Emergency Neurosciences Division

Neurosciences research in the Department of Emergency Medicine has grown substantially over the past year. In response, we created the Emergency Neurosciences division within Emergency Medicine. This Division has generated significant NIH dollars. Dr. David Wright, Director of this Division, is the Principal Investigator of the ProTECT III multicenter clinical trial, a $28M dollar NINDS funded study. Emory/Grady is the lead center for the study, which involves over 31 hospitals nationwide. In addition, Emergency Neurosciences hosts the only Neurological Emergencies Treatment Trials Network Hub (NETT-SEC, PI – Wright) in the southeastern United States. The NETT-SEC is actively participating in 4 NIH funded clinical trials, all of which bring in significant NIH funding. Our performance in these trials has been outstanding, as we are the top national NETT recruiter (1/17) for the ALIAS and ProTECT III trials and #4/17 for the RAMPART study.

Nett

The NIH has created a Neurological Emergencies Treatment Trials (NETT) Network to conduct large simple trials to reduce the burden of very acute injuries and illnesses affecting the brain, spinal cord, and peripheral nervous system. The network recognizes and seeks to explore the special narrow window of opportunity that seems to exist in treating neurologic damage from a variety of pathologies ranging from stroke to traumatic brain injury to seizures to meningitis. The study of very rapid interventions will have to be implemented by paramedics in the field, or by physicians in the Emergency Department. This network provides the basis for conducting efficient studies in these environments.

Alias

ALIAS - High-Dose Albumin Therapy for Neuroprotection in Acute Ischemic Stroke 

The purpose of the ALIAS trial is to evaluate the effectiveness of high-dose, intravenous human serum albumin.  Human serum albumin is a natural protein already in clinical use for a variety of indications.  In animal laboratory studies it has been shown that it reduces the size of the infarction (amount of tissue death) in the brain and improves neurological function after a stroke and also decreases or eliminates the brain swelling that may occur; these effects may reduce or prevent the brain damage resulting from a stroke in humans.

Rampart

RAMPART - Rapid Anticonvulsant Medication Prior to Arrival Trial

Status epilepticus, a condition of persistent seizures that do not stop, is a true neurologic emergency associated with significant death and disability.  Paramedics treat status epilepticus with anti-seizure medicine, but giving medicine through a vein can be difficult or slow in a seizing patient.  This study will determine (1) if the anti-seizure drug midazolam given as a shot in the muscle stops seizures as well as the anti-seizure medicine lorazepam given directly into a vein, and (2) the rapidity and safety of these two medicines given in these different ways.  The RAMPART study will be conducted using special rules for studies in which the subjects are too sick or incapacitated to either agree to or decline to participate at the time they are being treated in the ambulance or in the Emergency Room. 

Protect

ProTECTProgesterone for Traumatic Brain Injury: Experimental Clinical Treatment

Traumatic brain injury (TBI) is a major cause of premature death and disability worldwide.  With the exception of mannitol, no therapy has been found to be effective in reducing mortality and improving functional outcomes.  Progesterone is a steroid found to have powerful neuroprotective properties in multiple different animal models of brain injury.  Based on encouraging pilot clinical trial results, the ProTECT trial will determine the efficacy and confirm safety of this treatment in adults with moderate to severe TBI.

POINT - Platelet-Oriented Inhibition in New TIA Trial

 The Primary Specific Aim of this randomized, double-blind, multicenter clinical trial is to determine whether clopidogrel (Plavix) 75 mg/day by mouth after a loading dose of 600 mg is effective in reducing the 90-day risk of major ischemic vascular events (ischemic stroke, myocardial infarction, and ischemic vascular death) when initiated within 12 hours of TIA onset in patients receiving aspirin 50-325 mg/day.

SHINE - Stroke Hyperglycemia Insulin Network Effort

This is a multicenter, prospective, randomized, controlled trial, with blinded outcomes. It aims to determine the efficacy and provide further safety data on the use of insulin infusion therapy for glucose control in hyperglycemic acute ischemic stroke patients. Treatment with insulin infusion will be given within 12 hours of symptom onset. The primary outcome to be assessed at 90 days will be the difference in favorable outcome measured by the modified Rankin Scale score in the insulin infusion group compared to the control group. The rates of symptomatic hypoglycemia with prolonged neurological worsening as well as asymptomatic hypoglycemia will be assessed. The secondary outcomes will assess additional neurological and functional outcomes. This highly collaborative research program is nearly guaranteed to advance the field of stroke care.

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