Frequently Asked Questions

What is Activa Tremor Control Therapy (thalamic stimulation) for disabling tremor?
Activa Tremor Control Therapy is an adapatable and reversible non-destructive therapy that uses small electrical pulses to stimulate the brain and block the brain signals that cause tremor. The therapy involves the implantation of an insulated wire lead in the thalamus area of the brain. The lead is connected by an extension to an Implantable Pulse Generator (like a cardiac pacemaker) implanted beneath the skin in the chest area. The stimulation is turned on by the patient with a hand-held magnet. All parts of the system are implanted under the skin.
Who is a candidate for this therapy?
People with disabling tremor that cannot be controlled by drugs and people who experience intolerable side effects from drugs may be candidates for this therapy. In addition, patients who have had thalamotomy on one side of the brain, but still experience disabling tremor on the opposite side, may be treated effectively with Tremor Control Therapy.
What is tremor?
Tremor is uncontrollable rhythmic movement of a limb produced by muscle contractions. Tremor is common in a condition called Essential Tremor and in Parkinson's disease. Tremor may significantly interfere with a person's ability to lead a normal lifestyle.
How is tremor generally treated?
There is no cure for tremor or its underlying causes. However, effective treatment can help control symptoms. For people with Essential Tremor, propranolol and primidone are the most frequently used medications. Tremor in Parkinson's disease is generally treated with levodopa and other drugs.
How effective is drug therapy?
Drugs are generally effective in treating tremor for most people. However, in some people the side effects are so significant that they limit the doses that can be tolerated. In addition, the effectiveness of medications can decrease over time. With long-term use of levodopa, people may experience fluctuations in drug effectiveness.
What are the benefits and possible side effects of Tremor Control Therapy?
Tremor Control Therapy significantly reduces tremor in more than 80% of patients who have had the system implanted. The amount of tremor reduction varies. Most people experience almost complete relief from tremor on the side stimulated. Reduction in tremor is associated with improvement in performance of activities of daily living. Some people experience partial tremor relief, allowing them to be more functional. Some people may not benefit.
The effectiveness of the therapy for a particular person is tested during the surgery before a stimulation system is implanted . This testing helps ensure benefit prior to implantation.
Tremor Control Therapy has the additional advantage of "adaptability", because the stimulation can be adjusted as needed to optimize tremor relief and minimize side effects. Side effects, such as problems with balance, speech, and numbness, are usually reversible, mild, and accepted. The system also can be turned off or removed. Patients use a hand-held magnet to switch the stimulator between high, low, and off settings. For example, they can turn their stimulation level to high when their tremor increases because of stress, or they can turn their stimulation off when they go to sleep (tremor ceases with sleep).
Because brain tissue is not destroyed after the lead is implanted, patients treated with the therapy have preserved their future options as new therapies develop.
Ask your doctor…
As with any therapy, this procedure involves some risks. Persons considering this therapy should discuss both the potential risks and the benefits with their physician.
Tremor Suppression is Immediate
· High frequency thalamic stimulation may suppress tremor as soon as the system is turned on.
· Thalamic stimulation allows most patients to resume activities inhibited by tremor, such as handwriting and self-feeding.
· According to Benabid et al., thalamic stimulation may reduce or eliminate the need for medication. One study showed that one-third of Parkinson's Disease patients reduced their L-Dopa dosage by 30%.
The stimulation system is designed to deliver high frequency electrical stimulation using a multi-electrode lead placed in the ventral intermediate nucleus (Vim) of the thalamus. The implantable pulse generator (IPG) is placed subcutaneously in the pectoral area. The IPG is attached to an extension, which is tunneled and attached to the implanted lead.

Side effects, such as problems with balance, speech, and numbness, are reversible, mild, and accepted by most patients. Thalamic stimulation has the advantage of being adaptable. Stimulation can be turned up or down to minimize side effects and optimize symptom relief.

Are There Other Surgical Interventions for Disabling Tremor and other Parkinsonian Symptoms?

• Thalamotomy is a type of brain surgery that involves making a lesion (controlled destruction of brain tissue) in the thalamus, the area of the brain that produces tremors. Thalamotomy has been shown to effectively reduce tremor in some patients. However, it is not frequently performed because of the risk of disabling and permanent side effects, such as problems with balance, speech, and numbness.
• Pallidotomy is another type of neuro-destructive brain surgery sometimes performed to reduce Parkinsonian tremor accompanied by the additional symptoms of rigidity, slow movement, and uncoordinated movements. Like thalamotomy, it carries the risk of disabling and permanent side effects.
• Fetal neural implant (or nigral implant) is an experimental technique for the treatment of Parkinsonian symptoms. The procedure involves transplanting fetal tissue into the brain to replace degenerated nerves. Many issues are still unresolved, such as the source of embryonic tissue, the amount of tissue required, the number of brain penetrations needed, and rejection of transplanted tissue.
  

Is this a new therapy?
Stimulation therapy has been used since the early 1970s to control chronic pain. In the mid-1980s, researchers in France pioneered the use of stimulation in the thalamus of the brain to control tremor. The therapy has been tested extensively and is now commercially available.
Will Tremor Control Therapy cure my disease?
No. It treats tremor, but it does not cure the underlying condition that causes the tremor.
Will this therapy eliminate my tremor?
Most people experience complete relief from tremor while others experience some or no benefit.
Will I be able to go back to my normal routine?
Many people can do activities they could not participate in prior to this therapy.

Does Tremor Control Therapy cure the cause of tremor?

There is no cure for Essential Tremor or Parkinson's disease at this time. Tremor Control Therapy treats tremor, but does not cure the underlying condition that causes the tremor. If the therapy is discontinued, the patient's tremor will return.

How many people are currently using Tremor Control Therapy?

Thousands of people worldwide are benefiting from this therapy. It has been available in Europe, Canada and Australia since 1995.