A Message from the President
Dear INS members and friends,
Since the last quarterly newsletter, the full board has met and previewed the site of our 13th World Congress in Edinburgh, which takes place May 27 to June 1, 2017.
We were welcomed by beautiful scenery, mild weather, and a uniformly kind reception. That captivating tone seemed to characterize this scenic, historic capital of nearly 500,000 persons. Our meeting venue itself borders a striking district of tree-lined parks and ornate monuments alongside Edinburgh’s iconic castle.
Only days after returning home, we received the sad news that founding member Prof. Michiel Staal, MD, PhD, succumbed July 12, 2016, at age 66, to terminal brain cancer. With his steadfast commitment to teaching, research, and cross-disciplinary collaboration, Michiel was a talented, wry, and insightful figure who exerted an invaluable and long-lasting impact on our field. He retired last year from the Groningen University Neurosurgery Department. His foresight and drive had been instrumental in the founding of the society and its first international meetings early in his career, 26 years ago (see an historical account). His friend and colleague Mike DeJongste, MD, PhD, has written a special tribute in this newsletter, and our hearts go out to his family and loved ones as we share in their loss.
As the field has evolved since the first INS scientific congress in 1992, so have our international meetings. The year 2017 will mark the first time that we hold sessions in a freestanding convention center rather than a single meeting hotel. During the meeting in July, the board toured this fully equipped, spacious, and modern facility just steps from top Edinburgh hotels. In addition, the venue is within 10 miles of Edinburgh’s international airport. We were impressed with the accessibility and grandeur of the city and facilities, and I hope you will begin looking into travel plans now in order to join us in Edinburgh. http://www.conventioncenterhotelsguide.com/edinburgh-conference-centre/map.html
The Scientific Program Committee members and I are excited about the prospect of presenting recent research that spans a truly diverse range of topics during the 3.5 days of scientific sessions at the 2017 congress. We anticipate including late-breaking research results, and also offering Best Abstract awards again, as we started at the INS 2015 scientific congress in Montreal.
Meanwhile, the Biennial Meeting Committee has been looking ahead to 2019 and, during the July meeting, discussed a short-list of possible meeting locations. Please stay tuned to hear more about these future plans.
Finally, it is with great anticipation that I look forward to the INS first Interim Meeting in Chengdu, China, which, at the time of this writing, takes place later in August. I am grateful to everyone who has contributed to make that development a reality.
In closing, I extend warm wishes to all of you and look forward to our continued interactions, whether that be at home or abroad.
Timothy Deer, MD
President of INS
Outlook Article Describes Opioid Concerns, Neuromodulation Options
Interviews with two members of the International Neuromodulation Society, Drs. Marc Russo and Charles Brooker, are central aspects of a recent Nature magazine Outlook piece about non-opioid options for chronic pain.
The article explains the limitations of opioids, the genesis and extent of chronic pain, and the importance of stress and psychological factors. It describes current or potential alternative pain-relievers that are intended block opioid receptors without leading to addiction.
The piece asserts that a wave of technologies may be coming to address chronic pain. It mentions emerging spinal cord stimulation devices that either employ closed-loop sensor control to automatically titrate treatment, or deliver high-frequency stimulation, or are small implants that are amenable to office-based procedures, and are externally powered by inductive coupling. The article concludes that spinal cord stimulation is no longer a treatment of last resort.
In the article, Dr. Russo points out that it may be possible to deter development of chronic pain in the first place by assessing acute pain patients for risk factors. A rapid-response team could then intervene to limit pain severity and thus decrease the chances of sensitization that contributes to development of chronic pain.
Risk factors can be spotted in questionnaires that assess stress or anxiety, and through simple office testing. For the latter, a test of different painful stimuli in two different locations can help identify the roughly 20% of patients who do not have good diffuse noxious inhibitory control. If awareness of one sensation does not override the other, that indicates their spinal column essentially has an abnormal ability for pain signals to get through, and less of a filtering effect to help prioritize which noxious stimulus to attend to.
The article summarizes the experience of chronic pain patients -- one treated by Dr. Russo, the other by Dr. Brooker -- who, after years of minimal pain relief, were aided by spinal cord stimulation.
