International Neuromodulation Society Expert Panel

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Welcome!
Periodic discussions took place through 2019 in the Members Only Area of the INS website, where they are archived for later viewing.

The Oct. 30 - Nov. 13, 2019 Expert Panel:

"Clinical Experience with Directional Deep Brain Stimulation Leads"

Jan Vesper, MD, PhD; Konstantin Slavin, MD; and Marie Krüger, MD

Directional deep brain stimulation was developed to steer electrical energy toward therapeutic targets and away from undesired structures. The availability of directional leads influences approaches to lead placement and programming. Up to now, the volume of tissue activated was shaped by imaging models of electrical current only. Now it becomes possible to steer electrical current directly. It will also be a matter of debate whether or not directional leads will be able to widen the therapeutic window without losing the long-term efficacy.

Prof. Jan Vesper, MD, PhD, is INS treasurer and professor of Functional Neurosurgery and Stereotaxy, University Clinic, and Head of the Center of Neuromodulation, Düsseldorf, Germany. A past president of the German Neuromodulation Society, he has been a member of the German working group for Deep Brain Stimulation and presented abstracts at the 2017 North American Neuromodulation Society meeting on the use of segmented DBS leads in Parkinson's disease and dystonia.

Prof. Konstantin Slavin, MD, FAANS is INS secretary and chief of section and fellowship director for Stereotactic and Functional Neurosurgery in the Department of Neurosurgery at the University of Illinois at Chicago. He completed neurosurgery residencies in Moscow and the U.S. and has filled leadership positions as past president of the American Society for Stereotactic and Functional Neurosurgery; vice president of the World Society for Stereotactic and Functional Neurosurgery; past secretary of the North American Neuromodulation Society; and a past executive committee member of the Joint Section on Pain of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. He has published many peer-reviewed journal articles and serves as associate editor or editorial board member for Neuromodulation, Neurosurgery, Stereotactic and Functional Neurosurgery, Surgical Neurology International, and others. His first book on Peripheral Nerve Stimulation was published in 2011; another book, co-edited with Sam Eljamel on Neurostimulation: Practice and Principles, came out in 2013, and his latest book Stimulation of Peripheral Nervous System: The Neuromodulation Frontier was released in 2015.

Marie Krüger, MD, has completed a functional neurosurgery fellowship in Vancouver, Canada (Dr. Christopher Honey) and is now a consultant neurosurgeon and Head of the Stereotactic and Functional Division of the Neurosurgical Department at the Kantonsspital in St. Gallen, Switzerland. She is a member of the Swiss Neuromodulation Society, the European Society for Stereotactic and Functional Neurosurgery and World Society for Stereotactic and Functional Neurosurgery (WSSFN). She has experience in depicting directional leads using different methods like the rotational fluoroscopy as well as visualization software such as Guide-XT and Lead-DBS. In 2019 she presented trials on directional leads for tremor and pain at meetings of the WSSFN and the Canadian Neuromodulation Society.

More about past panels:

The Jan. 22 – Feb. 5, 2019 Expert Panel:

"Neurostimulation for Pelvic Pain, Co-Moderated by Gynecology and Pain Management Specialists"

Richard P. Marvel, MD, FACOG, FACS, Corey W. Hunter, MD, FIPP, and Thierry Vancaillie, MD (Belgium), RANZCOG, FFPMANZCA

Dr. Richard P. Marvel is a gynecologist who has specialized in all facets of the evaluation and management of women with chronic pelvic pain. In addition to the gynecologic management, he is an accomplished minimally invasive surgeon, performs peripheral nerve surgery related to the pelvis, and performs pudendal neuromodulation and pudendal nerve decompression. He has been an active member and past president of the International Pelvic Pain Society and is currently on the Board of Directors. Among his peer-reviewed publications is an oral abstract presented at the INS 13th World Congress in 2017 on "Outcomes of Pudendal Neuromodulation in Patients Failing Multiple Conservative Treatments for Pudendal Neuralgia".

