Healthcare at West Virginia University

A. Some people leave the hospital the day after the implant procedure. Most individuals recover quickly and most experience little discomfort through the healing period. However, physicians do advise people to avoid exerting themselves for several weeks after implant.

A. Most people with Activa® Tremor Control Therapy will not feel the stimulation at all, but will feel the effects of stimulation when it reduces the symptoms of tremor. However, some people may feel a brief tingling sensation when the therapy is first turned on. Higher levels of stimulation have been described as uncomfortable, "jolting" or "shocking" by some patients.

A. The Activa® System consists of three implantable components:

• DBS™ lead - A thin, insulated wire lead (pronounced LEED) with four electrodes at the tip. Using standard clinical imaging techniques and stereotactic equipment, the neurosurgeon positions the electrodes of the lead in the brain's thalamus, and the lead is anchored to the skull.
• Neurostimulator - The extentsion is connected to a neurostimulator, a small, sealed device simulator to a cardiac pacemaker that contains a battery and electronics. The neurostimualator 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
• Extension - An insulated wire that is surgically passed under the skin of the head, neck, and shoulder to connect the lead to the implanted neurostimulator.

A. People with the Activa® System should consult their physician before engaging in any medical treatment (for example, magnetic resonance imaging [MRI], ultrasound, mammograms, electrocautery and heart defibrillation). Diathermy, should not be permitted under any circumstances.

A. Battery longevity varies, depending on the parameter settings and number of hours that the neurostimulator is turned on each day. Estimated longevity is about three to five years at typical settings, with 16 hours of use per day.

A. To adjust the stimulation, a physician or clinician uses a programmer that communicates with the neurostimulator through radio frequency — a non-invasive way of adjusting stimulation to match the patient's need for tremor control.

A.The neurostimulator generates electrical pulses that are delivered by the extension and lead to targeted cells in the thalamus of the brain. These pulses can be non-invasively adjusted by a clinician using a programmer and transmitted via radio telemetry to the implanted neurostimulator.

Physician researchers have found that the electrical pulses block brain signals that cause tremor. Certain nerve cells become overactive to the point of causing uncontrollable muscle excitation in tremor patients, and electrical stimulation interferes with this abnormal activity. This has been characterized as "a jamming of the neural network" to interrupt the tremor.

The Activa® System is turned on and off with a small, hand-held magnet that is held against the patient's body for one or two seconds in the area where the neurostimulator is implanted (beneath the collarbone). Patients can use the magnet to switch the stimulator among on or off settings. For example, they can turn their neurostimulation level to high when their tremor increases due to stress, or they can turn it off when they go to sleep. (Tremor ceases with sleep.)

Access Review™, a handheld device that replaces the magnet used by patients, can be prescribed by your physician. This controller allows patients to: turn the neurostimulator on and off; verify if the stimulator is on or off; and check the status of the neurostimulator battery.

A. No.

A. No, when the neurostimulator battery needs to be changed, the old neurostimulator is replaced by an entirely new neurostimulator; the extension and leads are not typically replaced. The neurostimulator replacement procedure can be done under local anesthesia in an outpatient clinic.

A. All Activa® components, with the exception of the hand-held magnet and therapy controller, are inside the body. Depending on a person's body build, the neurostimulator may be noticeable as a small bulge under the skin, but it typically isn't noticeable under clothes. There also may be a slight bump on the top of the patient's head, but it usually isn't visible under hair. A doctor will try to implant the neurostimulator in a place that is most comfortable and cosmetically appealing to patients.