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Neuromodulation News: October 2018

President's Message l INS 14th World Congress Scientific Program l 14th World Congress Abstract Submissions l Interim Meeting in August l Joint INS European Chapter Meeting l Current and Future Expert Panels l Dutch Neuromodulation Database l Ways to Get Involved

A Message from the President

I am honored to have been inducted as the new President of the International Neuromodulation Society at the 1st Joint Congress of the INS European Chapters in Nijmegen, the Netherlands last month. As many of you know, I have devoted most of the past decade to serving as Editor-in-Chief of our journal Neuromodulation: Technology at the Neural Interface. During this time, the journal has doubled its annual page count and doubled the number of annual issues. Despite this, the journal’s impact factor has risen dramatically, with our 2-year impact factor currently at 2.78 and our 5-year impact factor over 3! During my three-year presidential term, Dr. Robert Foreman will assume the role of Acting Editor-in-Chief, continuing our journal’s growth in both prestige and impact.

While esteemed Past-Presidents of the INS have focused on increasing public education and growth of international INS chapters, I feel that it is time to devote our energies to increase the value of the INS to our members and the patients that they serve. Certainly, two INS activities have provided a tremendous ongoing service to our members: our biennial meeting and our journal.

In addition to advancing knowledge of the field through our journal, the INS is already recognized worldwide for its multidisciplinary world congress. I want to encourage everyone to submit scientific abstracts for the meeting by Dec. 3, 2018 and register for the 14th World Congress in Sydney from May 25 – 30, 2019. There is a registration discount for registering early by Jan. 22, 2019. We anticipate a state-of-the-art meeting in a fascinating setting, with a strong international faculty and outstanding scientific program. I hope you will be a part of this dynamic event to interact with international peers and learn what the future holds for the many neuromodulation therapies.

With the recent addition of a biennial meeting highlighting the local growth of neuromodulation in developing countries (most recently in Rio de Janeiro, Brazil) and our regional group chapter meetings (most recently the 1st Joint Congress of the INS European Chapters), we have worked to provide additional value to our international members.

In light of the many challenges facing our field, however, we must do more. Very recently, political moves are occurring in Australia that threaten to limit access to neuromodulation to only those with the highest level of insurance coverage. In Spain, there has been a significant decrease in national funding for neuromodulation therapies. Meanwhile, a clinical researcher recognized for his work in deep brain stimulation for pain, Prof. Tipu Aziz, can no longer perform those surgeries in the U.K. In China, research into DBS for addiction disorders is now forbidden except in military hospitals. Challenges to patient access and physician reimbursement appear to be increasing in the United States as well; several insurance payors continue to refuse payment for dorsal root ganglion stimulation on the basis of it being an “experimental therapy” despite a positive large scale randomized clinical trial and both FDA and CMS approval.

I believe that the INS stands upon four foundational pillars, each of which demands our attention and action: research, education, quality assurance/quality management, and patient access. During my presidential term, we are committed to serving the research pillar for our membership through two major projects: the development of guidelines for research and reporting in neuromodulation, as well as the development of a mechanism to provide research awards and recognition to young investigators in neuromodulation. Our educational efforts will concern the development of teaching programs for implanters, referring health care providers, and patients, to be pursued both independently and in collaboration with other organizations and our individual chapters. We further must commit to quality assurance and quality management in neuromodulation and as such, the INS will develop guidelines for training and qualification in neuromodulation, certification in neuromodulation therapies, and centers of excellence in neuromodulation. This will require a collaborative effort involving several societies and our member chapters. Finally, the patient access pillar of the INS requires that we provide expert support, education, and documentation in a proactive fashion to help our worldwide constituency.

With these efforts, and with the assistance of our officers, board of directors, focused committees and members, I expect that we will succeed in providing greater value for members of the INS and their patients. The future of medicine appears to be closely related to the future of neuromodulation and this future seems very bright, indeed.

