Harold Adams: Saving and improving lives for 50 years
Harold Adams, MD, remembers a young man who had suffered a severe stroke and was paralyzed in all four limbs. His prognosis? Wheelchair-bound or bedridden for the rest of his life. After being treated at UI Hospitals & Clinics, he was sent for rehabilitation.
“Three months later, he walked into our clinic and my colleagues and I just about fell over. We never expected to see him like that,” recalls Adams, professor emeritus of neurology. “Miracles do happen.”
After 50 years in stroke research and education, Adams has seen his fair share of amazing results. His clinical research has led to critical changes in the care of stroke patients, including his own father. In that case, Adams had just finished conducting research on a new stroke medication.
“When my dad had a transient ischemic attack (TIA), he was able to take that very same medication,” says Adams. “That treatment helped my father; I was incredibly happy.”
A beloved professor, a revered researcher
Adams joined the faculty of UI Hospitals & Clinics in 1976. Since that time, he has published hundreds of peer-reviewed articles, received countless teaching awards, and accepted the A. B. Baker Award for Lifetime Achievement in Neurologic Education from the American Academy of Neurology. Though offered other positions during his career, Adams chose to remain at UI Hospitals & Clinics.
“The university has been very good to me,” he says. “They had the resources for me to collaborate with colleagues and allowed my career to move forward.”
Adams says his colleagues were very successful in receiving grant funding from the National Institutes of Health (NIH) and other sources.
“We produced good scientific information,” he says. “In some ways, we helped develop the whole field of stroke research.”
For example, Adams published his findings regarding TOAST classification for subtypes of ischemic stroke.
“That paper has been cited more than 10,000 times in the literature and is widely used in both clinical research and epidemiological research,” he says.
The evolution of stroke care
Stroke care covers a large category of vascular diseases of the brain. Hemorrhagic stroke, for example, is much different than ischemic stroke.
When Adams first began in the field, there was no therapy proven effective in preventing or treating stroke. He says the first real major advance in stroke prevention were antiplatelet agents, such as aspirin. Later, he says, there were new drugs, like the one used for his dad.
“That was also before CT scans, so we did not know whether the patients had major infarction to begin with,” he says. “As a result, stroke patients were treated very late in the process and the treatments often didn’t work, resulting in loss of brain function and more serious complications.”
The introduction of clot-busting therapies
In the late 1980s, researchers began a large-scale trial on tissue plasminogen activation (tPA). In the early 1990s, this treatment was found to be effective. In 1996, Adams served on the Food and Drug Administration review panel that recommended tPA use in the United States.
“In fact, the U.S. was the first country in the world to approve tPA use, and it’s now the standard for stroke care,” he says. “In 1996, I also chaired the panel for the American Heart Association to write guidelines for the treatment of ischemic stroke, including the use of tPA.”
In a process called drip and ship, a patient today may be treated at a small community hospital here in Iowa. That hospital, with consultation with UI Hospitals & Clinics, will initiate the tPA treatment drip locally and then ship the patient to UI Hospitals & Clinics for subsequent care.
“We still need more therapies to maximize recovery after stroke,” says Adams. “And I think that’s going to be an important area of research in the future. But the simple message today is that stroke can be cured. Patients who used to die or become disabled from stroke can now return to normal life.”
tPA is a naturally occurring protein found in cells that line blood vessels. It helps convert plasminogen to plasmin, an enzyme responsible for the breakdown of clots, helping restore blood flow to the brain. This restored flow is critical to preserving brain function. The ideal window for tPA administration is four and a half hours (or less) after stroke symptoms present. Time matters. In stroke care, Adams says, “Time is brain.”