title: The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury.
abstract: BACKGROUND
  Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or peripheral or cranial nerves for the purpose of modulating the neural activity of the targeted structures to achieve specific therapeutic effects. Surgical placement of neurostimulation devices is associated with risks of neurologic injury, as well as possible sequelae from the local or systemic effects of the intervention. The goal of the Neurostimulation Appropriateness Consensus Committee (NACC) is to improve the safety of neurostimulation.
  
  
  METHODS
  The International Neuromodulation Society (INS) is dedicated to improving neurostimulation efficacy and patient safety. Over the past two decades the INS has established a process to use best evidence to improve care. This article updates work published by the NACC in 2014. NACC authors were chosen based on nomination to the INS executive board and were selected based on publications, academic acumen, international impact, and diversity. In areas in which evidence was lacking, the NACC used expert opinion to reach consensus.
  
  
  RESULTS
  The INS has developed recommendations that when properly utilized should improve patient safety and reduce the risk of injury and associated complications with implantable devices.
  
  
  CONCLUSIONS
  On behalf of INS, the NACC has published recommendations intended to reduce the risk of neurological injuries and complications while implanting stimulators.
authors.affiliation: Center for Pain Relief, Charleston, WV, USA.
authors.forename: Timothy R
authors.initials: TR
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authors.affiliation: Mayo Clinic, Rochester, MN, USA.
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authors.affiliation: Summit Pain Alliance, Santa Rosa, CA, USA.
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authors.affiliation: St. Luke's University Health Network, Bethlehem, PA, USA.
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authors.affiliation: Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Provenzano
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Konstantin
authors.identifier: http://orcid.org/0000-0002-7946-8639
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authors.lastname: Slavin
authors.affiliation: Florida Pain Melbourne Clinic, Melbourne, FL, USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Golovac
authors.affiliation: Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Jeffrey
authors.initials: J
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authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Rosenow
authors.affiliation: Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Kayode
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authors.lastname: Williams
authors.affiliation: Holy Cross Hospital, Ft. Lauderdale, FL, USA.
authors.forename: Porter
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authors.lastname: McRoberts
authors.affiliation: Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Narouze
authors.affiliation: The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Eldabe
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.affiliation: Valencia School of Medicine, Hospital General Universitario, Valencia, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: De Andrés
authors.affiliation: Anaesthesia and Pain Management Department, EHC Hosptial, Morges, and CHUV University Hospital, Lausanne, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Buchser
authors.affiliation: Service de Neurochirurgie, CHU de Poitiers, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rigoard
authors.affiliation: Marcus Neuroscience Institute, Boca Raton, FL, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Levy
authors.affiliation: Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Simpson
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
mesh_terms: D032921:Consensus; D004599:Electric Stimulation Therapy / Q000379:methods* / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D009422:Nervous System Diseases / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011367:Professional Staff Committees / Q000592:standards*
keywords: chronic pain; deep brain stimulation; motor cortex stimulation; neurological safety; neurostimulation; peripheral nerve stimulation; spinal cord injury; spinal cord stimulation