Most Advanced Deep Brain Stimulation (DBS) Therapy Ever Empowers Patients To Take More Control Of Neurological Disorders

Main Category: Neurology / Neuroscience
Also Included In: Parkinson's Disease
Article Date: 13 Jan 2009 - 5:00 PDT

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For the first time ever in the UK patients suffering from Parkinson's disease, essential tremor and dystonia can now take more control of disabling motor symptoms at the push of a button to directly adjust their therapy to suit their needs. The next generation in devices to join the Medtronic Deep Brain Stimulation (DBS) therapy portfolio - Activa(R) PC and Activa(R) RC - are the most advanced in technological innovations and include new programming tools that allow patients to choose among different therapy levels to suit their different activities.

Activa(R) DBS therapy devices deliver a mild electrical stimulation to targeted areas in the brain responsible for controlling movement. Activa(R) RC provides the first and only rechargeable device in the world, freeing patients from undergoing battery replacement surgery for nearly a decade, in some cases up to five times longer than previous devices.

Patients will also benefit from greater comfort as the new devices are up to 50 percent smaller in size than previous devices. These latest devices give patients more control over disabling motor symptoms, such as stiffness, slowness of movement and shaking. Patients are able to adjust their therapy within the parameters chosen by their physician, allowing increased movement control if they want to go for a walk or drink a cup of coffee, or improved stillness to allow a tranquil night's sleep.

"The latest DBS devices can make a dramatic difference in a patient's life giving them both the power and the choice to adjust their therapy to suit their needs," said Professor Tipu Aziz, Professor of Neurosurgery at the John Radcliffe Hospital, Oxford. "The rechargeable device also provides the added benefit of reducing the number of surgeries patients have to go through in their lifetime. Patients that previously required replacement surgery every two years can now live operation free for up to 9 years."

Over 12 million patients in Europe suffer from neurodegenerative disorders which can cause disability and impaired functioning.(1),(2),(3),(4) Medtronic DBS therapy brings powerful, long-term improvements to motor functions and quality of life in patients with primary dystonia(5) and essential tremor(6) and is the most efficacious therapy to enhance quality of life in patients with Parkinson's disease.(7) Medtronic DBS therapy is fully reversible and has a favourable safety profile.(8)

In addition to patient benefits, the use of Medtronic DBS therapy has also been shown to provide essential savings for healthcare systems. For instance, by reducing the medication required by patients with Parkinson's disease following DBS, and minimising the need for follow up visits for patients with dystonia once optimal therapeutic settings have been determined, research has shown significant savings in cost and time for them.(5),(9)

"This is a pioneering milestone for the millions of patients throughout Europe who can be treated with the latest innovations in DBS," said Oern Stuge, President Europe and Central Asia, Medtronic. "Physicians and patients can benefit from the only portfolio of approved DBS devices in the world and from Medtronic's unique twenty years of experience in DBS to really experience a different and better quality of life."

About DBS

DBS is a mild electrical stimulation in the brain which influences movement control. DBS therapy blocks signals within the brain that are responsible for the debilitating motor symptoms, such as stiffness, slowness of movement and shaking.

About Activa

Medtronic Deep Brain Stimulation therapy was launched in Europe in 1995 for the treatment of essential and Parkinson's tremor. Since the initial launch of Medtronic DBS the list of indications has grown to include symptoms brought on from advanced Parkinson's disease and dystonia. To date, more than 55,000 patients worldwide have received Medtronic DBS therapy.

The latest additions to the Medtronic DBS family - Activa(R) RC (Rechargeable Cell) and Activa(R) PC (Primary Cell) - are up to 50% smaller, include rechargeable options, and offer unique programming benefits to meet physician and patient needs.

Implanted components of the system include:

- Lead: The lead is a thin insulated coiled wire with four electrodes at the tip that is implanted in the brain

- Extension: The lead is connected to an extension, a thin, insulated coiled wire that is threaded under the skin from the head, down the neck and into the upper chest

- Neurostimulator: The extension is connected to a neurostimulator, a small, sealed device similar to a cardiac pacemaker that contains a battery and electronics. The neurostimulator is implanted beneath the skin in the chest. It produces the electrical pulses needed for stimulation. These electrical pulses are delivered through the extension and lead to symptom-specific brain areas called globus pallidus internus (GPi), subthalamic nucleus (STN) or ventral intermediate nucleus of the thalamus (Vim).

With Activa RC, patients can recharge their stimulator in the comfort of their home. The wearable charging system includes a patient programmer to monitor when the battery requires charging, a lightweight pouch and a wireless system that connects to the neurostimulator, ensuring maximum recharging whilst the patient goes about their daily activities.

External components of the system include:

- A physician programmer: (N'Vision(R)) is used to adjust neurostimulator parameters. The electrical pulses can be non-invasively adjusted by a clinician from the physician programmer and transmitted via radio telemetry to the implanted neurostimulator

- A hand-held patient programmer: is used by the patient to turn the neurostimulator off or on, to self-adjust the stimulation within a range of options preset by the physician and check the battery status of the implanted neurostimulator.

For the first time these devices also store records related to the benefits or side effects associated with various programming parameters which will allow programming to be easily and carefully optimised over time based on individual patient response.

About Medtronic

Medtronic, Inc., headquartered in Minneapolis, is the global leader in medical technology - alleviating pain, restoring health, and extending life for millions of people around the world.

(1) Bain PG, Findley LJ, Thompson PD, Gresty MA, Rothwell JC, Harding AE, et al. "A study of hereditary essential tremor." Brain. 1994; 117:805-824.

(2) Zesiewicz, TA et al. Practice Parameter: Therapies for essential tremor. American Academy of Neurology. June 2005.

(3) The European Dystonia Federation. http://www.dystonia-europe.org/europe/EDF_Dystonia_The_Facts_FINAL.htm. Accessed 22 October 2008

(4) European Parkinson's Disease Association http://www.parkinsonsdecisionaid.eu.com/awarenessCampaign/2008/executiveSummary.asp Accessed 22 October 2008.

(5) Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Lagrange C, et al. Bilateral, pallidal, deep-brain stimulation in primary generalised dystonia: a prospective 3 year follow-up study. Lancet Neurol. 2007; 6: 223-229.

(6) Rehncrona S et al. Long-term efficacy of thalamic deep brain stimulation for tremor: double blind assessments. Mov Disord. 2003; 18: 163-170

(7) Martinez-Martin P, Deuschl G. Effect of medical and surgical interventions on health-related quality of life in Parkinson's disease. Mov Disord. 2007; 22(6): 757-765.

(8) Voges et al, Thirty days complication rate following surgery performed for Deep Brain Stimulation. Mov Disorders 2007; 22(10):1486-9.

(9) Fraix V et al. Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson's disease. J Neurol Neurosug Pschiatry. 2006;77(4):443-9.

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