Both physicians point out the expansion of options for managing chronic pain, with Dr. Russo commenting that pain medicine was established as a specialty after World War II and is the youngest, and probably the most quickly changing, field of medicine.
Late-Breaking News
 Call for Late Breaking Research
Given the highly dynamic nature of the neuromodulation field, the INS Executive and Biennial Congress Committees would like to offer one last opportunity to propose late breaking research for presentation in plenary or breakout sessions at the INS 13th World Congress in Edinburgh, Neuromodulation: Technology Changes Lives. The deadline is Thursday, the 22nd of September – no later – and proposals should adhere to the instructions and be submitted to [email protected].
Also, as this newsletter was in production, we received confirmation and will be working to announce an INS members-only Expert Panel on Spasticity Management from Nov. 1 - 15, 2016, with
- Michael Saulino, MD, co-author on best practices in intrathecal drug delivery in the August 2016 issue of Neuromodulation: Technology at the Neural Interface, and
- Konstantina Petropoulou, MD, PhD, who authored the 2013 article on the INS website, Managing Spasticity with a Focus on Rehabilitation
Details of the interactive online session, to take place in the Global Discussion Forum, will be emailed and posted on the Global Events Calendar.
Several INS committees are developing their respective programs and will be providing committee updates in future issues; an update from International Women in Neuromodulation Committee (iWIN) follows.
Committee News
The International Women in Neuromodulation (iWIN) committee sends news of their progress, and an invitation to their reception at the 13th World Congress, in an update written by co-chair Julie Pilitsis, MD, PhD:
This year marks the inaugural year of the International Neuromodulation Society’s International Women in Neuromodulation Committee (iWIN). Co-chairs are Drs. Luz Caceres, Halena Gazelka, Gul Koknel Talu and Julie Pilitsis. We are grateful to the INS Board of Directors for supporting the formation of iWIN and to the INS journal Neuromodulation for having 10 prominent female neuromodulators on its editorial board.
We believe the first step to a diversified workforce is for all of organized neuromodulation to strive to be inclusive and for iWIN to lead the way. In order to achieve this goal, residents/fellows/junior faculty need to be exposed to people that “look like them” on the podium at meetings and in leadership positions. iWIN has particular challenges as cultural responsibilities and expectations are so varied.
Through my role in international outreach in neurosurgery, I know that the rates of women physicians involved in invasive therapies vary from country to country. For example in India, there are only approximately 15 female neurosurgeons. One of them relates that she was discouraged from the field as “she would be taking away a job from a man.” For those that do make it, there are talks on work-life balance and career is a matter of survival. In other cultures, 50% or more of surgical residents are women.
Thus, the first iWIN initiative needed to focus on understanding our membership and its needs. We surveyed 147 iWIN potential members. We appreciate all those who responded and noted the female implanters seem to be newer to stimulation (even with some senior faculty being newer implanters) as compared to their male colleagues. There was a similar breakdown in specialties between women and men. It appears that more female implanters work in the public sector as compared to general INS membership. The barriers were similar to male colleagues and included provider and payer support for more novel therapies.
Educational and networking opportunities appear to be the greatest way to serve the needs of iWIN members. To that end, we welcome all INS and iWIN members to the iWIN reception at INS 2017 to show your support. Please stay tuned for more details.
Canadian Neuromodulation Society Annual Scientific Meeting in September Will Honor Its Founder
The Canadian Neuromodulation Society’s 9th Annual Scientific Meeting will be held Friday, Sept. 30 – to Sunday, Oct. 2, 2016. The meeting takes place in Regina, Saskatchewan in honor of the late Krishna Kumar, MD. He was pioneer in the field as a neurosurgery professor at the University of Saskatchewan, and founding president of the Canadian chapter 10 years ago.
All members of the INS, including those in the Canadian or North American chapters, will receive a $100 registration discount.
