bellander, BM; Belli, A; Benali, H; Berardino, M; Beretta, L; Blaabjerg, M; Bragge, P; Brazinova, A; Brinck, V; Brooker, J; Brorsson, C; Buki, A; Bullinger, M; Cabeleira, M; Caccioppola, A; Calappi, E; Calvi, MR; Cameron, P; Lozano, GC; Carbonara, M; Castaño-León, AM; Cavallo, S; Chevallard, G; Chieregato, A; Citerio, G; Clusmann, H; Coburn, MS; Coles, J; Cooper, JD; Correia, M; Čović, A; Curry, N; Czeiter, E; Czosnyka, M; Dahyot-Fizelier, C; Dark, P; Dawes, H; De Keyser, V; Degos, V; Della Corte, F; Boogert, HD; Depreitere, B; Đilvesi, Đ; Dixit, A; Donoghue, E; Dreier, J; Dulière, GL; Ercole, A; Esser, P; Ezer, E; Fabricius, M; Feigin, VL; Foks, K; Frisvold, S; Furmanov, A; Gagliardo, P; Galanaud, D; Gantner, D; Gao, G; George, P; Ghuysen, A; Giga, L; Glocker, B; Golubović, J; Gomez, PA; Gratz, J; Gravesteijn, B; Grossi, F; Gruen, RL; Gupta, D; Haagsma, JA; Haitsma, I; Helbok, R; Helseth, E; Horton, L; Huijben, J; Hutchinson, PJ; Jacobs, B; Jankowski, S; Jarrett, M; Jiang, JY
Background: Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Methods: Exposure–response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24 h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Findings: Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13–15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13–15 and positive CT (1.21–2.81), GCS 9–12 (1.16–2.02), GCS 3–8 (1.09–1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51–1.80) percentages of unfavourable outcome were 37–51% in the lowest quintiles of biomarker levels and reached 90–94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83–3.79), the percentages were 2–4% and 19–28% in the lowest and highest biomarker quintiles, respectively. Interpretation: Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity. Funding: European Union 7th Framework program (EC grant 602150), Hannelore Kohl Stiftung, One Mind, Integra LifeSciences, Neuro-Trauma Sciences, NIHR Rosetrees Trust.
Differing Definitions of First-Ever Stroke Influence Incidence Estimates More Than Trends: A Study Using Linked Administrative Data
(S. Karger AG, 2023-09-26) Youens, David; Katzenellenbogen, Judith; Srinivasa Ragavan, Rathina; Sodhi-Berry, Nita; Carson, Jennie; Zemedikun, Dawit; Thrift, Amanda G; Feigin, Valery; Nedkoff, Lee
Introduction Researchers apply varying definitions when measuring stroke incidence using administrative data. We aimed to investigate the sensitivity of incidence estimates to varying definitions of stroke and lookback periods, and to provide updated incidence rates and trends for Western Australia (WA). Methods We used linked state-wide hospital and death data from 1985-2017 to identify incident strokes from 2005-2017. A standard definition was applied which included strokes coded as the principal hospital diagnosis or the underlying cause of death, with a 10-year lookback used to clear prevalent cases. Alternative definitions were compared against the standard definition by percentage difference in case numbers. Age-standardised incidence rates were calculated, and age- and sex-adjusted Poisson regression models used to estimate incidence trends. Results The standard definition with a 10-year lookback period captured 31,274 incident strokes. Capture increased by 19.3% when including secondary diagnoses, 4.1% when including nontraumatic subdural and extradural haemorrhage, and 8.1% when including associated causes of death. Excluding death records reduced capture by 11.1%. A 20-year lookback reduced over-ascertainment by 2.0% and a 1-year lookback increased capture by 13.3%. Incidence declined 0.6% annually (95% confidence interval -0.9, -0.3). Annual reductions were similar for most definitions except when death records were excluded (-0.1%, CI -0.4, 0.2) and with the shortest lookback periods (greatest annual reduction). Conclusion Stroke incidence has declined in WA. Differing methods of identifying stroke influence estimates of incidence to a greater extent than estimates of trends. Reductions in stroke incidence over time are primarily driven by declines in hospitalised stroke.
