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Department of Neurology

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Steven R. Levine, M.D.

Professor of Neurology and Emergency Medicine

Vice-Chair of Neurology

Associate Dean for Clinical Research and Faculty Development, COM

SUNY Downstate Medical Center, Brooklyn, NY

e-mail: steven.levine@downstate.edu

 

Research Interests:

My areas of clinical research focus are in cerebrovascular disease, specifically:

1) Antiphospholipid antibodies (aPL) and cerebrovascular disease.

I have been investigating the role of various aPL in predicting stroke risk (initial and recurrent), having developed the Antiphospholipid Antibodies and Stroke Study Group (APASS). Currently, I am investigating the role of persistent positivity of several aPL (specifically antibodies to β2-glycoprotein-I, antiphosphatidylserine antibodies, and anticardiolipin antibodies) as a portfolio in predicting recurrent stroke and thrombo-occlusive events. A recently started project, funded by NHLBI, is investigating the role of various aPL in predicting pathologically proven cerebral infarction in a large cohort of aging individuals (at RUSH University), as well as looking at mechanism of infarction related to annexin resistence and relationship of aPL to intracranial large vessel atherosclerosis.

2) Telemedicine for stroke (“Telestroke”).

a) Developing a protocol to study the use of hand-held devices (iPad, iPhone) for use in obtaining and interpreting acute head CT scans in acute stroke patients – determining the validity and reliability compared to the gold standard neuroradiology read on a desk top/work station. Long term goal is to develop the ability to conduct clinical stroke treatment trials using telemedicine at community/rural hospital sites.

b) Developing and validating quality indicators for acute stroke care via telemedicine

3) Thrombolytic therapy for acute ischemic stroke

a) Studying the prevalence, magnitude, and prognostic significance of rapidly improving stroke symptoms/signs (RISS) in acute stroke patients. Long term goal is to determine optimal treatment decisions for patients with rapidly improving symptoms/signs based on magnitude of RISS

b) Developing a diagnostic and treatment protocol for wake-up stroke (stroke recognized upon awakening) for determining safety of thrombolytic therapy (phase 1 trial). Long term goal is to develop a randomized clinical trial of wake up stroke.

PUBLICATIONS (2007-2010)

  • Feldmann E, Wilterdink JL, Kosinski A, Lynn M, Chimowitz MI, Smith HH, Nichols, Rogg J, Cloft, Wechsler L, Saver J, Levine SR, Tegeler C, Adams R, Sloan M, and the The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial Investigators: The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial. Neurology 2007;68: 2099-2106.
  • Demchuk AM, Khan F, Hill MD, Barber PA, Silver B, Patel S, Levine SR: Importance of leukoaraiosis on CT for tPA decision making: Evaluation of the NINDS rt-PA Stroke Study. Cerebrovasc Dis 2008;26:120-125.
  • Cucchiara BL, Tanne D, Levine SR, Demchuk A, Kasner SE: A risk score to predict intracerebral hemorrhage after rt-PA for acute ischemic stroke. J Stroke Cerebrovasc Dis 2008;17:331-3.
  • Turan TN, Maidan L, Cotsonis G, Lynn MJ, Romano JG, Levine SR, Chimowitz MI, for the WASID Investigators: Failure of antithrombotic therapy and risk of stroke in patients with symptomatic intracranial stenosis. Stroke 2009;40:505-509.
  • Rajamani K, Chaturvedi S, Jin Z, Homma S, Brey RL, Tilley BC, Sacco RL, Thompson JLP, Mohr JP, Levine SR, on behalf of the PICSS/APASS Investigators. Patent foramen ovale, cardiac valve thickening and antiphospholipid antibodies as risk factors for subsequent vascular events: The PICSS-APASS Study. Stroke 2009;40:2337-42.
  • Cucchiara B, Kasner SE, Tanne D, Levine SR, Demchuk A, Messe SR, Sansing L, Lee KR, Lyden P, for the SAINT Investigators: Factors associated with intracerebral hemorrhage following thrombolytic therapy for ischemic stroke: pooled analysis of placebo data from the SAINT-I and SAINT-II trials. Stroke 2009;40:3067-72.
  • Rhoney DH, Coplin WM, Lin Y, Frankel M, Lyden PD, Levine SR: Time of day, outcome, and response to thrombolytic therapy: The National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Trial experience. J Stroke Cerebrovasc Dis 2010;19:40-48.
  • Chan, YF, Nagurka R, Richardson L, Zaets S, Brimacombe M, Levine, SR: Effectiveness of stroke education in the emergency department waiting room, J Stroke Cerebrovasc Dis 2010;19:209-15.
  • Moskowitz A, Chan Y-F Y, Bruns J, Levine SR: A Survey of emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010; 41:805-9.
  • Haley EC, Thompson JLP, Grotta JC, Lyden PD, Hemmen TM, Brown DL, Fanale C, Libman R, Kwiatkowski TG, Llinas RH, Levine SR, Johnston KC, Buchsbaum R, Levy G, Levin B, for the TNK in Stroke Investigators: Phase IIB/III trial of tenecteplase in acute stroke: Results of a prematurely terminated randomized clinical trial. Stroke 2010;41:707-711.
  • Messé SR, Kasner SE, Cucchiara BL, Demchuk A, Tanne D, Ouyang B, Levine SR; for the NINDS t-PA Stroke Study Group: Dosing errors did not have a major impact on outcome in the NINDS t-PA Stroke Study. J Stroke Cerebrovasc Dis 2010;19: In Press.
  • Cucchiara B, Kasner SE, Tanne D, Levine SR, Demchuk A, Messe SR, Sansing L, Lees KR, Lyden P, for the SAINT Investigators: Validation assessment of risk scores to predict postthrombolysis ICH. Int J Stroke 2010, In Press.