The program is online at: http://neuromodulation.ca/images/CNS%202016/2016_program_20160822.pdf
More Upcoming INS Chapter Meetings
As noted on the International Neuromodulation Society Global Events Calendar, other chapters are also holding annual scientific meetings in the next three months:
Nordic Neuromodulation Society annual scientific meeting:
Sept. 1 – 3, 2016
Uppsala, Sweden
Spanish Neuromodulation Society annual scientific meeting:
Oct. 20-22, 2016
Seville, Spain
Neuromodulation Society of the United Kingdom and Ireland annual scientific meeting:
Nov. 3-4, 2016
Manchester, England
Italian Neuromodulation Society annual scientific meeting:
Nov. 3-4, 2016
Naples, Italy
German Society of Neuromodulation annual scientific meeting:
Nov. 10-12, 2016
Düsseldorf, Germany.
Progress on International Neuromodulation Database
The neuromodulation database registry initiated more than six years ago in Denmark is progressing with new refinements and features. The database, a collaboration between the departments of Neurosurgery and Anesthesiology at Aarhus University Hospital, is an open-access, Internet-based platform that collaborating institutions in other countries can use. Since the system is based on individual mirrors, participating countries or centers can get their own version of the database, after forming a board to be responsible for handling legal issues.
Details about the database are now available at http://neurizon.org
The website lists currently running databases involving INS members in Switzerland and Germany as well as Denmark.
The site also includes an example of the kinds of reports that can be created with the data.
The database began with spinal cord stimulation cases and now includes peripheral nerve stimulation, peripheral nerve field stimulation, dorsal root ganglion stimulation, and intrathecal drug delivery.
The intrathecal drug delivery component allows capturing and viewing data on complete patient management, including procedures, pump maintenance and programming, medicine, and trial dose effect registration.
The team improved the system speed through new code and also improved the administrator tools, says Nordic Neuromodulation Society chairman, Kaare Meier, MD, PhD, one of three main developers of the database platform.
He and his colleagues welcome inquiries from potential new users, as well as feedback or suggestions about potential improvements.
Meanwhile, in the U.K., work continues by the Neuromodulation Society of the United Kingdom and Ireland in establishing a national registry.
The Neuromodulation Society of Australia and New Zealand Extended Its March 2016 Annual Scientific Meeting to Two Days
The Neuromodulation Society of Australia and New Zealand (NSANZ) 11th Annual Scientific Meeting was held 12 – 13 March 2016, in Perth, Western Australia, immediately prior to the Australian Pain Society Annual Conference. The Committee trialed a two-day program format for 2016 which was extremely well received, attracting delegates from nine countries, a well-supported trade exhibition and a strong sponsor presence.
With an overarching theme of Neuromodulation: Mainstream Medicine, the meeting program was led by esteemed industry heavyweights Professor Sam Eldabe, Dr Lawrence Poree, Dr Michael Stanton-Hicks and Dr Simon Thomson, and featured invited speakers, panel sessions, case studies, masterclasses, poster presentations, special interest sessions for pain trainees and novice implanters, a nursing and allied health breakout session and a focus session on sacral stimulation.
The meeting appealed to a wide variety of specialists, with content which explored the diversifying science and therapeutic applications of neuromodulation in pain and other applications. Landmark research was also presented, including recent pivotal studies from the U.S. that are evolving the quality of evidence in this space.
The meeting received overwhelmingly positive feedback and is a triumph for NSANZ.
Please mark your calendars for the NSANZ 12th Annual Scientific Meeting which will take place in Adelaide, South Australia from 8 – 9 April 2017.
INS was Represented at Neuromodulation: The Science, Where the Keynote Talk Addressed NINDS Neuromodulation Funding
Anyone who may be interested in applying for neuroscience-based research funding should watch the U.S. BRAIN Initiative website for funding opportunities announced in the latter half of 2016, according to Stephanie Fertig, director of Small Business Programs at the U.S. National Institute of Neurological Disorders and Stroke (NINDS).
She highlighted federal funding contributions in a keynote talk at Neuromodulation: The Science 2016, and added that BRAIN Initiative funding is not limited to U.S. researchers.
The meeting was organized by International Neuromodulation Society (INS) Emeritus Director-at-Large Elliot Krames, MD and INS member Eric Grigsby, MD. The INS staffed a booth during the May meeting in San Francisco, where many of the presenters were INS members.