INS Director-at-Large Dr. Corey W. Hunter is an interventional pain management physician practicing in New York City, holding board certifications in Physical Medicine & Rehabilitation and Pain Medicine. He is founder and Executive Director of the Ainsworth Institute of Pain Management in New York City and holds an appointment as Assistant Clinical Professor in PM&R at the Icahn School of Medicine at Mount Sinai Medical Center. He has a keen interest in teaching and has published in a number of peer-reviewed journals and textbooks on topics that include dorsal root ganglion stimulation, pelvic pain, regenerative medicine, complex regional pain syndrome, amputee pain, advanced spinal cord stimulation techniques, and targeted drug delivery. In August 2018, Dr. Hunter published in Neuromodulation: Technology at the Neural Interface on "Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration"

Dr. Vancaillie is a gynecologist and pain medicine specialist. He is clinical professor in Women’s Health at the University of New South Wales, as well as founder and director of the Women’s Health and Research Institute of Australia in Sydney. Ever since his internship at the Katholieke Universiteit in Leuven, Belgium, in 1979, Dr. Vancaillie has been interested in pelvic pain. He co-authored a textbook “Chronic Pelvic Pain”, published by Cambridge University Press in 2014. To improve outcomes for women with pelvic pain, he advocates a multidisciplinary treatment approach. His most recent publication “Pain after vaginal prolapse repair surgery with mesh needs to be treated” was published by the Australian and New Zealand Journal of Obstetrics and Gynaecology in December 2018.

The Oct. 23 – Nov. 6, 2018 Expert Panel:

“Neurostimulation for Management of Stump and Phantom Limb Pain in the Amputee”

Timothy Deer, MD, DABPM, FIPP; Paul Verrills, MBBS, FAFMM, GDMM (Hons), MM (Pain Medicine), FIPP

Regarding the two discussion moderators, Dr. Deer, the president of the International Neuromodulation Society and president of The Spine and Nerve Center of the Virginias,  will participate in discussion of the complex topic of amputation pain including stump pain and phantom pain. Dr. Deer, the first physician to stimulate the dorsal room ganglion (DRG) in the world and a principal investigator for the ACCURATE study, addressed the use of DRG stimulation for this array of pain syndromes and other forms of spinal cord and peripheral nerve stimulation. He is an advocate of neuromodulation as part of a multimodal treatment for complex patients to reduce the need for opioids and to improve the lives and function of those who suffer.  
 
Dr. Verrills from Metro Pain Group in Melbourne worked with the DRG system from the very beginning, performing the pre-commercial studies to help with refining both the technique and the equipment, and subsequently the first commercial implants. He was privileged to help co-lead the team that "taught the teachers" in the USA and pioneered the trans-foraminal S1 technique that now allows more options for foot and stump pain. He is passionate about neuromodulation techniques now available for complex patients that perhaps we couldn’t adequately help in the past.

The February - March 2018 Expert Panel:

"Facial Pain and Neuromodulation"

Christopher Honey, MD, DPhil, FRCSC; Stana Bojanic, BSc MB BS FRCS (SN); and Andre Machado, MD, PhD

Dr. Christopher Honey, president of the INS chapter in Canada, is recognized for his experience with motor cortex stimulation for facial pain. Ms. Stana Bojanic, president of the Neuroodulation Society of the United Kingdom and Ireland, serves as part of a multidisciplinary treatment team in instances of facial trauma. She is part of the neuromodulation team using peripheral nerve stimulation for neuropathic face pain and intractable trigeminal neuralgia. Dr. Andre Machado, who authored the first-ever randomized controlled trial of deep brain stimulation for pain in the Annals of Neurology, was an invited co-moderator. As chairman of Cleveland Clinic's Neurological Institute, his primary research interest has been on studying the targeting of the affective sphere of pain as a means of improving outcomes and quality of life.

