Robert Adams

Robert J Adams MS MD

Professor of Neuroscience ; University Eminent Scholar; Director South Carolina Center of Economic Excellence in Stroke; Director MUSC Stroke Center

Robert J. Adams, MS, MD, formerly the Presidential Distinguished Chair, Regents Professor of Neurology, and Co-Director of the Cerebrovascular Section in the Department of Neurology at the Medical College of Georgia in Augusta, Georgia moved to MUSC in 2007 and assumed the titles of University Eminent Scholar, Professor of Neuroscience and Director of the South Carolina Center for Economic Excellence in Stroke.

Dr Adams is certified by the American Board of Psychiatry and Neurology (Diplomate) and the National Board of Medical Examiners.  Dr Adams received his bachelor of Science in Electrical Engineering from St. Louis University and his medical degree from the University of Arkansas for Medical Sciences. He also has an MS degree in Engineering Design and Economic Evaluation from the University of Colorado at Boulder.

He completed an internship at the University of Arkansas for Medical Sciences in Little Rock, and neurology residency in the Department of Neurology at the Medical College of Georgia in Augusta. Dr Adams is an active member of numerous professional societies, including the American Academy of Neurology, the American Medical Association, the American Heart Association (AHA), the American Stroke Association, the American Neurological Association, and the American Society of Hematology.

He is the past Chair of the Stroke Council Leadership Committee, and past chair of the American Stroke Association Stroke Advisory Committee. He is a past member of the Board of Directors of the AHA. His extensive research experience includes 4 NIH investigator-initiated grants. He co-designed and directed 2 multicenter clinical trials, STOP and STOP II, which were the first randomized clinical trials of stroke prevention in sickle cell disease and in any childhood stroke condition.

Dr Adams has published more than 60 peer-reviewed articles, including 3 original publications in New England Journal of Medicine, and numerous book chapters and reviews, and has participated in guideline and scientific statement development on various aspects of stroke management through the AHA/American Stroke Association, the American Academy of Neurology and National Heart Lung and Blood Institute.

His primary research activities are in stroke prevention and novel delivery programs of stroke care. Dr Adams received the Outstanding Young Faculty Award in Clinical Sciences, Medical College of Georgia, May 1990, the Distinguished Faculty Award for Clinical Sciences, Medical College of Georgia School of Medicine, May 1996, and the Distinguished Alumnus Award, University of Arkansas Medical Sciences, June 2001,  Distinguished Faculty Award for Clinical Sciences, from the Faculty Senate of the School of Medicine, Medical College of Georgia, 2005; the  Distinguished Service Award for Chairing the American Stroke Association Stroke Advisory Committee. 2004-2005, the Presidential Lectureship of the American Academy of Neurology, San Diego, California April 3, 2006. He was given the Award of Meritorious Achievement from the American Heart Association in Washington DC April 9, 2006, for his leadership at the national level in the development and oversight of the JCAHO Primary Stroke Center Certification program.

Dr Adams has been recognized as one of America’s Top Doctors of 2001 – 2007. He is co founder of REACH Call Inc, a corporation that provides system equipment, software and decision support for urgent specialist consultations for stroke and other emergency conditions via the internet. He serves also as Chief Medical Consultant for this company which brings expert experience to remote sites to assist in emergency evaluation and treatment of acute stroke.

 Abstract: Primary Stroke Prevention: 20 years On

Primary stroke prevention in children was made practical by the demonstration that Transcranial Doppler Ultrasound (TCD) could identify children with SCD who have a high enough risk of stroke to, first of all, test treatments in a randomized trial, and then after the positive STOP trial results, gain traction in clinical practice.

Briefly, instead of transfusing 200 children to prevent one stroke a year (based on the unselected first stroke rate of .5%/year), using TCD at the cutoff of >  200 cm/sec time averaged mean of the maximum velocity (10%/yr untreated risk of stroke), the NNT, “number needed to transfuse”, drops to 10. It is not likely to drop further but one can always look for refinements in prediction.

Has this made a difference?  Evidence now exists that in the US rates of first time stroke in children with SCD have dropped.  Phase IV (post STOP trial) reports from several clinics have suggested that first strokes have become unusual and often are seen in cases that were not regularly screened.  Data from the national inpatient sample indicate that SCD comprised 8.7% of pediatric stroke in 1997 but only 4.8% in 2006 (p=.04). The comparable number for adults with SCD rose from .3% to .5% in this period.

Recently it was reported that, based on data from the National Center for Health Statistics,  the disparity in stroke deaths in children between blacks and whites in the US dropped by 74% since 1998 for ischemic stroke but not for hemorrhage. They argued that the most plausible reason for this was wider application of  the STOP protocol.

This has had two other consequences that were not readily apparent when I began the project at the age of 37 in 1986. The first is that the number of children on transfusion has risen, probably by a lot, making the search for alternatives that much more important.

The second is that the problem of stroke in adults with SCD, and the appalling lack of data and research “in the pipeline”, is becoming more acute.  In my opinion the need to initiate high impact research is urgent.

Two other realizations have emerged. The first is that TCD detects a “physiological lesion”, an aberrant response to anemia causing increased cerebral blood flow and blood flow velocity well beyond what is predicted by the lower hemoglobin (the “normal SCD compensated state” ), long before it detects a morphological one ; the second is that what I first thought we were doing in this work was prevention of brain injury from stroke but, just as important, with early screening  and aggressive early intervention, we are providing  “vascular protection”,  protecting the only Circle of Willis these persons will ever have by preventing severe stenosis and moyamoya.

I will review the logic and data that suggest the single most important predictor of regression of TCD and stabilization of the angiographic appearance is the TCD velocity at the time treatment is initiated.

Where we go from here will also be discussed.

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