Robert M. Levy, MD, PhD
INS President


INS 14th World Congress Scientific Program

Many thanks to all who submitted proposals to International Neuromodulation Society for the 14th World Congress scientific program. With an abundance of excellent proposals, there was not enough space to include them all, so we encourage members whose sessions did not make it into the main program to submit abstracts as there was much good material that simply could not fit into the main program, and the Scientific Committee is keen to see this material in the abstracts with the potential for podium presentation of selected abstract presentations.

The abstract submission deadline is Dec. 3, 2018. Submissions are welcome through the abstract system on the INS 2019 Congress website. We have reserved space in the scientific program to present over 100 oral abstract presentations on the congress stage, in addition to poster sessions.

If you haven’t already, please take a moment to review the INS 2019 preliminary scientific program, which is now available online. The scientific committees thoughtfully crafted the scientific program through several rounds of peer review to fill practice gaps and mitigate commercial bias. Members of the new INS Scientific Oversight Committee, a non-conflicted panel of experts in the field, conducted the final review to resolve any remaining conflicts and biases. The goal of this process was to offer as objective, balanced, and comprehensive educational content as possible.

The program covers a broad range of cutting-edge developments and late-breaking research. Some highlights of the plenary and thematic breakout sessions include:

  • Improving delivery of neuromodulation for pain
  • What is on the horizon for stimulation patterning
  • Objective markers to assess spinal cord stimulation
  • The current state of battery-free systems
  • A novel model of brain function
  • Non-surgical deep brain stimulation
  • Motor recovery after stroke or spinal cord injury
  • Neuromodulation mechanisms of action
  • Adaptive deep brain stimulation
  • Neuromodulation for epilepsy
  • Pelvic organ motility disorders
  • Neuromodulation for obesity or eating disorders
  • Cardiovascular neuromodulation

We are pleased to offer two new sessions in 2019: an Allied Health Professional Course, as well as one on Neuromodulation in Asia.

INS 14th World Congress Preconferences and Workshop

Two pre-conferences and a workshop will precede the 3.5-day scientific program of the INS 14th World Congress.

Saturday, May 25:

- Noninvasive Brain Stimulation Preconference - The preconference will focus on applying advances in MRI, EEG, and neuroscience to further develop repetitive transcranial magnetic stimulation to treat psychiatric disorders, chronic pain, hemiparesis, and other disorders, as well as gain insight into brain function. Abstract submissions are welcome for the noninvasive brain stimulation preconference. The abstract deadline is December 3, 2018.

Sunday, May 26:

- Innovations in Neuromodulation:  – We are excited about the theme of the fifth “Innovations Day”  preconference, Disruptive Innovation: The Driving Force of Progress in Neuromodulation. We aim to bring together some 200 leaders in the global neuromodulation and investment communities to hear about disruptive technology within the context of our field, from emerging companies and innovators and entrepreneurs speaking about their vision for a future undergoing rapid evolution.

- Hands-on Cadaver Workshop – The workshop, hosted in collaboration with the Neuromodulation Society of Australia and New Zealand (NSANZ) at Macquarie University, will offer focused instruction on the latest neuromodulation therapies in didactic and hands-on sessions.

- Public Education Event

On the afternoon of Sunday, May 26, NSANZ is hosting a free public education program to raise awareness of neuromodulation, featuring educational presentations for a lay audience and patient panels. All are welcome to attend.

Stay tuned for further details about INS 2019!

We encourage you to start planning your travel now by visiting the congress website to learn more about traveling to the Congress, and exploring Sydney and beyond. The INS has negotiated airfare discounts with Qantas for registered delegates and their companions.

Note: You may need a visa to visit Australia; be sure to consult your local Australian consulate for details.

We hope you will join us for INS 2019 and encourage your friends and colleagues to come with you!  Please help us spread the word by using the promotional toolkit that we have developed for #INS2019.

See you in Sydney!

Chair, INS 14th World Congress
Director-at-Large, International Neuromodulation Society


INS 14th World Congress Abstract Submissions

The INS 14th World Congress abstract submission deadline is Dec. 3, 2018. Submissions are welcome through the abstract system on the INS2019 Congress website. In addition to poster presentations, scientific program sessions will accommodate more than 100 podium presentations of oral abstracts. Also, there is a special abstract submission category for the Noninvasive Brain Stimulation Preconference to take place on Saturday, May 25.

