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. Specialists from DCNS and other departments are part of the program. 

Clinical Care

Unfortunately most of this year involved discussions with management about pathways-of-care, waitlists, and budgets. We were stopped from implanting new patients because we were over-budget half-way through the year. We then had to explain to patients that they had to wait until the new fiscal year. Despite our successful deep brain stimulation (DBS) for treatment-resistant depression study, achieving an approximate 50 per cent response rate, we are no longer allowed to implant patients with this indication, unless the Department of Psychiatry pays for the implants.

Dr. Veronica Bruno joined the movement disorders program and her focus is on DBS clinically and scientifically. We implanted only nine new patients with bilateral systems, and follow about 150 people in total. The pain program has been assessing about two to three new patients a month, trialing one to two and implanting one new patient a month. We follow about 70 patients with implanted neuromodulation systems for pain. Ongoing physician availability issues have reduced the interest in stimulation for headache in Calgary.

Education

There is ongoing interest in neuromodulation by trainees at fellowship, graduate and summer student levels. Drs. Darren Clark and Elliot Brown, both AIHS fellows, remained with the DBS for a depression study. Dr. Nick Strzalkowski completed his Eyes High and Parkinson Foundation fellowships, moving on to a faculty position in Juy 2018. Dr. Sohail Noor defended his PhD and received a post-doc at Case Western with the Neural Prosthesis group. Rachel Sondergaard and Linda Kim continued in their PhD programs studying mechanisms and new targets of DBS in humans and animal models. We are looking forward to helping train a neurologist fellow in movement disorders and a resident in pain medicine this coming year. The Neuromodulation program funded several summer students from Dalhousie, MRU, Queens, and UofC, in addition to an international MITACS summer student from Mexico. We hosted visiting speakers from University of Pittsburgh (Dr. Rob Gaunt 13-Oct-17), University College London (Dr. Rob Brownstone 3-Nov-17), and Brown University (Dr. David Brandman, 23-Feb-18).

Research 

We published a systematic review on DBS for dystonia in Parkinsonism and Related Disorders, another one on DBS for depression in Frontiers in Psychiatry, as well as a group publication on this topic in the Journal of Neurology, Neurosurgery and Psychiatry. There are several papers on DBS for depression in progress and our results were presented at several meetings. We studied patients with stimulators for both pain and movement disorders to develop a new psychometric questionnaire for reporting of somatosensory percepts in the Journal of Neural Engineering. 

Trainees presented posters at the International Neuroethics Society meeting—winning a travel award— and the Neural Interfaces conference, with another travel award. Preliminary data about using transcranial magnetic stimulation to alter cerebellothalamic circuits in Parkinson’s patients with DBS was presented at the Parkinson Foundation annual meeting. 

In collaboration with engineering, we continued to develop new technologies to study how DBS works in animal models and we presented at the International Society for Optics and Photonics conference. Trainees presented posters at the Society for Biological Psychiatry, Federation of European Neuroscience Societies, and the European Neuropsychopharmacology meeting—on the imaging biomarkers of response to DBS for depression. Collaborators from University of Alberta presented at Human Brain Mapping. Dr. Kiss received a grant to study the cost effectiveness of movement disorder surgery by MR-guided focused ultrasound and deep brain stimulation (DBS). She was named Deputy Editor for Brain Stimulation, the preeminent journal in the field (impact factor 6). 

Future Directions

In the coming year we hope to have our budgets stabilized and develop other creative methods to assure funding for our patients. We look forward to working with Dr. Aaron Phillips, a new physiologist in the Libin and HBI, interested in spinal cord stimulation for spinal cord injury autonomic dysfunction, and hosting professors from Lausanne who are leading the international efforts in this field.

Members

Cardiology: Dr. Todd Anderson

Neurology: Dr. Yahya Agha-Khani, Dr. Werner Becker, Dr. Veronica Bruno, Dr. Davide Martino

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

Nursing: Laina McAusland (UofC research), Cheri Gray, Kara Hallett, Colleen Harris, Brittany Hoffarth-Palchewich, Karen Hunka, Pia Lawrence, Jackie Martini, Raj Parmar, Valerie Sherwood, Sandy Stephen, Meredith Wild

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

Physical Medicine and Rehabilitation: Dr. Rebecca Charbonneau, Dr. Dan McGowan 

Physiotherapy: Cliona Corbett (mat leave), 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

(Updated Dec. 2018)