Interview mit Professor Padmavathy Narayanan Sylaja
Geführt von Prof. Claudio Bassetti, Dekan der Medizinischen Fakultät
You are the Professor of Neurology and Head of the stroke program at the renowned Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST) in Trivandrum, Kerala. Could you tell us a little about the start of your impressive career in neurology?
I completed my residency in neurology at SCTIMST. SCTIMST is one of five institutes of national importance in India, and its structure is unique in the country.
The hospital wing is dedicated entirely to the care of cardiology and neurology patients. A second wing focuses on public health. There are also many international collaborations in this area. A third wing covers biomedical engineering. Many biomedical innovations have been and continue to be developed here. A very well-known example is an artificial heart valve, called the Sree Chitra heart valve, which is much more affordable than comparable products and is widely used.
Admission to SCTIMST neurology residency is highly competitive, and I was fortunate to be able to complete my residency there. It was only at SCTIMST that I was introduced to medical research and saw how translational research and patient care go hand in hand.
Did you have a role model who inspired your interest in neurology?
Yes, Prof. Kurupath Radhakrishnan, an internationally renowned epileptologist and a pioneer in epilepsy surgery in India. From him, I learned a great deal about translational medical research, patient care, and also about specialized care in subspecialties of neurology such as epilepsy and stroke. After completing my residency, I was offered a faculty position on Prof. Kurupath Radhakrishnan’s team in 1996 and worked on epilepsy.
Today, you are a world-renowned stroke specialist. How did you come to focus on this area of neurology?
When I first started my permanent position, SCTIMST indeed had a stroke clinic, but no acute care or thrombolysis was available. That remained the case well into the early 2000s.
In 2005, I went to the University of Calgary for about 20 months for a stroke fellowship, where I met Dr. Andrew Demchuk, my inspiring mentor in stroke medicine. When I returned to SCTIMST after the fellowship, I took over as head of the stroke unit and established a comprehensive stroke care program.
After returning to India, you helped establish the Indian Stroke Clinical Trial Network (INSTRuCT Network) and have been leading it as co-principal investigator ever since. The network is dedicated to conducting randomized clinical trials and is unique in the Asian region. What motivated you to found the network?
Until well into the 2000s, India did not conduct any clinical trials of its own involving therapies developed in India. India only participated in international trials.
At the University of Calgary, I learned what it takes to conduct clinical trials. That’s how the idea for the network came about. Along with Dr Jeyaraj Pandian from Christian Medical College, Punjab, we established the INSTRUCT network funded by the Indian Council of Medical Research. We had known each other since our residency days. Our institute was the South Indian Coordinating center for the INSTRUCT.
I’m proud to say that the network now includes over 50 centers. Collaboration within the network is excellent, and we generate high-quality data. We have the opportunity to present our research findings at the plenary sessions of major international conferences. It took a great deal of effort to get the network to this point. We are very proud of how the network has developed and where we stand today.
Our goal has always been to conduct clinical trials that truly make a difference to India. A milestone in this regard was the RESTORE Trial, the first large randomized clinical trial to investigate traditional Ayurvedic rehabilitative treatment in stroke patients. The trial has shown that Ayurvedic therapy is safe but not superior to conventional physiotherapy—an important finding, given the great significance of Ayurveda in India and beyond.
What are the current challenges in caring for stroke patients in India?
A major challenge is that we need more stroke centers to address the stroke burden in India. For over 10 years, we have been training primary care providers and nurses in the initial care of stroke patients. Being a technical consultant for stroke for the state appointed by the government, we could establish 10 primary stroke care units in district hospitals in my state of Kerala. Other major challenges are the costs of acute stroke care and the very limited availability of mechanical thrombectomy. The rising burden of risk factors and the young age of many stroke patients are also major challenges. Hence, we need to focus on primary prevention.
You are not only a leading researcher in stroke prevention and treatment but also a highly respected mentor. What advice do you give to the next generation of researchers?
Three things are particularly important to me. First, I am convinced that excellent clinical skills are essential for conducting good clinical research. A broad professional education and practical experience in working with patients are essential. My second piece of advice is to publish! Countless exciting studies remain unknown because people don’t take the time to publish alongside their clinical work. Third, I always encourage my young colleagues to gain experience abroad. My stay at the University of Calgary from 2005 to 2006 was immensely valuable and crucial for my career.
Prof. Sylaja, thank you very much for speaking with us, and congratulations on your honorary doctorate.