The November 2017 Expert Panel:

"The potential and limitations of recent innovations in Deep Brain Stimulation (DBS)"

Alex Green, MD and Jan Vesper, MD, PhD

Alex Green, MD, is a functional Neurosurgeon at Oxford University Hospitals in the UK, and immediate past President of the British Society of Stereotactic and Functional Neurosurgery and an active member of the UK DBS network, where innovations in technology and the use of DBS are debated and promoted. He has implanted over 30 directional leads and his was one of the world’s first centres to implant and assess directional leads. He has also used intraoperative local field potential recording and other techniques to localise electrodes. Jan Vesper, MD, PhD, is professor of Functional Neurosurgery and Stereotaxy, University Clinic, Head of the Center of Neuromodulation, Düsseldorf, Germany. He is also president of the German Neuromodulation Society and a member of the German working group for Deep Brain Stimulation. In the 2017, he presented abstracts at the North American Neuromodulation Society annual meeting on the use of segmented DBS leads in Parkinson's disease and dystonia.

The January - February 2017 panel:

"Pelvic Pain and Neuromodulation"

INS Director-at-Large Leonardo Kapural, MD, PhD

Voted by his peers as a "Best Doctor in America," Dr. Kapural is a professor of anesthesiology at the Wake Forest University School of Medicine and Interventional Pain Physician at Carolinas Pain Institute. Dr. Kapural explained, "Despite the fact that we still do not have evidence-based literature to support steps in the algorithm for treatment of pelvic pain, this panel is assembled to discuss and clarify indications, patient selection, selection of approaches and hardware for chronic pelvic pain neuromodulation. Novel approaches and waveforms will also be discussed."

The November 2016 panel:

"Spasticity Management"

Konstantina Petropoulou, MD, PhD and Dr. Michael Saulino, MD, PhD

Konstantina Petropoulou, MD, PhD, heads the Greece National Health System’s 2^nd Department of Physical and Rehabilitation Medicine (PRM) in Athens. A past president of the Hellenic Society of Physical and Rehabilitation Medicine, in 2013 Dr. Petropoulou wrote a comprehensive review for the INS newsletter on “Managing Spasticity with a Focus on Rehabilitation”. (Her abbreviated curriculum vitae provides more.)

Michael Saulino, MD, PhD, co-authored a number of papers on best practices in intrathecal drug delivery in the August 2016 issue of Neuromodulation: Technology at the Neural Interface. Dr. Saulino, a physiatrist at MossRehab, is board certified in Physical Medicine and Rehabilitation, Spinal Cord Injury Medicine and Pain Management.

The October 2014 panel:

"Neuromodulation and Ischemic Pain"

INS President Dr. Simon Thomson, Dr. Shoaeddin Damirchi, and Dr. Gianni Colini Baldeschi

Dr. Damirchi, Chief Vascular Surgeon, Evangelisches Krankenhaus Herne, Director of the Vascular Center Herne / Castrop-Rauxel, Germany, remarked, "As a vascular surgeon in a high-volume center my daily routine is to revascularize patients with critical limb ischemia, if necessary in open, endovascular or hybrid procedures down to the foot. But despite all efforts there is a certain percentage where no or no more revascularization is possible. I always looked out for possibilities to save those patients from major amputation. In 2010,I started using neuromodulation in non-reconstructable limb ischemia and would not want to miss this effective treatment in well-chosen cases. I look very much forward to a stimulating discussion with colleagues sharing our experiences with more than 80 cases."

The August 2014 panel:

"How do we take neurostimulation beyond the Neuromodulation Appropriateness Consensus Committee (NACC)?"

INS President Dr. Simon Thomson, INS President-Elect and NACC Chair Dr. Timothy Deer, INS Secretary Dr. Marc Russo, and INS Editor-in-Chief Dr. Robert Levy

(To learn more about the co-moderators, please read about them on the INS Board page.)

