Amaza Reitmeier, VP Global Brain Health at Medtronic discusses new, amazing Parkinson's treatment.

Hi, thanks for watching episode #130 of the Doctor Podcast Show and I'm your host, Doctor Robert Sichert. Please subscribe, follow, like and repost Dr. podcast episode so we can get more great, excellent guests like we have today. Today's episode is about a life changing, amazing treatment for many patients who have Parkinson's disease and have tremors that significantly disrupt their lives. Our guest today is Ameza Reitmeyer, a healthcare executive with over 20 years of experience in Med tech Ameza is the vice president of global brain health solutions at Medtronic.

Medtronic is the largest medical device company in the world with about 90,000 employees in 150 countries, an annual sales of about $34 billion. It has devices that treat over 70 different medical conditions and is currently involved in over 170 clinical trials. With a deep passion for transforming lives through innovation, Amazes spearheads the newly established Global Brain Health Solutions team, an enterprise wide initiative aimed at positioning Medtronic as the world's leading brain health company.

Her work is driven by a bold vision to shape the future of brain health through sensing enabled therapies, which we'll talk about in detail and groundbreaking partnerships and a long term innovation road map that transforms care for people with a variety of neurologic conditions and disorders. Amazes approach blends clinical insight, market foresight and human centered design as well. She and her team are leading the transformation of deep brain stimulation. We'll call that DBS for short. DBS therapy through the global expansion of Brain Sense technology, which is the world's first commercial scale brain Computer interface, or BCI, The Tronics Brain Sense Adaptive Deep Brain Stimulation Device redefines how brain signals are captured and used to personalize therapy for patients with Parkinson's disease, tremors.

Brain Sense, or ADBS, was recently recognized by Time magazine as a 2025 Best Invention in Healthcare because it's helped so many patients with Medtronic's Brain Sense Adaptive Deep Brain Stimulation. Surgeons implant a stimulator in the patient's chest similar to a card, cardiac or heart pacemaker, which is connected with electrodes in the neck and goes into the brain. The Brain Sense device continuously analyzes brain waves typical of Parkinson's tremors and steps in to modify those signals when they are detected.

The dynamic real time adaptability makes it more accurate, providing just the right stimulation to reduce tremors and make a huge difference in the lives of Parkinson's patients. So Amaza, thanks for taking the time today to share your knowledge and experience with Medtronic's Brain Computer interface Systems. We really appreciate it. It's an honor to be here, Robert. Thank you so much for the invitation. Thanks. So Branson's ADBS, or Adaptive Deep Brain Stimulation, was recently approved by the FDA earlier this year.

From your vantage point leading brain health solutions at Medtronic, what does this milestone represent for the field and for the teams of researchers and clinicians who helped make it possible? Well, you know that DBS has been available as a safe and effective treatment for people with Parkinson's for over 30 years, but this is the first time that a system has been able to, in real time, sense and respond to a person's changing conditions throughout the day. If you care for people with Parkinson's, you know that one of the biggest challenges they face is that the disease is very dynamic, often changing from minute to minute or hour to hour based on how you're doing, whether your medications have taken full effect or not.

And what we've learned over the last 20 years is that there's a brain signal that we can sense in our device that changes as those symptoms change. So when we can sense that signal and adapt the stimulation to the changing fluctuations of the patient throughout the day, for many patients, it gives them a much smoother, more easy experience throughout the day and they simply feel better for more of the day. We were able to demonstrate this with our ADAPT PD study, which was the basis for our FDA approval.

And it's just, it's been an incredibly exciting time to watch as now more than 1500 people around the world have had this activated and are feeling the benefits. Wow, that's that's awesome. So it's an overnight success that took 30 years to develop. Aren't they all right? That that's, that's really incredible. So the first DBS devices were used for Parkinson's about 30 years ago. How are they different than what's currently available with Brain Sense? Well, the first DBS devices were much larger.

They had only primary cell batteries that couldn't be recharged and they didn't have the capability to sense. So five years ago we introduced a new platform called the Percept platform, starting with a non rechargeable or a recharge free device and then a year and a half ago a rechargeable device that had embedded within its special sensors that could be used to detect the brain signals. Now these sensors weren't turned on for therapeutic purposes until we had FDA clearance, but they live within those devices.

