Activa Parkinson’s and Essential Tremor Control Therapy
Activa® Parkinson’s and Essential Tremor Control Therapy from Medtronic is one of the most significant and innovative advances in the treatment of Parkinson’s disease and Essential Tremor in more than 30 years. The treatment uses two surgically implanted medical devices, similar to cardiac pacemakers, to deliver electrical stimulation to precisely targeted areas within each side of the brain. Continuous stimulation of these areas modifies the signals that cause the disabling motor symptoms of the disease. As a result, many patients achieve greater control over their body movements.
The Activa System
The Activa System consists of three implantable components:
- 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 consists of 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 through the lead to the globus pallidus or subthalamic nucleus in the brain.
External components of the system include a physician programmer (used to adjust neurostimulator parameters) and the patient’s hand-held magnet. The hand-held magnet is placed over the neurostimulator to turn the neurostimulator off or on.
The neurostimulator generates electrical pulses that are delivered by the extension and lead to targeted structures-the thalamus, the subthalamic nucleus (STN) or the globus pallidus interna (GPi) within the brain. The pulses can be non-invasively adjusted by a clinician from a physician programmer and transmitted via radio telemetry to the implanted neurostimulator. Physician researchers have found that the electrical pulses modify brain signals that cause the symptoms of Parkinson’s disease and Essential Tremor.
Procedure and Follow-Up
- A multidisciplinary team is required to deliver Activa Therapy. The neurologist selects appropriate patients and manages them postoperatively. The neurosurgeon performs the procedure to precisely implant the system that delivers the therapeutic stimulation.
- Implanting one system (consisting of a neurostimulator, extension and lead) usually takes about four hours for a functional Stereotactic neurosurgeon experienced with Activa Therapy. Two systems are used for Activa Parkinson’s and Essential Tremor Control Therapy
- After recovery from the surgery, the patient returns to the physician for reprogramming of the stimulation parameters to optimize symptom control and minimize any side effects. The clinician will then schedule routine follow-up appointments.
- Once the device is implanted, neurologists or other clinicians may adjust the stimulation using a portable programmer that controls and monitors the neurostimulator functions. This is done noninvasively in an outpatient setting.
- Battery longevity varies, depending on the parameter settings and number of hours the neurostimulator is turned on each day. At typical therapeutic settings, the battery lasts an average of three to five years, but it could be less than three years depending on individual patient requirements. A simple surgical procedure is used to replace the neurostimulator; the extension and lead are typically not replaced.
Neurologists and neurosurgeons have used electrical stimulation since the 1960s as a way to locate and distinguish specific sites in the brain. In the process, they discovered that stimulation of certain brain structures suppresses the symptoms of neurological disorders such as Essential Tremor and Parkinson’s disease. Medtronic developed brain stimulation technology in the 1980s in conjunction with leading physician researchers. In 1987, professors Alim-Louis Benabid and Pierre Pollak of the University of Grenoble in France published the results of the first application of deep brain stimulation for the treatment of movement disorders. Since then, two indications for Activa Therapy have become commercially available:
- Activa Tremor Control Therapy, which has been approved in Canada, Europe and Australia since 1995 and in the United States since 1997, targets the thalamus to suppress tremor associated with Essential Tremor or Parkinson’s disease. The thalamus is the brain’s message relay center and is intricately involved in movement control.
- Activa Parkinson’s Control Therapy is now approved in the United States. It has been approved in Canada, Europe and Australia since 1998. It extends the use of Medtronic’s brain stimulation technology to benefit patients with advanced, levodopa-responsive Parkinson’s disease. Activa Parkinson’s Control Therapy targets the subthalamic nucleus (STN) or the globus pallidus interna (GPi) to suppress symptoms of Parkinson’s disease. These areas are also intricately involved in movement control.
Cost and Coverage
- The cost of Activa Therapy to patients varies by benefit plan. The approximate cost of the implant procedure, including the devices, hospital stay and physician fees, is $50,000-60,000 per bilateral procedure. This estimate will vary depending on length of stay.
- Currently, Medicare and some health care plans allow for coverage of Activa Parkinson’s Control Therapy in many states. Following approval by the FDA, Medtronic anticipates Medicare will provide coverage in the other states, and other payers will extend coverage for this therapy. Most patients will be responsible for a deductible and/or co-payments/co-insurance.
- Some Parkinson’s patients may find their out-of-pocket costs decrease after receiving Activa Therapy as a result of requiring fewer health care services.
Available in the Fox Valley
Karl A. Greene, MD, PhD., Neurosurgeon at NeuroSpine Center of Wisconsin is trained in the placement of Deep Brain Stimulators and has successfully performed this surgery and other functional stereotactic procedures for the treatment of essential tremor and Parkinson’s disease. For more information, contact Dr. Greene at (920) 882-8200.
Karl A. Greene, MD, PhD, FACS
For more information call 920-882-8200 or 1-888-231-5236