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Deep Brain Stimulation (DBS)



     Deep Brain Stimulation (DBS) is the Aptiva Therapy by Medtronic

Activa Parkinson's Control Therapy from Medtronic is one of the most significant advances in the treatment of Parkinson's disease in more than 30 years offering an innovative treatment approach. The treatment uses two surgically implanted medical devices, similar to cardiac pacemakers, to deliver electrical stimulation to precisely targeted areas on each side of the brain. Continuous stimulation of these areas blocks the signals that cause the disabling motor symptoms of the disease. As a result, many patients achieve greater control over their body movements.

Activa Parkinson's Control Therapy works by electrically stimulating targeted structures in the brain - the subthalamic nucleus (STN) or globus pallidus interna (GPi) - that control movement and muscle function. A lead with tiny electrodes is surgically implanted in the brain and connected by an extension that lies under the skin to a neurostimulator implanted near the collarbone. The electrical stimulation can be non-invasively adjusted to meet each patient's needs.

Advanced levodopa-responsive Parkinson's patients with movement-related symptoms that cannot be controlled by drugs, and people who experience intolerable side effects from drugs may be candidates for the therapy. "Levodopa-responsive" means the primary symptoms of Parkinson's disease respond to the drug levodopa.
A positive response confirms a diagnosis of Parkinson's disease, rather than conditions with similar symptoms. "Advanced" means Parkinson's disease that has progressed to a stage with motor fluctuations that inconsistently responds to L-dopa. It's at this stage that the disease causes serious disability. 


  Until there is a cure, this was my
  option which gave me a better
   quality of life

A person's age or pre-existing condition does not exclude him/her from becoming a candidate for Activa Therapy (in the clinical trial the ages of patients receiving Activa Therapy ranged from 32 to 75); however, a doctor takes all patient factors into consideration before a determination is made.

There is no cure for Parkinson's disease at this time. Activa Parkinson's Control Therapy can treat some of the symptoms of Parkinson's disease and improve function, but does not cure the underlying condition. If the therapy is discontinued, the patient's symptoms will return.

Since 1997, more than 14,000 people worldwide have benefited from Activa Therapy for Essential Tremor and Parkinson's disease.
For more information about Activa Therapy, patients are encouraged to contact their physician to discuss whether this therapy may help them.


Quick Facts about DBS-STN Surgery


1. 80% see benefit from their DBS's.

2. There are very few teams that are truly excellent at DBS operations. You MUST get the best team you can, even if it involves some travel.

3. The average for programming seems to be around 12 appts. You should expect more, be happy with less.

4. Most DBS teams have a contract with Blue Cross/Blue Shield and Medicare that covers the operation. Mine was covered 100%. All personnel are covered. You should check with your insurance carrier as to your specific coverage.

5. Go here for screening info:

6. There is no age limit for DBS. The oldest successful DBS recipient is 84. The youngest is 18.

Most of the DBS'ers I know are quite happy with their DBS's.

I know I am!

                                   Activa Tremor Control Therapy

As approved by the FDA in August 1997, the ActivaTM system stimulates the ventral intermediate nucleus of the thalamus to interrupt wayward signals that cause tremor.

The totally implanted components of the system include: quadripolar deep brain stimulation (DBS) leads, the Itrel II implantable pulse generator (IPG), and an extension that connects the lead to the IPG.

The lead, measuring 1.27 mm in diameter with a standard length of 40 cm, consists of platinum/iridium wire insulated with polytetrafluroethylene (PFTE) and polyurethane. On the tip of the lead is an array of four 1.5-mm platinum/iridium electrode contacts spaced 0.5 to 1.5 mm apart.
While only one electrode is activated during use, the multi-electrode design helps insure that electrical stimulation can still be delivered, even if the lead shifts slightly in the brain over time. Completing the DBS lead kit is a tungsten stylet, which the surgeon uses during the operation for precise lead placement. A 14-mm burr hole ring and cap anchors the lead to the top of the skull.


Options open.

The Activa system, approved for marketing by the U.S. Food and Drug Administration (FDA) in August 1997, consists of these basic implanted components :

Deep brain stimulation (DBS) lead, a thin, insulated multiwire coil with four electrodes on the end. Using magnetic resonance imaging or other medical imaging techniques as a guide, the surgeon carefully inserts the lead into the targeted area of the brain associated with motor control.

Itrel II neurostimulator, a pacemaker-like device consisting of a battery and microelectronic circuitry that delivers mild electrical pulses to the brain. It is implanted just below the collarbone.

Extension, an insulated multiwire device that is passed under the skin of the head, neck, and shoulder to connect the implanted electrode lead in the brain to the implanted neurostimulator.

Once the device is implanted, the patient uses a hand-held magnet to turn Activa on or off--or to choose between high or low stimulation settings.

"The Activa System is a huge step forward for the treatment of motion disorders," says Dr. Steve Wilkinson, a neurosurgeon who has performed about 150 Activa implants at the University of Kansas Medical Center. "Not only does it result in dramatic improvements in people's lives, but it is reversible, allowing for new advances in the future."

Wilkinson adds that, for many patients, neurostimulation is preferable to thalamotomy, a procedure in which a surgeon uses a probe to essentially burn away a section of tissue in the thalamus, the communications center in the brain associated with motor control. The surgery sometimes can result in permanent side effects, such as slurred speech or mild paralysis.

In a widely publicized December People article, actor Michael J. Fox, then 37, revealed that he had undergone a thalamotomy to control the tremors he suffered as a result of Parkinson's Disease. "If he were my patient, I probably would have recommended the Activa implant, especially because of his young age," adds Dr. Wilkinson.

So far in the U.S., the FDA has given commercial approval for using the Activa system to stimulate one side of the brain. This allows for the control of shaking on one side of the body. In Europe, however, CE mark approval, received in April of 1998, permits patients to have two neurostimulator implants, which can reduce virtually all tremor. In addition, surgeons there are permitted to place the electrodes into deeper regions of the brain--the subthalamic nucleus or the globus pallidus. This reduces other problems associated with Parkinson's disease, such as stiffness in limbs and joints,slow movement, and poor balance and coordination.

Medtronic hopes to have FDA approvals for this broader range of treatments by the spring of the year 2000. Lynn Otten and her colleagues also are working on newer and more patient-friendly versions of the neurostimulator.

For patients-a rebirth

On the golf course, Morrie Long can't resist a little hustle--especially when it's all in fun. Suffering from Parkinson's disease since 1982, the former mutual funds salesman looks like an easy mark. That is until he turns on his Activa neurostimulator, which instantly puts an end to the almost constant tremors that once made it impossible for him to even put a ball on a tee, or swing a club.

Long, of Hutchinson, KS, is one of hundreds of people whose lives have been transformed by what medical authorities say is the most impressive new therapy in decades for Parkinson's Disease and other movement disorders.

"On a scale of 1 to 10, I'd rate my tremor at about a 9," says Long, 72. "I've seen some people with worse, but to me it was as bad as it could get."

Since surgery to receive the ActivaTM Tremor Control therapy in 1996, Long's tremor is now almost undetectable. And he no longer needs medication. The only side effect has been a mild tingling on the right corner of his mouth when he first turns on the neurostimulator.

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