There will be an abstract competition among submissions whose primary author is registered for the main congress as a current INS member. The top five abstracts will be recognized for their quality, originality and ingenuity in basic or clinical science. Awardees will be notified in advance, and recognized on stage during a plenary session on the morning of Monday, May 27, 2019. In addition, primary author recipients will receive a congress registration fee refund.


Second INS Interim Meeting in Rio de Janeiro

Last August 2018, the “Wonderful City” of Rio de Janeiro, Brazil, held the 2nd INS Interim Meeting with the subject: Working Toward the Future. The choice of a Latin American city to host such an important event was taken at the INS 13th World Congress in Edinburgh, aiming to spread current knowledge of how neuromodulation can improve our patients’ lives all over the world.

Indeed, the INS supported and encouraged in different ways the achievement of this meeting. Our special thanks to: Dr. Timothy Deer, Dr. Robert Levy and Tia Sofatzis. A grant from the INS supported simultaneous translation between Portuguese, Spanish and English, and covered faculty travel.

Image caption: Brazilian Neuromodulation Society President Prof. Alexandre Amaral, second from left, is flanked by incoming INS President Dr. Robert Levy, left, and outgoing INS President Dr. Timothy Deer, third from left. Second Interim Meeting Scientific Committee Coordinator Dr. Daniel Benzecry de Almeida is at the far right.

The 140 participants included neurosurgeons, neurologists, anesthesiologists, psychiatrists, orthopedists, pain specialists and other health professionals. They came from Argentina, Australia, Belgium, Brazil, Canada, Colombia, Panama, Portugal, the United Kingdom, the United States, and Uruguay.

Over four days, there were 56 speakers from four continents – six Latin America countries, and the United States, Europe and Australia – who presented 92 parts of the program. These included two preconference workshops on clinical practice and surgical techniques of neuromodulation; industry symposia by Abbott and Medtronic; an exhibition of leading companies in the neuromodulation sector (especially in Latin America); and the scientific program.

The scientific program was especially prepared to provide basic and advanced learning of neuromodulation techniques.

Our first goal was to provide valuable information about common diseases treated, such as craniofacial pain, complex regional pain syndrome, failed-back syndrome, neuropathic pain, and cancer pain, among others. Diagnostic criteria and conservative treatment modalities were also discussed. But a significant time was taken to debate how neuromodulatory techniques can efficiently and positively decrease pain and dysfunction.

Non-invasive techniques such as transcranial magnetic stimulation and transcranial direct current stimulation have also been widely discussed, from basic concepts to current application in a variety of disorders such as chronic pain, neurocognitive rehabilitation, psychiatric disorders, aphasia, traumatic brain injury and stroke.

Furthermore, other important subjects were discussed, such as the role of neuromodulation for the treatment of movement disorders, spasticity, epilepsy, psychiatric disorders and visceral disorders.

Finally, many talks about what to expect from the future were given. Techniques such as cellular therapies, neurostimulation for neurodegenerative diseases and brain-machine interface were discussed. For all these reasons, the feedback on this meeting has been very rewarding. Our sincere thanks to all those who helped in many ways to achieve this success.

Members of the scientific committee were:

Alexandre C. Amaral, President of the Congress and President of the INS Brazilian Chapter

Daniel Benzecry de Almeida, Scientific Committee Coordinator

Alexandre Novicki Francisco
Arthur Cukiert
Carlos Sacomani
Egas Caparelli
Erich Fonoff
Hougelle Simplício
José Osvaldo de Oliveira Jr
Leandro Braun
Marcel Simis
Osvaldo Vilela

In addition to this wonderful educational opportunity, at the meeting of the INS Brazilian Chapter, we decided to invest in accreditation of training centers in neuromodulation procedures, and to promote agreements for the realization of satellite symposia in the congresses of the specialties of general neurosurgery, functional neurosurgery and anesthesiology.