At NINDs, Fertig said, most neuromodulation funding supports investigator-initiated projects. About half the funded projects involve medical devices. In the past, projects winning grant support have ranged from translational studies to small clinical trials.
Her advice to any would-be grantees pursuing investigator-initiated projects? “Contact program staff well in advance of applying.”
Funding opportunities from NINDS can be found at:
http://www.ninds.nih.gov
More details about the U.S. small-business program are available at:
https://sbir.nih.gov/
Michiel Staal, August 17, 1949 – July 12, 2016
By Mike JL DeJongste
Michiel J. Staal was born in Amsterdam August 17, 1949. Michiel was born a Leo, or lion, and as that suggests, he knew how to be in the lead.
After he passed his medical exams in Utrecht he pursued theoretical and clinical training before he went to Uganda to work in a missionary hospital for two years. After his return to the Netherlands he worked in Eindhoven in the cardiac surgery department were he worked in intensive care. There he investigated “Some aspects of infection surveillance in open-heart surgery,” which was the topic of his thesis in 1983.
He married Anna Schreinemachers in 1973. They had two children, Arne and Lisa, and two grandchildren. Michiel came to Groningen to become a resident in neurosurgery. He qualified as a neurosurgeon there in 1985.
I first met him in 1986, a year after he was appointed to the Department of Neurosurgery at the University of Groningen. He had just received a grant of 300,000 euros from the Dutch government to evaluate different indications for spinal cord stimulation (SCS). Happily enough for me, angina turned out to be one of the best indications for SCS. Since then we start collaborating more and more intensively. However, at that time, we only had a vague idea of how we could treat patients with severe angina by using electrical neuromodulation. I had only treated a couple of patients with transcutaneous electrical nerve stimulation (TENS). However, Michiel was immediately enthusiastic about the idea of evaluating angina as a putative indication for spinal cord stimulation. And so our lives and adventures took off into an increasingly puzzling, dazzling and inspiring world of neuromoduation. One of our highlights was of course taking our trips to Moscow, where we were treated as real VIPS. (See Wikipedia: Boris Yeltsin for context about that time period).
Fortunately, our friendship soon grew to include other interests such as woodworking, playing tennis and following courses and practicing all kinds of artistic expressions.
In 1989 Michiel Staal hosted the very successful first International Congress on Epidural Spinal Cord Stimulation (ICESS) in Groningen. Two years after the ICESS meeting this initiative resulted in the creation of bylaws for the INS and its establishment in Paris, France in 1991. A year later in May 1992 the first INS congress took place in Rome. (See an account of this period in the October 2015 issue of the INS Newsletter). Biannually, around the world, INS congresses have been organized since then.
Michiel Staal wrote many articles on neuromodulation and received a professorship for neuromodulation in 2003. In his inaugural speech as a professor on “current, fluids and cells,” he highlighted all aspects of neuromodulation.
He was chairman of the Benelux Neuromodulation Society (BNS) chapter of the INS from 2009-2014. He successfully organized several symposia on motor cortex stimulation (in Brussels in 2011) and a joint BNS meeting with the foundation of the Baltic States-Nordic chapter. Unfortunately, the latter had to be postponed for a year, due to the eruption of the Eyjafjallajökull volcano in Iceland. The joint meeting took place in Groningen in 2011.
After his retirement in July 2014, his head was full of ideas, initiatives and challenges: to travel with his wife Anna, to do more woodworking, to enjoy their house in France and spend time with his grandchildren etc. Unfortunately, this was only for a very limited time since he got ill in February 2015. Gradually, Michiel started to become more and more disabled. At last, we could only made small trips to grab a cup of coffee somewhere close by and return home shortly thereafter. On July 12, 2016 Michiel Staal died from brain cancer.
I cherish many great moments we shared together and extend my condolences to his wife Anna, their children Arne and Lisa, Arne’s wife Jin, granddaughters Lianne and Elisa (see photo), and the rest of the family in their loss.
Michiel Staal with granddaughters Elisa (in pink) and Lianne, right, with Dr. DeJongste's granddaughter Liza, left, in 2016.
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