Insomnia has many causes: afternoon caffeine, excess screen time, existential crises, and others. For Pratik Chhatbar, MD, PhD, it’s the thought of providing stroke patients with tailored, innovative therapies that offer real improvements to quality of life that keep him up at night. For our next “Faculty Spotlight” interview, Chhatbar talks to us about his new role at Duke researching non-invasive brain stimulation to help stroke recovery alongside incoming Stroke Division Chief Wuwei (Wayne) Feng, MD, MS. He also talks about how neuromodulation may be key to help individuals with stroke and other conditions, the past and future of stroke research, and the machine chauffeur that helps him get to and from work.
What are your current responsibilities within the Neurology Department? What does a typical day for you look like?
I am on 100% research effort with focus on using non-invasive brain stimulation methods (with focus on transcranial direct current stimulation or tDCS) in improving stroke recovery. Having just joined Duke, I am still figuring my ways on getting my research to speed and setting up research space with incoming Stroke Division Chief Dr. Wuwei (Wayne) Feng, who I have been working with for past 5 years.
There is no typical day: I tend to focus on a project that can span days to weeks. The projects can be data analyses, manuscript writing, grant writing, grant/paper reviews (latter is the fastest!), protocol writing, helping sites with getting up to the speed on multi-site projects, programming/building a custom device/tech, etc. Of course research subjects and collaborations take priority so I would pause whatever I am doing to see a patient or meet a colleague. I am specifically excited about the collaborative opportunities at Duke!
How and when did you first get interested in neurology?
During the later years of my medical school I was very interested in brain-computer interfaces and computational neuroscience. I got an opportunity to work with Dr. Joseph Francis (now University of Houston) and Dr. John Chapin (who was a mentor of Dr. Miguel Nicolelis as well) for non-human primate work, where I served as a one man army from setting up a protocol, customizing the electrophysiology devices and setup including programming, primate training, brain surgeries to implant invasive Utah and other microelectrode arrays, experimental data collection, processing and analysis, and writing publications.
My interest was further bolstered when I started in vivo two-photon imaging work with Dr. Prakash Kara to investigate the role of neurovascular coupling at single neuron/vascular levels at MUSC. Dr. Feng offered an opportunity to work with stroke patients and I have been fortunate to develop a niche in tDCS dose escalation, individualization as well as some disparity research through a team of mentors including Drs. Kautz, Adams, Lackland, George at MUSC.
What is most interesting to you about the field of stroke research?
The prospect of quality-of-life improvement for stroke patients using individualized, high-dose neuromodulation is what keeps me up at night. Eventually in the long run we should be able to record and stimulate any part of the brain, at cellular level, in a minimally invasive manner which would be helpful to not only stroke patients but also any neuropsychiatric condition as well as able-bodied human beings.
In 2015 you contributed to a study that examined whether a measure of corticospinal tract (CST) injury could help predict motor outcomes in individuals who have had a stroke. What were the main findings of that study? How will the results help us better treat stroke patients?
The study further bolstered the controversial 70% recovery rule and that imaging (using biomarker called weighted corticospinal tract lesion load or wCST-LL) at the time of stroke can be a better predictor of clinical outcome at 3 months when compared to behavioral assessment in acute phase of stroke, especially in cases with significant acute disabilities. With upcoming TRANSPORT2 trial, we will further this research and try to refine wCST-LL and combine it with other investigational tools like TMS to better predict stroke recovery. This will help us determine at a very early stage which patients can benefit the most with rehabilitative therapies and therefore we can more efficiently allocate our healthcare resources towards optimal outcome.
What is the most interesting question about stroke research that you hope to see answered in the next decade?
Being focused on stroke recovery aspect, I feel that over the next decade we will come up with therapies, both behavioral and neuromodulatory, that will bring the quality of life of stroke survivors at mRS 3 level or better. Additionally, there will be a need for super-specialists that would primarily focus on stroke recovery aspects.
What other passions or hobbies do you have outside of the Department?
As I revealed to some faculty, I am a big fan of Elon Musk (buy $TSLA as much as you can as this time won’t come again!) and a proponent of green energy and sustainable future of humankind and all creatures of the earth. So, I keep a close look at and contribute my 2 cents towards renewable energy, space exploration, AI and technologies that are meaningful for our survival and progress while taking minimum toll on the environment, Earth or otherwise (Mars?).
As for advocating for ongoing burning issues, I am a proponent of job equality and hiring non-discrimination based on country of birth. While Duke has non-discrimination policy based on country of birth when hiring, aligned to pretty much any employer that I know of here in the US, archaic immigration laws put a birth country cap on employment-based immigration, resulting in many professionals of my level (or even senior than me, if they are not in academic positions) to call this country home just because they were born in high-population countries like India and China. Having passed “Dream and Promise Act” (HR6, with 232 co-sponsors) today only, hopefully the Rules Committee will next pass “Fairness for High-Skilled Immigrants Act” (HR1044, with whooping 297 co-sponsors) to bring it to floor for a vote and make it a law of the land.
I am a big gadget fan and my latest toy is CommaAI’s open pilot which is a machine chauffeur (aspiring to be like Tesla’s autopilot, but nowhere close yet) that drives my Prius to and from work as well as long drives between Durham and Charleston almost every week to see my family, especially my 6 year old boy Sohum (he graduated from Kindergarten last week, yay!) I am a family person and kids love me! Bicycling is my favorite sport which I did for 6 years by biking to work in Charleston and hopefully I can continue it here at Duke.