Deep brain stimulation system
Vercise™ Gevia™ deep brain stimulation (DBS) system is a directional neurostimulation device developed by Boston Scientific for the symptomatic treatment of patients with Parkinson’s disease, dystonia and essential tremor.
The device is based on the cochlear implant technology, which stimulates auditory nerves, producing a hearing sensation.
The Vercise Cartesia™ directional lead was launched first in Europe in 2015 and subsequently in the global market. The Vercise Gevia DBS system received CE mark for marketing in Europe in June 2017. The US Food and Drug Administration (FDA) cleared the device along with the companion, Vercise Cartesia directional lead, for clinical use in August 2019.
The system received ImageReady™ labelling from the FDA for full-body magnetic resonance imaging (MRI) of patients, which means a patient implanted with the device can safely undergo MRI scan.
The DBS system is a full-body MR conditional device comprising leads, extensions, stimulator and Burr hole cover.
Two Vercise Cartesia directional leads of the system, containing eight separately controlled cylindrical electrodes, are implanted into the brain. The leads create precisely targeted stimulation at the subthalamic nucleus (STN) in the brain. The STN is adaptive to the changes occurring in the brain. Its simulation provides symptomatic relief and avoids unwanted side effects.
The titanium-cased stimulator is implanted under the skin at the same side of the lead near the pectoral region with an extension connected directly to the stimulator. The rechargeable battery of the system lasts for approximately 15 years. A tunnelling tool is used to make the required path under the skin for implanting the DBS leads and extensions.
The SureTek™ Burr hole cover is used to anchor the leads and is compatible with a 14mm perforator. A radiofrequency telemetry link is used to communicate with the stimulator, using a handheld remote control from a distance of 18in. The remote control can be programmed using the Bionic Navigator™ software.
Before a patient undergoes an MRI scan, the stimulator is fully charged and the MRI mode on the system is enabled. MRI systems with the magnetic strength of 1.5 Tesla (1.5T), maximum spatial field gradient of 4,000 gauss per cm (40T / m), and gradient systems with a maximum gradient slew rate per axis of less than or equal to 200T / m / s are eligible for scanning the patients with the implanted DBS system.
The system features Vercise Neural Navigator 2 programming software with STIMVIEW™ technology.
The software allows healthcare professionals to visualise the distribution of stimulation into the brain. It enables the range, direction, and shape and size of the electrical impulses to be controlled to provide highly personalised therapy to the patients.
The clinical efficiency of the DBS system was demonstrated in a multi-centre, prospective, double-blind, randomised controlled clinical study named INTREPID, enrolling 292 patients with Parkinson’s disease and demonstrating approximately 48% improvement in the motor skills of the patients treated with the system.
The improvement was measured for more than two years by the Unified Parkinson’s Disease Rating Scale (UPDRS) III scores, which are used to determine the overall motor disability.
In another clinical study, VANTAGE, 40 Parkinson’s patients were treated with the DBS system. At week 52, 63% of the patients showed improvement in motors skills and quality of life.
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