Prof. Alexandre C. Amaral
Functional Neurosurgeon
President Brazilian Chapter International Neuromodulation Society


Report on the 1st Joint Congress of the INS European Chapters

Why organize the first European Congress on neuromodulation?

The initiative to organize the 1st Joint European Congress on Neuromodulation was encouraged by previous successful collaborations to organize scientific meetings together, among different European chapters. The collaboration among European INS chapters seems warranted, given the relatively low number of members of most of the European chapters. In addition, the reasons to organize the 1st Joint Congress of the INS European Chapters are justified through offering opportunities to exchange scientific ideas and to create networks between people from academic, industry and regulatory authorities, with a special emphasis on nurses and between young and established scientists and other professionals in the field of neuromodulation. Furthermore, with respect to the implementation of new European legislations (EDMA & Eucomed code for ethical business), limiting the industries to support physicians, we believed the incentive of a European Neuromodulation Congress might be successful, given the potential win-win option for participants, industries and others with an interest in neuromodulation.

How to organize such a meeting?

After the INS board had agreed with our initiative we were advised by the INS board to have presidents of two European chapters at the scientific (and organizing) committees. We were very pleased with the presidents of the Nordic (Kaare Meier) and of the German (Jan Vesper) chapters of the INS, who both were willing to participate. Moreover, since there was a lot of enthusiasm among the European presidents during this INS board meeting, and following the voting to have the 1st European meeting in the Netherlands, we started to set up a framework for a program and install a website ( Simultaneously, we sent e-mails to all European INS presidents to ask for their support, regarding which topics to address; program proposals; how many days the Congress may last; interest in chapter sessions; workshops etc. They also were suggested to consult with their boards and members. The proposed program framework comprised of two days of international meeting, one day for workshops and one day for the chapters.  Country-specific topics (for instance reimbursement) could be addressed during chapter meetings (1/2 day), according to the bylaws. For the chapter meetings the organizing committee only had a facilitating role (i.e. offered room and infrastructure, if requested). The program had to be organized by the individual European chapters. The intention was to provide exposure of the chapters’ boards for their members.

Image caption: Board members of the newly formed INS chapter, the National Neuromodulation Society in Russia (NNSR), posed during the meeting in Nijmegen with INS President Dr. Robert Levy, fourth from left, and Dr. Konstantin Slavin, far right, chief consultant of the board.

The members of both committees performed site visits (three times) and had regular teleconferences (six times). Minutes were taken, discussed and regularly sent to the president and secretariat of the INS.

Predetermined conditions

We took into consideration that the accent had to be on collaboration and networking among the European chapter members. Therefore, we scheduled sufficient room for socializing, and not for many parallel sessions, an overloaded program, or a copy-paste from other congresses on neuromodulation. We also assumed that focusing on new groups of workers in neuromodulation, like nurses and technicians, and addressing specific topics, like registries and having fancy new learning tools such as 3D anatomy, made this first event even more attractive for a greater audience.

Furthermore, we considered it important to maintain the “identity” of the chapters for the members. In addition to the opportunity for exposure of the specific aims of a chapter during the chapter meeting, the challenge was to let the members recognize their chapters’ input in the program! And even more difficult, to balance the input per country. If no suggestions were made by the chapter, then the president was asked to chair a session. Having no estimation of the number of participants and given the relatively low fees and costs we deemed necessary to make the Congress successful, we decided not to go for a "fancy" location.

Summary of outcomes

We all were very happy with the venue location at the van der Valk Lent, Nijmegen and the final program, attracting 511 registrants from 32 countries. Subsequently, registration had to be closed, since the conference rooms could not hold all participants! The pre-congress workshops (cadaver workshop and nurse workshop) were excellently organized at the Radboud University. The nurse workshop had the maximum number of 43 attendees, out of the 75 nurses having registered. In the main program in addition to a variety of excellent speakers from the different European countries, special attention was paid to specific topics, like brain-computer interfaces, brain criminals and the final touch by the illusionist Dr. Victor Mids.