Insights From ARCOS-V's Transition to Remote Data Collection During the Covid-19 Pandemic: A Descriptive Study
(S. Karger AG, 2024) Henry, Nathan IN; Nair, Balakrishnan; Ranta, Anna; Krishnamurthi, Rita; Bhatia, Anjali; Feigin, Valery
INTRODUCTION: The ARCOS-V study, an epidemiological study on stroke and transient ischemic attack (TIA), faced the challenge of continuing data collection amidst the COVID-19 pandemic. This study aims to describe the methodological changes and challenges encountered during the transition from paper-based methods to digital data collection for the ARCOS-V study, and to provide insights into the potential of using digital tools to transform epidemiological research. METHODS: The study adapted to remote data collection using REDCap and Zoom, involving daily health record reviews, direct data entry by trained researchers, and remote follow-up assessments. The process was secured with encryption and role-based access controls. The transition period was analyzed to evaluate the effectiveness and challenges of the new approach. RESULTS: The digital transition allowed for uninterrupted monitoring of stroke and TIA cases during lockdowns. Using REDCap and Zoom improved data reach, accuracy, and security. However, it also revealed issues such as the potential for systematic data entry errors and the need for robust security measures to protect sensitive health information. CONCLUSION: The ARCOS-V study's digital transformation exemplifies the resilience of epidemiological research in the face of a global crisis. The successful adaptation to digital data collection methods highlights the potential benefits of such tools, particularly as we enter a new age of Artificial Intelligence (AI).
National Plans and Awareness Campaigns as Priorities for Achieving Global Brain Health
(Elsevier BV, 2024) Winter, Sebastian F; Walsh, Donna; Catsman-Berrevoets, Coriene; Feigin, Valery; Destrebecq, Frédéric; Dickson, Suzanne L; Leonardi, Matilde; Hoemberg, Volker; Tassorelli, Cristina; Ferretti, Maria Teresa; Dé, Anna; Chadha, Antonella Santuccione; Lynch, Chris; Bakhtadze, Sophia; Saylor, Deanna; Hwang, Soonmyung; Rostasy, Kevin; Kluger, Benzi M; Wright, Claire; Zee, Phyllis C; Dodick, David W; Jaarsma, Joke; Owolabi, Mayowa O; Zaletel, Jelka; Albreht, Tit; Dhamija, Rajinder K; Helme, Anne; Laurson-Doube, Joanna; Amos, Action; Baingana, Florence K; Baker, Gus A; Sofia, Francesca; Galvin, Orla; Hawrot, Tadeusz
Summary Neurological conditions are the leading cause of death and disability combined. This public health crisis has become a global priority with the introduction of WHO's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022–2031 (IGAP). 18 months after this plan was adopted, global neurology stakeholders, including representatives of the OneNeurology Partnership (a consortium uniting global neurology organisations), take stock and advocate for urgent acceleration of IGAP implementation. Drawing on lessons from relevant global health contexts, this Health Policy identifies two priority IGAP targets to expedite national delivery of the entire 10-year plan: namely, to update national policies and plans, and to create awareness campaigns and advocacy programmes for neurological conditions and brain health. To ensure rapid attainment of the identified priority targets, six strategic drivers are proposed: universal community awareness, integrated neurology approaches, intersectoral governance, regionally coordinated IGAP domestication, lived experience-informed policy making, and neurological mainstreaming (advocating to embed brain health into broader policy agendas). Contextualised with globally emerging IGAP-directed efforts and key considerations for intersectoral policy design, this novel framework provides actionable recommendations for policy makers and IGAP implementation partners. Timely, synergistic pursuit of the six drivers might aid WHO member states in cultivating public awareness and policy structures required for successful intersectoral roll-out of IGAP by 2031, paving the way towards brain health for all.
