Questions about the Activa Therapy surgical procedure:

Q-18: How are the parts of the system implanted?

A: The Activa Therapy System is implanted by a functional stereotactic neurosurgeon, a neurosurgeon who specializes in central nervous system function. The neurosurgeon uses a stereotactic head frame and imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) scanning to map the brain and localize the target within the brain. After the appropriate area of the brain is located, the neurosurgeon drills a nickel-sized burr hole in the skull, guides the lead through the hole, and implants the lead in the targeted site within the brain.

Before the lead implant procedure, the patient's scalp is anesthetized, to minimize discomfort. The patient remains awake and alert so the neurosurgeon and a movement disorder neurologist can test the stimulation to maximize symptom suppression and minimize side effects. To ensure proper placement of the lead, the patient must be alert during this part of the procedure for the following reasons:

• The patient must demonstrate how well symptoms are suppressed (e.g., by holding hands outstretched to assess tremor, or by rapidly tapping the thumb and forefinger together),
• The patient needs to report any side effects, and
• Anesthesia may temporarily suppress symptoms.

If the patient's symptoms are suppressed during the test stimulation, the neurostimulator and extension will be implanted. The patient is given a general anesthetic or sedative. The extension is passed under the skin of the scalp, neck and shoulder to the neurostimulator location. A small incision is made near the collarbone or in the abdomen, for younger primary dystonia patients, and the neurostimulator is implanted beneath the skin. The extension is connected to the neurostimulator and the incision is closed.

Q-19: How long will I stay in the hospital for tests, the surgery, and recovery?

A: The length of hospitalization varies, but is often just a few days for the pre-operative tests, implant surgery, and recovery.

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