Eighty-five abstracts were accepted. Oral abstracts were presented during parallel sessions. Poster presentations were executed on electronic screens, with three-minute pitches by the investigator. The Michiel Staal Corust awards to support researchers were given to Dr. Gerrit Gmel, from Australia, for best oral abstract: “Electrophysiological responses of the S3 sacral nerve in humans during neuromodulation for faecal incontinence”, and to Dr. Terje Kirketeig, Sweden, for best poster abstract: “Device survival and explant patterns in 446 patients treated with spinal cord stimulation”.

The Congress Website (still available) was very well designed and directly linked to the INS website. The availability of an app for the program and other information was also successful and the app was used frequently. More and more, integrated accurate mobile and web-based content is becoming a prerequisite for a congress.

In contrast, the facilities for the industries were not optimal at the venue. To overcome this inconvenience, it seems worthwhile to request the companies send pictures or detailed drawings for their booths, including measurements of the booth (height x length x breadth in cm), and to concentrate the industry booths in one exhibition hall.

Another shortcoming was that the app lacked the Saturday program. Unfortunately, probably related to inadequate announcement, there were sometimes only a few attendees at the poster presentations. It also may be worthwhile to consider a scoring system (making use of the app) to increase audience participation during the abstract and poster sessions. It further seems a big challenge to increase the input from the chapters into the program, however, it is indistinct how to improve the contribution of the chapters in the organization and program. The same holds true for the number of participants for the cadaver workshop, however, providing more hands-on time per session may help.

It is debatable whether four days in a row is too long. For the next European Congress, the organizing committee may consider having one and the same day for workshops and chapter meetings and two international days. The INS board decides how to vote for the next venue to get the 2nd European meeting organized. In addition, it may be worthwhile to take into consideration a general European assembly of the INS (European) members. Possible topics of interest for future European meetings may be a comparison of various national guidelines on neuromodulation, to formulate mutual outcome parameters for successful treatment, and to involve patients in the program.

Organizing and scientific committees

Robert van Dongen, anesthesiologist, local chair
Caro Edelbroek, nurse practitioner, chair nurse workshop
Mike de Jongste, cardiologist, chair
Erkan Kurt, neurosurgeon, chair cadaver workshop
Kaare Meier, president of the Nordic Neuromodulation Society
Monique Steegers, president of the Benelux Neuromodulation Society
Jan Vesper, president of the German Neuromodulation Society
Sharon de Puijsselaar, GCB
Alexandra van Driessen, Radboud UMC

INS Expert Panels on Amputation Pain and Pelvic Pain

INS members may participate in a current Expert Panel and an upcoming one:

“Neurostimulation for Management of Stump and Phantom Limb Pain in the Amputee” is being held from Oct. 23 through Nov. 6, 2018, in the Global Discussion Forum of the Members Only section of the INS website.

The focus of the session is intended to be a multifaceted discussion of dorsal root ganglion (DRG) stimulation, spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), and neurophysiology. It is being co-moderated by Timothy Deer, MD, DABPM, FIPP, and Paul Verrills, MBBS, FAFMM, GDMM (Hons), MM (Pain Medicine), FIPP, who will discuss the use of DRG stimulation for this array of pain syndromes, and other forms of spinal cord and peripheral nerve stimulation. They are being joined by INS members Kasra Amirdelfan, MD, and Amol Soin, MD, who have been asked to discuss SCS and PNS, respectively. Also, J. Leon Morales-Quezada, MD, MSc, PhD, MPH, associate director of the Spaulding Neuromodulation Center at Harvard University, was invited to cover the mechanisms behind deafferentation pain, and may discuss peripheral nerve stimulation for pain control.

In preparing for the session, Dr. Deer commented that he advocates neuromodulation as part of a multimodal treatment for complex issues to reduce the need for opioids and improve the lives and function of those who suffer. He and Dr. Verrills were both involved in early development of dorsal root ganglion stimulation therapy for chronic pain. Dr. Verrills commented that he is passionate about neuromodulation techniques now available for complex patients that perhaps we couldn’t adequately help in the past.