Pragmatic Solutions to Reduce Global Stroke Burden: World Stroke Organization – Lancet Neurology Commission Report
(S. Karger AG, 2023-11-23) Krishnamurthi, Rita V; Gall, Seana; Martins, Sheila O; Norrving, Bo; Pandian, Jeyaraj D; Feigin, Valery L; Owolabi, Mayowa O
Stroke Is Not an Accident: An Integrative Review on the Use of the Term ‘Cerebrovascular Accident’
(S. Karger AG, 2024) Burns, Catherine; Sanders, Ailie; Sanders, Lauren M; Dalli, Lachlan L; Feigin, Valery; Cadilhac, Dominique A; Donnan, Geoffrey; Norrving, Bo; Olaiya, Muideen T; Nair, Balakrishnan; Henry, Nathan; Kilkenny, Monique F
BACKGROUND: Cerebrovascular accident (CVA) is an outdated term for describing stroke as it implies stroke is an accident. We conducted an integrative review to determine use of CVA in terms of 1) frequency in major medical journals over time; 2) associated publication characteristics (e.g., number of authors, senior author country, topic); and 3) frequency in medical records. METHODS: We searched Google Scholar for publications in leading neurology and vascular journals (Quartile 1) across two 5-year periods (1998-2002 and 2018-2022) using the terms "cerebrovascular accident" or "CVA." Two reviewers independently reviewed full-text publications and recorded the frequency of CVA use. Rates of use (per 1,000 articles/year) were calculated for each journal and time period. Associations of publication characteristics with CVA use were determined using multivariable logistic regression models. In addition, admission and discharge forms in the Auckland Regional Community Stroke Study (ARCOS V) were audited for frequency of use of the term CVA. RESULTS: Of the 1,643 publications retrieved, 1,539 were reviewed in full. Of these, CVA was used ≥1 time in 676 publications, and ≥2 times in 276 publications (129 in 1998-2002; 147 in 2018-2022). The terms CVA and stroke both appeared in 57% of publications where CVA was used ≥2 times in 1998-2002, compared to 65% in 2018-2022. Majority of publications were on the topic of stroke (22% in 1998-2002; 20% in 2018-2022). There were no associations between publication characteristics and the use of CVA. The highest rate of CVA use in 2018-2022 was in Circulation, and increased over time from 1.3 uses per 1,000 publications in 1998-2002 to 1.8 uses per 1,000 publications in 2018-2022. The largest reduction the use of CVA was in Neuroepidemiology (2.0 uses per 1,000 publications in 1998-2002 to 0 uses in 2018-2022). The term CVA was identified in 0.2% of stroke admission and discharge forms audited (17/7808). CONCLUSION: We found evidence of changes in the use of CVA in the scientific literature over the past two decades. Editors, authors and clinicians should avoid the use of the term CVA as it perpetuates the use of a non-specific, non-diagnostic, and non-scientific term.
Symptoms and Engagement in Anti-social Behaviour 10 Years Following Mild Traumatic Brain Injury Within a Community Civilian Sample: A Prospective Cohort Study with Age-Sex Matched Control Group.
(Elsevier, 2023) Theadom, Alice; Jones, Kelly; Starkey, Nicola; Barker-Collo, Suzanne; Ameratunga, Shanthi; Faulkner, Josh; Ao, Braden Te; Feigin, V
OBJECTIVE: To determine if there are longer-term impacts on symptoms, health status, mood and behaviour 10-years following a mild traumatic brain injury (mTBI). DESIGN: Prospective cohort study SETTING: Community-based, civilian sample PARTICIPANTS: Adults aged ≥16 years at follow up who experienced a mTBI 10-years ago, and an age and sex-matched non-injured control group. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: MTBI cases and controls were asked to complete self-report assessments of functioning (WHODAS 2.0), symptoms (Rivermead Post-Concussion Symptom Questionnaire), health status (100-point scale), alcohol (AUDIT-C) and substance use (ASSIST), and whether they had engaged in any anti-social behaviours over the past 12-months. RESULTS: Data were analysed for 368 participants (184 mTBI cases and 184 age-sex matched controls). Just over a third of mTBI cases (64, 34.8%) reported that they were still affected by their index mTBI 10-years later. After adjusting for education and ethnicity, the mTBI group had statistically higher overall symptom burden (F=22.32, p<0.001, ηp2 =0.07) compared to controls. This difference remained after excluding those who experienced a recurrent TBI. The mTBI group were more than three times as likely to have engaged in anti-social behaviour during the previous 12-months (F=5.89, p=0.02). There were no group differences in health status, functioning, or problematic alcohol or substance use 10-years post-injury. CONCLUSIONS: This study provides evidence of potential longer-term associations between mTBI, post-concussion symptoms and anti-social behaviour which warrants further evaluation. Future research should also examine if longer-term effects may be preventable with access to early rehabilitation post-injury.
