Brain Stimulation

Medtronic has announced both the US launch of deep brain stimulation (DBS) for medically-refractory epilepsy and the first commercially implanted patient at Emory University in Atlanta, USA. According to the Epilepsy Foundation, as many as 3.4 million Americans have epilepsy, with one-third estimated to be drug resistant.

DBS therapy for epilepsy delivers controlled electrical pulses to a target in the brain called the anterior nucleus of the thalamus (ANT), which is part of a network involved in seizures. Recently, the US Food and Drug Administration (FDA) granted premarket approval for Medtronic DBS therapy for epilepsy as adjunctive treatment for reducing the frequency of partial-onset seizures in individuals 18 years of age or older who are refractory, or drug-resistant, to three or more antiepileptic medications. The approval was based on results from the SANTE (Stimulation of the anterior nucleus of the thalamus in epilepsy) trial, wherein patients had a median seizure frequency reduction of 75% at seven years’ post-implant.

“The commercial availability of DBS provides an important surgical treatment option for patients who suffer from epilepsy and do not respond to medication,” said Robert E Gross, MBNA Bowman chair & professor, Emory University Department of Neurosurgery, neurosurgical primary investigator for the SANTE trial. “ANT DBS has been shown to significantly reduce the frequency and severity of seizures and improve quality of life out to seven years. The first patient implanted since commercialisation is doing very well. While it has only been two months since the system was turned on, his frequency of seizures has declined by more than 50%, and we expect improvement to increase further with additional programming sessions.”

“I have seen first-hand the negative effects of medication-resistant seizures in many of my patients – some are unable to hold a job or maintain a high quality of life,” said Robert Fisher, director of the Stanford Epilepsy Center, Stanford University, and lead principal investigator of the SANTE trial. “I have also seen through my involvement in the SANTE trial how DBS reduced the number and often the severity of seizures.”

With FDA approval and supporting clinical evidence, several health insurers have updated their policies to include ANT DBS therapy for epilepsy as a covered indication. This includes Aetna, which covers patients across the USA; Blue Cross Blue Shield CareFirst, which covers patients in Washington D.C., Maryland, and Virginia; and HAP which is a Michigan based Health Plan. In total, these insurers represent almost 26 million covered lives and enable access to this new treatment option for patients who may benefit from this therapy. Medtronic continues to work with other payers to expand coverage and provide this therapy to more patients.

“With the FDA approval, commercial launch, and policy updates from several health insurers, we are positioned to help more people than ever before. We are also initiating a 140 subject post-approval study where we will evaluate three-year safety and effectiveness outcomes at centres in the US and Europe,” said Mike Daly, vice president and general manager of the Brain Modulation business, which is part of the Restorative Therapies Group at Medtronic.