“Neurostimulation for Pelvic Pain” will be co-moderated from Jan. 22 through Feb. 5, 2019, by Richard P. Marvel, MD, FACOG, FACS; INS Director-at-Large Corey W. Hunter, MD, FIPP, and Prof. Thierry Vancaillie, MD (Belgium), RANZCOG, FFPMANZCA.

Dr. 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 its Board of Directors.

Dr. 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.

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” is due for publication by the Australian and New Zealand Journal of Obstetrics and Gynaecology in December 2018.


Dutch Neuromodulation Database

Caro Edelbroek, MA, Nurse Practitioner, Pain and Palliative Care Center, Rijnstate Hospital, the Netherlands

Neuromodulation is a technique that can offer patients with chronic, disabling and sometimes emotional devastating pain, effective pain relief and improvement in function. To prove effectiveness of newer therapies not only scientific research is mandatory. Nationwide databases following cohorts of patients enable us to improve quality, to benchmark and in the end even to better understand which patients might respond best to the therapy.

An additional value of a nationwide database is its use in the discussion with the government and health insurance companies. Showing that you are in control. The high quality of effectiveness helps to keep reimbursement of indications and to get newer indications or techniques approved.

In 1982 in the Netherlands, the Quality System Neuromodulation (QSN) was founded. The QSN is part of data management system project manager internet service (ProMISe) in Leiden, which is used by 23 organizations and holds 326 projects. In the 2008 the Dutch neuromodulation society (VvNN) became responsible for managing this database. The VvNN ensures the quality of care in neuromodulation in the Netherlands, by working together with the Dutch anesthesiologists society (NVA) pain section, the pain nurse society and the patient society on neuromodulation (PVNN). The VvNN board consists of anesthesiologists, rehabilitation physicians, neurosurgeons and nurse practitioners.

The main objective to start this database was monitoring the number of implants, diagnoses, and complications of all implanted patients with neuromodulation in the Netherlands. The scope of QSN includes spinal cord stimulation (SCS) for failed back surgery syndrome (FBSS), complex regional pain syndrome, angina pectoris, peripheral vascular disease and peripheral neuropathy. Furthermore, it covers intrathecal drug delivery and intrathecal baclofen therapy.

After a quality research project and feedback received from the different pain centers, in the beginning of this year the database was updated. This research was done by a policy and management student from the Erasmus University Rotterdam. Interviewing was conducted to evaluate the database and get insight from different stakeholders. The most important feedback was that stakeholders wanted the dataset to be less time-consuming and have the data reported back in a simple and clear way. The update meant the dataset was minimalized and a dashboard facility was added.

The goal of this evaluation and update was to create a broad support among the daily users and get them more motivated to enter the data properly. A very important factor to get the data complete and trustworthy is critical observation of the database and clear goals setting. Furthermore, very important are clear agreements on the privacy of the data, for patients but also for the participating pain centers. For example data about numbers of complication for each site must be treated with care and should be interpreted in the right way. A clear policy on privacy and ownership of data is very important for compliance of pain centers and getting physicians involved and committed.

At this moment 29 pain centers in the Netherlands are collecting data in the QSN database. A download and dashboard function is available. The dashboard shows data of each pain center and can be used for benchmarking; pain centers can compare their data to the other participating centers.

Over a period of eight years from 2010-2017, there were more than 8,000 implants registered for SCS. On average, there are 500 new implants a year and 500 revisions/replacements of internal pulse generators (IPGs). This number of new and replaced IPGs over this time period has been rather stable. Since the restart after the update in 2018, the reported number of new and replaced IPGs seems to have increased, with 50-100 more implanted IPGs reported at this time in 2018 compared to the same period in 2017.

The most reported diagnosis is FBSS. The complication rate is comparable to the complication rates reported internationally in the scientific literature.

A solid working database with compliance of the participating pain centers will improve quality of care for patients treated with neuromodulation, contribute to ensure the future for neuromodulation, give insight and transparency, and increase safety by influencing the implantation sites by benchmarking. The use of the QSN database in the Netherlands is mandatory starting from this year forward.

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Last Updated on Monday, November 22, 2021 11:22 AM