Research impact

The reach of CCBS research extends well beyond academia. It is important that our researchers apply their findings to save lives, help develop new treatments and interventions, influence government policy and engage the public with what we are doing.

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Major strengths include:

• Saving lives - by leading clinical trials of drug treatments, neuroimaging and other interventions in acute stroke
• Influencing global policy - by diagnosing and evaluating transmission risk of human prion disease
• Improving clinical practice and patient wellbeing - by educating practitioners and providing resources about unexplained neurological symptoms

Case study 1: Using aspirin to reduce the global burden of stroke

What was the underpinning research?

Professor Peter Sandercock led the International Stroke Trial (IST) with colleagues Professor Martin Dennis, Professor Joanna Wardlaw and others. IST was a randomised controlled trial in patients with acute ischaemic stroke within 48 hours of stroke onset, evaluating the safety and efficacy of aspirin, heparin, both or neither.

IST showed that for every 1000 patients treated immediately with aspirin, 10 patients avoid early recurrent stroke or death, and at 6 months after stroke onset, 13 more were alive and independent.

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What impact has this work had?

Aspirin is now strongly recommended, and high-dose heparin is ‘not recommended’, for routine use as part of standard treatment for acute ischaemic stroke worldwide. The guideline statements have led to implementation of appropriate health policy and quality improvement and audit programmes.

In the UK, routine use of two weeks aspirin therapy for all eligible stroke patients is estimated to translate to 930 fewer deaths each year and 1800 more people alive and independent.

Because aspirin is so cheap, this intervention is highly cost-effective.

The World Stroke Academy has a programme of events in many countries including developing nations, to implement affordable evidence-based stroke care that includes aspirin.

Case study 2: Defining diagnostic criteria for human prion disease

What was the underpinning research?

The Creutzfeldt-Jakob Disease (CJD) Unit, led by Professors Richard Knight, Robert Will, and James Ironside has led the way in Europe with case ascertainment and diagnosis of human prion disease.

The Unit has developed and validated diagnostic criteria for all forms of human prion disease, based on detailed study of suspect cases referred through the UK surveillance system it established in 1990. Staff have visited suspect UK cases in life (mean 113 cases/year) and have visited families of cases identified after death, collected clinical and investigation results, and correlated them with the final clinical and pathological diagnoses.

Data have been pooled from many countries via the CJD International Surveillance Network.

What impact has this work had?

NCJDRSU staff have played instrumental roles in advising national and international policy-makers. The team presents an annual report to the UK Department of Health and regularly provides data in relation to parliamentary questions.

The Edinburgh-devised criteria have been adopted by the World Health Organization and the European Centre for Disease Prevention and Control. Professor Knight has presented data to the US Congress/Senate and the 2010 Centers for Disease Control and Prevention CJD diagnostic criteria were adapted from the Edinburgh and the WHO criteria.

The Unit acts as the hub for reporting of cases of vCJD to the EU and its laboratory services have provided an important diagnostic aid to the NHS.

The staff work closely with CJD charities and support groups both in the UK and internationally to provide accurate information for patients and families.

Case study 3: Identification and treatment of functional disorders in neurology

What was the underpinning research?

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More than a quarter of all individuals presenting to a GP in the UK—in excess of 100 million consultations per year—have pain, paralysis, bowel symptoms or chronic fatigue which are part of a functional disorder rather than due to a structural disease.

Dr Jon Stone and Dr Alan Carson with colleague Professor Michael Sharpe (now in Oxford), demonstrated that 30% of referrals to neurology clinics in the UK had functional symptoms that were as disabling and distressing as those suffered by patients with neurological disease.

The team showed that guided self-help and cognitive behaviour therapy were more effective than the current standard treatments.

What impact has this work had?

The Edinburgh work has challenged the once popularly held view that functional symptoms are eventually explained by disease or life-events and that they cannot be treated.

The work has led to changes in national and international guidelines on the management of disorders. It has also led specifically to individual service developments across the UK.

The Edinburgh group also set up a website for the community of individuals with medically unexplained symptoms (www.neurosymptoms.org). This site receives an average of 30,000 hits per month and has been translated into 12 languages. For this website, Dr Jon Stone won the Jean Hunter Prize for Nervous Diseases from the Royal College of Physicians of London.