Neuromodulation Program

Program Lead: Dr. Zelma Kiss

Neuromodulation is the altering/modulation of nervous system function by means of implantable devices or neural prostheses. It includes peripheral nerve, spinal cord and brain electrical stimulation, as well as drug delivery devices. Many conditions are treated, including movement disorders, epilepsy, pain, angina, depression, spinal cord injury, headache, and spasticity.

News

This year marked new beginnings. Dr. Magali Robert was named the new Director of the Chronic Pain Centre. Her experience with neuromodulation for bladder control, having done sacral nerve stimulation for decades, has fueled her interest in developing pain neuromodulation fully in Calgary. In April we welcomed Dr. Fady Girgis, a stereotactic & functional neurosurgeon back to Calgary. Dr. Girgis did his medical school and residency at U of C, followed by a stereotactic and functional fellowship in Cleveland. He practiced as an academic functional neurosurgeon in California at the University of California Davis for several years prior to returning to Calgary and joining our group. Dr. Camila Aquino, a new movement disorders neurologist and epidemiologist, arrived at the end of this academic year. Her practice and research will focus on patients with DBS for Parkinson disease.

Education

Dr. Darren Clark was the Parkinson Alberta fellow, also working part time for a biomedical start-up company. Rachel Sondergaard and Linda Kim continued in their PhD programs studying the pathophysiology of dystonia and new targets for DBS in humans and animal models. Dr. Vishal Varshney completed his residency in pain medicine and started his practice at UBC. Summer students from Mount Royal and the University of Calgary studied neuromodulation and neurophysiology in 2019. One of them, Nicole Zalasky, liked it so much she started an MSc on this topic in 2020.

Research

We continued collecting prospective data on all patients undergoing stimulation procedures. Just before retiring, Dr. Becker published a commentary on sphenopalatine ganglion stimulation for chronic cluster headache in Lancet Neurology . Highlights were the publication of the outcome of our Alberta Innovates Health Solutions randomized double-blind cross-over clinical trial of DBS for depression in Lancet Psychiatry  in January 2020. This paper was the subject of a commentary in this high impact journal. Several additional papers ensued defining predictors of response to DBS, including papers in J Affective Disorders ,  Brain Stimulation  , and Neuropsychopharmacology . We also published a case study in Journal of Neurophysiology  investigating a mechanism of DBS in dystonia, and a commentary in Brain Stimulation  critiquing the medical device industry about its so-called “improvements”.  Our trainees figured prominently in these papers being first and/or second author in all original work.

Conferences

COVID-19 reduced conference presentations significantly. Prior to the pandemic we participated in the Canadian Neuromodulation Society meeting in Iqaluit in July 2019 and a panel discussion organized by Dr. Pereira as President of the Alberta Pain Society in Lake Louise in October 2019. Dr. Kiss was invited to participate in the Cleveland Course for Advanced Neuromodulation at Case Western University in August 2019.

Despite AHS freezing our neuromodulation budget, we still managed to send 2 key team members, Kara Hallett RN and Philis Heffner PT, to the North American Neuromodulation Society meeting in Las Vegas in January, from where they brought back new knowledge to the pain group.

Post-pandemic shut down we participated a virtual panel discussion for the Canadian Pain Society. While Dr. Kiss was the Chair of the poster session for the American Society for Stereotactic and Functional Neurosurgery, this turned into an abstract review committee as the meeting went virtual and instead moderated the psychiatric neurosurgery session in June 2020.

Future Directions

The coming year will depend somewhat on COVID-19 restrictions, however we anticipate working with the CPC to develop the optimal care pathways for pain patients to access neuromodulation therapies. Additional emphasis of the focused ultrasound program at the University of Calgary will be towards using ultrasound for neuromodulation. Also, we will be establishing an intracranial cognitive neurophysiology research program using epilepsy patients with implanted brain electrodes for epilepsy.

Members

Cardiology: Dr. Todd Anderson

Neurology: Dr. Camila Aquino, Dr. Werner Becker, Dr. Veronica Bruno, Dr. Davide Martino

Neurosurgery: Dr. Fady Girgis, Dr. Walter Hader, Dr. Mark Hamilton, Dr. Zelma Kiss

Nursing: Laina McAusland and Maida Khan (UofC research), Kara Hallett, Colleen Harris, Karen Hunka, Pia Lawrence, Jackie Martini, Raj Parmar, Valerie Sherwood, Meredith Wild

Pain Physicians: Dr. Ted Findlay, Dr. John Pereira, Dr. Kelly Shinkaruk (mat leave) (Chronic Pain Centre)

Physical Medicine and Rehabilitation:

Dr. Rebecca Charbonneau (mat leave), Dr. Dan McGowan

Physiotherapy: Cliona Corbett, Philis Heffner

Psychiatry: Dr. Aaron Mackie, Dr. Brienne McLane, Dr. Raj Ramasubbu

Psychology: Dr. Arlene Cox, Dr. Angela Haffenden

Respirology/Thoracic surgery: Dr. Sean McFadden, Dr. Karen Rimmer