Perspectives on the History of Neuromodulation-Relevant Societies

Introduction

Medical fields, as in other fields of scientific or intellectual endeavor, are advanced from an idea of necessity to reality only after those early adherents to the idea form associations to bring commonality of purpose to their association. As we shall see in this chapter, neuromodulation, ¹

1 Neuromodulation is defined by the INS as technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area.

as a field of scientific endeavor, was brought to the attention of other medical practitioners by a few bright and persistent medical practitioners who thought that the practice of neuromodulation deserves to be a separate field of scientific, engineering, and medical endeavor with its own members and its own journal and meetings to disseminate information that is relevant to the field.

In this chapter, we start with the field of stereotactic and functional neurosurgery, because, for the most part, neurosurgery birthed the field of neuromodulation with the early advent of stereotactic techniques to localize therapies, including electricity to alter function in the brain. Dr. Slavin will discuss the beginnings of the World Society for Stereotactic and Functional Neurosurgery (WSSFN), which will be followed by short histories of the International Neuromodulation Society (INS) by Dr. Barolat and Mr. Simpson, because it was a few disgruntled, WSSFN, break-away neurosurgeons, in collaboration with a few neurologists and anesthesiologists, who founded the INS. The last section, but not certainly the least, will be a discussion on the history of the North American Neuromodulation Society (NANS) by Dr. Stanton-Hicks, a past president of NANS. NANS represents the largest chapter of the INS and the first national chapter of the INS.

Today, the INS is an interdisciplinary field with more than 2500 members, worldwide, and more than 25 international chapters, representing practitioners of neuromodulation within the four corners of our globe. The INS are made up of neuroscientists, biomedical engineers, members of relevant industry, and clinicians, possibly represented by physicians and health caregivers from every other medical specialty that exists. The INS has meetings and a journal, Neuromodulation , and both are active in disseminating basic and clinical information relevant to our field. Now, on to those histories.

Perspectives on the History of the Neuromodulations Societies: Societies for Stereotactic and Functional Neurosurgery

Konstantin V. Slavin

University of Illinois at Chicago, Chicago, IL, United States

Before neuromodulation practitioners had their own societies, before neuromodulation became available to nonsurgical specialists, before pain medicine had formed as a separate specialty, there was a time when neuromodulation was in an exclusive purview of neurosurgeons. And before that, the treatment of chronic pain, movement disorders, epilepsy, and other conditions that are now managed with neuromodulation was mainly based on targeted ablation of nervous tissue by neurosurgeons, the approach that is still used as a valuable alternative to neuromodulation. The entire field of surgical management of these so-called functional disorders was, and still is, a subspecialty of neurological surgery—functional neurosurgery. Surgical techniques of functional neurosurgeons have been traditionally based on precise anatomical and physiologic targeting, frequently in an anatomically normal brain and spinal cord, and the ability to maintain accuracy and precision was mainly associated with the stereotactic method, a principle of navigation in three-dimensional space, based on known external and internal landmarks.

It is not surprising, therefore, that the first professional society of functional neurosurgeons was called the Society for Research in Stereoencephalotomy before it evolved into the present-day Society for Stereotactic and Functional Neurosurgery (SSFN). The society was founded by the pioneers in functional neurosurgery, a neuroscientist, neurologist, and experimenter, Dr. Ernest Adolf Spiegel (1895–1985), and his former student and scientific collaborator, neurosurgeon, Dr. Henry T. Wycis (1911–72), the same people who modified the original Horsley–Clarkedxmk stereotactic apparatus, adapting it for human use and linking it with intraoperative skull radiographs. They published the first clinical report of stereotactic thalamotomy in the journal Science in October 1947. The first interventions were performed in 1946 with a goal “to reduce the emotional reactivity by a procedure, much less drastic than frontal lobotomy” ( ), but in 1948, the same stereotactic device was used by the same team of pioneers for stereotactic pallidotomy on a patient with Huntington chorea ( ).

To grow the young field of functional and stereotactic neurosurgery, it was important to exchange ideas and discuss clinical results—these were the goals of the First International Symposium on Stereoencephalotomy that was held at Temple University Medical Center in Philadelphia, PA, on October 11–12, 1961. The event is considered epic in its nature; although there were only a few dozens of participants; the papers presented covered a wide range of subjects, with multiple presentations focusing on the electrical stimulation of deep brain structures for a variety of clinical conditions (in hindsight, one may say that 1961 symposium was focusing, to some extent, on what we today would consider neuromodulation).

At the conclusion of this symposium, the society was officially born; Spiegel was elected its president, Traugott Reichert of Freiburg, Germany, was elected vice president, and Wycis was elected secretary-treasurer. Remarkably, the newborn society chose to make its official journal, the oldest dedicated neurosurgical journal in the world, Confinia Neurologica ( Borderlands of Neurology ), which was founded by E.A. Spiegel in 1938 and published by Karger in Basel, Switzerland.