The Burden of Neurological Conditions in North Africa and the Middle East, 1990–2019: A Systematic Analysis of the Global Burden of Disease Study 2019
(Elsevier, 2024) GBD 2019 North Africa and Middle East Neurology Collaborators; Feigin, VL
Summary Background The burden of neurological conditions in north Africa and the Middle East is increasing. We aimed to assess the changes in the burden of neurological conditions in this super-region to aid with future decision making. Methods In this analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 data, we examined temporal trends of disability-adjusted life-years (DALYs; deaths and disabilities combined), deaths, incident cases, and prevalent cases of 14 major neurological conditions and eight subtypes in 21 countries in the north Africa and the Middle East super-region. Additionally, we assessed neurological DALYs due to 22 potentially modifiable risk factors, within four levels of classification, during the period 1990–2019. We used a Bayesian modelling estimation approach, and generated 95% uncertainty intervals (UIs) for final estimates on the basis of the 2·5th and 97·5th percentiles of 1000 draws from the posterior distribution. Findings In 2019, there were 441·1 thousand (95% UI 347·2–598·4) deaths and 17·6 million (12·5–24·7) neurological DALYs in north Africa and the Middle East. The leading causes of neurological DALYs were stroke, migraine, and Alzheimer's disease and other dementias (hereafter dementias). In north Africa and the Middle East in 2019, 85·8% (82·6–89·1) of stroke and 39·9% (26·4–54·7) of dementia age-standardised DALYs were attributable to modifiable risk factors. North Africa and the Middle East had the highest age-standardised DALY rates per 100 000 population due to dementia (387·0 [172·0–848·5]), Parkinson's disease (84·4 [74·7–103·2]), and migraine (601·4 [107·0–1371·8]) among the global super-regions. Between 1990 and 2019, there was a decrease in the age-standardised DALY rates related to meningitis (–75·8% [–81·1 to –69·5]), tetanus (–88·2% [–93·9 to –76·1]), stroke (–32·0% [–39·1 to –23·3]), intracerebral haemorrhage (–51·7% [–58·2 to –43·8]), idiopathic epilepsy (–26·2% [–43·6 to –1·1]), and subarachnoid haemorrhage (–62·8% [–71·6 to –41·0]), but for all other neurological conditions there was no change. During 1990–2019, the number of DALYs due to dementias, Parkinson's disease, multiple sclerosis, ischaemic stroke, and headache disorder (ie, migraine and tension-type headache) more than doubled in the super-region, and the burden of years lived with disability (YLDs), incidence, and prevalence of multiple sclerosis, motor neuron disease, Parkinson's disease, and ischaemic stroke increased both in age-standardised rate and count. During this period, the absolute burden of YLDs due to head and spinal injuries almost doubled. Interpretation The increasing burden of neurological conditions in north Africa and the Middle East accompanies the increasing ageing population. Stroke and dementia are the primary causes of neurological disability and death, primarily attributable to common modifiable risk factors. Synergistic, systematic, lifetime, and multi-sectoral interventions aimed at preventing or mitigating the burden are needed.
The HEARTS Partner Forum—Supporting Implementation of HEARTS to Treat and Control Hypertension
(Frontiers Media S.A., 2023) Khan, T; Moran, AE; Perel, P; Whelton, PK; Brainin, M; Feigin, Valery; Kostova, D; Richter, P; Ordunez, P; Hennis, A; Lackland, DT; Slama, S; Pineiro, D; Martins, S; Williams, B; Hofstra, L; Garg, R; Mikkelsen, B
Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths annually). In 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in their quest to prevent and control CVD. HEARTS is the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum, led by WHO, brings together the following 11 partner organizations: American Heart Association (AHA), Center for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO). The partners support countries in their implementation of the HEARTS technical package in various ways, including providing technical expertise, catalytic funding, capacity building and evidence generation and dissemination. HEARTS has demonstrated the feasibility and acceptability of a public health approach, with more than seven million people already on treatment for hypertension using a simple, algorithmic HEARTS approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD. Proposed future HEARTS Partner Forum activities are related to more concrete information sharing between partners and among countries, expanded areas of partner synergy, support for implementation, capacity building, and advocacy with country ministries of health, professional societies, academy and civil societies organizations. Advancing toward the shared goals of the HEARTS partners will require a more formal, structured approach to the forum and include goals, targets and published reports. In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD mortality and achieving global sustainable development goals (SDGs).

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