Research
Biomarkers and Drug Development Efforts to Prevent Epileptogenesis
Recent advances in stroke management have led to a significant reduction in stroke mortality. However, we have not made much progress in preventing and treating one of its most common and serious complications, post-stroke epilepsy (PSE). Moreover, the level of scientific evidence to manage PSE patients remains low. Therefore, identifying the epileptogenic changes soon after the stroke is critical. The Mishra Lab aims to develop neurotherapeutics to inhibit epileptogenesis after stroke and other cerebral insults, thus preventing epilepsy in individuals with a cerebral insult such as stroke.
Dr. Mishra has forged collaborations with a few researchers in stroke and epilepsy worldwide to reach this goal. in partnership with Patrick Kwan, BMedSci, MC, BChir, PhD (Monash University, Australia), Dr. Mishra has constituted an International Post-Stroke Epilepsy Research Consortium (IPSERC). This effort is interdisciplinary and truly international.
For more information on this initiative, please read: International Post Stroke Epilepsy Research Consortium (IPSERC): A consortium to accelerate discoveries in preventing epileptogenesis after stroke, (Epilepsy & Behavior, February 2022)
Steering Committee Members
- Jerome Engel Jr., MD - University of California, Los Angeles
- Jacqueline French, MD - New York University
- Alon Friedman, MD - Dalhousie University (Canada) and Ben Gurion University of the Negrev (Israel)
- Patrick Kwan, BMedSci, MC, BChir, PhD - Monash University
- Nishant K. Mishra, MD - Yale University
- Vijay Sharma, MD - National University of Singapore
Contact:
Healthy Ageing: Prevention of Post-Stroke Cognitive Impairment
We are studying the impact of neurocognitive interventions (e.g. active bilingualism) on the cognitive reserve of old individuals suffering from cerebrovascular disease. We use neuropsychological assessment, structural and functional imaging, and analysis of biological fluids to understand the mechanisms by which neurocognitive interventions contribute to the cognitive reserve, and thus delay vascular cognitive impairment and dementia.
Reperfusion Therapy in Acute Ischemic Stroke
Dr. Mishra has a long-standing interest in reperfusion stroke therapy. From 2008-2014, he primarily tackled the issue of whether the exclusion criteria for using iv alteplase in acute ischemic stroke proposed by the European Medicines Evaluation Agency (EMEA) is relevant. It was an essential question because several of the exclusion criteria for the use of iv tPA were not based on evidence, but rather on the absence of evidence. Additionally, the original trials had excluded these patients either to have a more homogenous population response to the iv alteplase or because the drug agency had advised them to do so. The recent AHA guideline regarding the use of iv alteplase takes note of Dr. Mishra's contributions to the field.
Furthermore, Dr. Mishra has investigated stroke patients' imaging profiles of prognostic value. For example, he contributed to the NIH-funded prospective observational study, CRISP, which assessed the CT perfusion profiles to identify patient most likely to have improved clinical outcomes from endovascular recanalization therapy.
Clinical research projects using imaging paradigms to select responsive stroke patient populations are underway.