The committee findings represent the first set of comprehensive guidelines regarding appropriate use of neurostimulation in chronic pain, and have been structured to facilitate periodic updates. The articles are intended to help both newer and more-experienced practitioners make sense of the wide-ranging scientific literature on neurostimulation for chronic pain. Formation of the NACC was modeled after the Polyanalgesic Consensus Conference, which has issued guidelines and updates four times since 2000 regarding the use of intrathecal drug delivery systems for chronic pain. 

The January 2014 panelists:

Dr. Peter Goadsby and Dr. Richard L. Weiner

Co-moderators Dr. Peter Goadsby and Dr. Richard L. Weiner addressed the evidence for, and challenges of, occipital nerve stimulation for medically refractory primary headache in a discussion that coincided with publication in Neuromodulation: Technology at the Neural Interface 16:6 of a retrospective case series, "Long-Term Outcome in Occipital Nerve Stimulation Patients With Medically Intractable Primary Headache Disorders."

Peter Goadsby, MD, PhD, directs the Headache Center at the University of California, San Francisco and co-authored the ONSTIM (Cephalalgia 2011), PRISM, and ICON studies of occipital nerve stimulation for medically intractable migraine or cluster headache, respectively.


Richard L. Weiner, MD, clinical associate professor of neurosurgery at the University of Texas Southwestern Medical Center and Chairman of Neurosurgery at THR Presbyterian Hospital of Dallas, developed subcutaneous peripheral nerve stimulation for relief of medically refractory occipital pain, with colleagues, conducting "first in man" implantation in the 1990s, which was published in Neuromodulation (Weiner RL, Reed KL. Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation. 1999 Jul;2(3):217-21. doi: 10.1046/j.1525-1403.1999.00217.x.).

The November 2013 panelists:

INS President Dr. Simon Thomson and INS Director-at-Large Dr. Konstantin Slavin

A discussion on the pros and cons of percutaneous vs. paddle leads for spinal cord stimulation (SCS) was co-moderated by Dr. Thomson, consultant in Anaesthesia and Pain Management at Basildon and Thurrock University NHS Trust, along with INS Dr. Slavin, professor of neurosurgery and head of Stereotactic and Functional Neurosurgery at the University of Illinois at Chicago. Dr. Thomson has been using SCS for 21 years and has extensive  experience placing percutaneous cylindrical SCS leads. He has also been involved in research, guideline writing, training, teaching and clinical audit. With a keen interest in spinal cord stimulation becoming a standard of practice to manage refractory pain of neuropathic, ischaemic or visceral origin, he has worked to ensure there is high quality clinical evidence for the effectiveness and safety of this therapy at an affordable cost. Dr. Slavin has treated hundreds of patients with SCS over the past 15 years, and was selected to co-host this discussion because of his expertise in both percutaneous and laminectomy-type SCS electrodes. Among other publications, Dr. Slavin co-authored “NANS Training Requirements for Spinal Cord Stimulation Devices: Selection, Implantation, and Follow-up” in Neuromodulation: Technology at the Neural Interface in 2009 and a recent paper on “Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads”, published in Neuromodulation: Technology at the Neural Interface in 2011.

The October 2013 panelist:

Prof. Turo Nurmikko,  MD, PhD

"Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain" was presented Oct. 8 through Oct. 22, 2013 by Prof. Turo Nurmikko,  MD, PhD, professor in Pain Relief, The Walton Centre NHS Foundation Trust, and director of the Pain Research Institute. He has led several research projects involving the peripheral and central mechanisms of chronic and experimental pain that involve the use of a variety of techniques such as functional and structural brain imaging, non-invasive brain stimulation, quantitative sensory testing and electrophysiology. This includes a number of studies involving the role of transcranial magnetic and transcranial direct current stimulation of the brain in chronic pain.