The next two meetings of the society took place in Copenhagen/Vienna in August/September 1965 and in Madrid in April 1967 ( Tables 1.1 and 1.2 ). Soon, thereafter, an American branch of the International Society for Research in Stereoencephalotomy was formed at its inaugural meeting in Atlantic City, NJ, on October 13, 1968 ( Tables 1.3 and 1.4 ). An independent European branch of the Society was formed at the Fifth International Symposium on Stereoencephalotomy in Freiburg, hosted by Riechert in September 1970. From its inception, this branch was called the European Society for Stereotactic and Functional Neurosurgery (ESSFN) ( Tables 1.5 and 1.6 ). Not long after that, at the conclusion of the Sixth Symposium of the International Society for Research in Stereoencephalotomy, in Tokyo on October 12–13, 1973, the Society changed its name to the World Society for Stereotactic and Functional Neurosurgery (WSSFN) with its American branch becoming the American Society for Stereotactic and Functional Neurosurgery (ASSFN) ( ).

The relationship between the world society and continental societies remains cordial and friendly; all members of ASSFN and ESSFN automatically become members of WSSFN. Similar arrangements exist with several national and regional societies for stereotactic and functional neurosurgery in Asia and Latin America. Since their inception, the WSSFN, the ASSFN, and the ESSFN have had regular well-attended conferences. Initially, the WSSFN and ASSFN alternated their quadrennial meetings during odd years, and the ESSFN had its biennial meetings during even years. As the field expanded and the amount of new information exponentially increased, having 4 years’ hiatus between meetings became unreasonable. Therefore, ASSFN switched its conference schedule and moved its meetings to May/June of even years, while ESSFN moved its meetings to September/October of even years. The WSSFN added interim meetings to the odd years between its quadrennial congresses.

Proceedings of the conferences continue to be published in the society’s journal, which has changed its name twice. In 1975, the name switched from Confinia Neurologica to Applied Neurophysiology , and then in 1988 it became Stereotactic and Functional Neurosurgery . The publisher of the journal was also its cofounder. In 1938, it was the meeting of Prof. Ernest Spiegel and Heinz Karger that resulted in the birth of the journal. Almost 80 years later, the journal publisher, the Karger family, remains our loyal friend and supporter ( ).

Currently, Stereotactic and Functional Neurosurgery serves as the official organ of the WSSFN, the ASSFN, the ESSFN, and several national societies. Spiegel edited it between 1938 and 1975; after that, it was edited by Dr. Philip L. Gildenberg, who took over the editorship and kept the journal at its high level of professional recognition for 27 years until 2002 when he passed his post to Dr. David W. Roberts, who is editing it now. With these three editors, the journal has reached its current height and became a premiere publication for every facet of functional neurosurgery worldwide. Currently, the journal comes out in eight issues per year and maintains a healthy impact factor through a rigorous peer-review process and unbiased, merit-based acceptance. The majority of readers receive an electronic version of the journal, but having it as a society membership benefit has allowed the publisher to avoid establishing “processing” and “publication” fees for the authors.

During the past five decades, the field of stereotactic and functional neurosurgery has gone through “ups and downs,” but the continuous growth of the society was and is always present, and just as one would expect, the emphasis gradually shifted from all kinds of destructive interventions to electrical and chemical neuromodulation. But even now, when neuromodulation represents a big part of our clinical practice, the specialty of stereotactic and functional neurosurgery is much more than neuromodulation. Stereotactic technique is used for navigation during open surgical interventions, minimally invasive biopsies, catheter placements, diagnostic electrode insertions, and frame-based and frameless radiosurgery. The spectrum of functional interventions, in addition to neuromodulation, includes all kinds of decompressive, ablative, and respective surgeries, and the tools that are used for these purposes include mechanical instrumentation, radiofrequency probes, cryoprobes, lasers, focused beams of radiation and brachytherapy seeds, chemical agents, and, most recently, genetic vectors and focused ultrasound. And, if the first functional and stereotactic interventions were aimed, primarily, at patients with psychiatric conditions, current surgical indications include movement disorders, chronic pain, medically refractory epilepsy, disorders of memory, mood and cognition, as well as the rapidly growing fields of neuroprosthetics, neurorestoration, and surgical facilitation of neurorehabilitation. All this dictates new priorities for the professional societies in stereotactic and functional neurosurgery. In addition to ongoing efforts in basic and clinical research, the societies are now focusing on providing quality education, creating practice guidelines, developing clinical evidence, and establishing access to the available technology and expertise.

The societies for stereotactic and functional neurosurgery today are stronger than ever. As the number of indications, interventions, and modalities expands, the need for experts who can perform these interventions safely and efficiently becomes more obvious.