The July 2013 panelists:

Prof. Frank Huygen, MD, PhD, FIPP, Marc Russo, MBBS DA FANZCA FFPMANZCA

"Neuromodulation in Complex Regional Pain Syndrome" was presented by Prof.  Frank Huygen, MD, PhD, FIPP, professor of Pain Medicine and head of the Center for Pain Medicine at Erasmus University Medical Centre in Rotterdam, and INS Secretary Marc Russo, MBBS, DA(UK)FANZCA, FFPMFANZCA, founder, past president and secretary of the Australian chapter of INS. Dr. Huygen is internationally recognized in the field. Dr. Russo directs the Hunter Pain Clinic in New South Wales and Inpatient CRPS Management Program at Lindard Private Hospital in Newcastle, Australia. He has treated more than 700 CRPS patients.

The April 2013 panelists:

Prof. Tipu Aziz, FMedSci, Alex Green, MD

“Deep Brain Stimulation for Neuropathic Pain” was presented by Prof. Tipu Aziz, FMedSci and Alex Green, MD of Oxford University. Together, they have treated some 5% of all patients who have had this procedure, and have published a retrospective study of their results in 59 patients over the course of up to 12 years.

The March 2013 panelist:

Leonardo Kapural, MD, PhD

Voted by his peers as a “Best Doctor in America,” Leonardo Kapural, MD, PhD is a professor of anesthesiology at the Wake Forest University School of Medicine and clinical director of the Wake Forest University Health Sciences Center Chronic Pain Center, Carolinas Pain Institute and Center for Clinical Research. Dr. Kapural moderated a discussion on "Neuromodulation for Visceral Pain." He has published more than 150 journal articles and abstracts and 20 book chapters regarding his interests, which center on discogenic low back pain, visceral abdominal pain, and spinal cord/peripheral nerve stimulation.

The Winter 2013 panelist:

Krishna Kumar, MD

Krishna Kumar, MD, is a clinical professor of neurosurgery at the University of Saskatchewan, School of Medicine, moderated a session on the topic of “Spinal Cord Stimulation Candidacy.”

The founding president of the Canadian Society of Neuromodulation and former director of the North American Neuromodulation Society (INS chapters), Dr. Kumar has presented and published more than 150 papers nationally and internationally, including a seminal paper, “Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome,” published in Pain in 2007 (with co-authors Rod Taylor, PhD, and Line Jacques, MD).

The November 2012 panelist:

Elliot Krames, MD

Dr. Krames, founder and emeritus editor-in-chief of the journal Neuromodulation: Technology at the Neural Interface, and past president of the International Neuromodulation Society, moderated an online discussion on “The Choice of Intrathecal Drugs for Pain.”

online biography for Dr. Krames:

Co-author,
Neuromodulation vol. 1-2

The October 2012 panelist:

Timothy Deer, MD

Dr. Deer, International Neuromodulation Society president-elect and lead author of the newly released Polyanalgesic Consensus Conference findings, joined Director-at-Large Eric Buchser, MD to moderate an online discussion on "Evolving Recommendations and Future Considerations Regarding Intrathecal Drug Delivery to Manage Pain".

online biography for Dr. Deer:

President-Elect
International Neuromodulation Society

The summer 2012 panelist:

Giancarlo Barolat, MD

Dr. Barolat led a panel from Aug. 29 - Sept. 12, 2012. His two topics were "Peripheral Nerve Field Stimulation" and "Avoiding Lead Migration". A pioneer of spinal cord stimulation for spasticity and pain management, he operates one of the largest neuromodulation practices in the United States, with patients referred from all over the country.

He is certified by both the American and the Italian Board of Neurosurgery. He served from 1994 - 2000 as president and from 2004 - 2007, and again in 2008 - 2011 as director-at-large of the International Neuromodulation Society, of which he is a founding member.

online biography:

Barolat Neuroscience
Denver

The initial 2012 panelist:

Konstantin V. Slavin, MD

The first Expert Panel hosted in 2012 was moderated by Dr. Konstantin Slavin, professor in the Neurosurgery Department of the University of Illinois at Chicago, about peripheral nerve stimulation for pain and other aspects of neuromodulation. During the first year, he took a lead role in organizing and overseeing periodic panels. More on his background:

faculty page:
Professor
Department of Neurosurgery
University of Illinois at Chicago