And so once we were able to prove that those signals could safely and effectively be used to adapt therapy, we've been able to activate that feature that's already embedded within the device. So over the years, the devices have gotten smaller and smarter, and we hope to continue to unlock things as we discover more about the mysteries of the brain through the signals that we can sense. Right, That's, that's amazing. Now Medtronic often talks about champions of of innovation across the ecosystem.

Who are some of the key groups like physicians, scientists, engineers you believe deserve recognition for advancing adaptive DBS from early research to recent global approval? Do you mind if I take you on a little bit of a journey through the history of this therapy? Yes, I I'd love that. That would be great. Wonderful. So from the very beginning of when we did DBS, we've always looked for brain signals. The the surgeons who plan the surgery used a technique called microelectrode recording to sense signals in the brain.

And if you've ever been in ADBS surgery, they turn the lights down. This is historically, they would turn the lights down and then slowly advance a microelectrode and listen for the unique signature of the neurons that live within the primary target for Parkinson's, the subthelemic nucleus at ESTN. And when you're in the room, you can hear a difference and you can see a difference When they get to the target of interest, the signal looks and sounds different. And that's all surgeons have known since the beginning of DBS that they're in the right location of the brain.

Well, we theorized that that same signal could be used potentially for therapy adaptation, but we couldn't prove it then. So 20 years ago, the first patents were filed based on this intuition that that same signal that they used to locate the target in the brain could also be used to adapt therapy. Then we had to study it. So we developed a system that we were able to attach externally to our devices to see if that same signal that we can detect intraoperatively could also be detected chronically.

And it turns out that we actually could detect that signal. And we were able to to to basically bridge the gap between that single cell signal and what we call a local field potential. So imagine, imagine for a moment that the brain is a stadium and you've got a cheering crowd in the audience, but you're listening for the voice of one person sitting in section 2O3. So you drop a little tiny microphone right in front of that person and listen to their voice. That's the neuronal signal. But we knew that we couldn't do that chronically, So what we wanted to listen for was the sound of the entire section 2O3.

So our leads are like a microphone on the entire section. But when section 2O3 cheers, you hear it. Imagine a home run is hit and the crowd goes wild. That's the signal that we can sense now. Then the question became, can we use that to to adapt therapy? Can we use it to track the symptoms of Parkinson's? So that began a 20 year journey that was a collaboration between researchers, scientists, engineers, veterinarians, if you can believe it, because the first sensing patients were actually sheep in our physiologic research lab and clinicians and researchers around the world to take that theory that that signal would matter and then prove it over the last 20 years.

So we've done that through a combination of research studies supported by grants from universities and governments through the NIH Brain Initiative, ultimately into the clinical research that we've done to prove that connection between a brain signal and the symptoms of Parkinson's so that we could advance therapy in this way. It's really been an amazing journey over the last 20 years. And there have been literally, I tell you, literally hundreds of people involved in this research in one way shape or another.

It's hard to thank them all. We wouldn't have time. Right. They also have thanked the patients who decided to try this to help themselves and and people in the future. Yeah, Thank you. That's a critical reminder. Thank you to all the brave patients who said yes when we asked them to take this journey. Right. So is this surgery done while the patient is asleep under general anesthesia, or is the patient awake during the surgery so that the doctors can get some feedback from the patient while they're placing these tiny electrodes in the brain?

So both are done historically and traditionally the patient would be awake during the surgery and the which sounds terrifying, but actually many patients find it fascinating because they have this experience. You you may have seen the recent video of the person playing the clarinet during surgery. I didn't see that, no. I'll, I'll have to send it to you. So we have videos of people playing the clarinet, playing the guitar, playing the violin. But the most common way that we test is not by handing them a musical instrument.

The most common way that they test is by handing them a glass of water. And so someone with a tremor who's unable to control their hand to drink a glass of water, they turn the stimulation on and your hand goes still and you're able to control and drink a glass of water. That's the simplest test that we do in the operating room. And it's absolutely amazing the feeling of relief that comes over a patient's face when they see their hand go still. But that's not the only way that it can be done. Now imaging has improved and gotten so good that the target can be precisely located and for an increasing number of people and and centers around the world, they're simply doing image verified lead location.

They place the lead, they verify that it's in the right place using MRI imaging and the patient can be asleep through the entire procedures. So it really is is an option based on the center and the physician, but it's nice that people have both options. So by studying patients first who are awake, the neurosurgeons and researchers figured out what area of the brain they need to put the wire into and exactly that they do the imaging and and know how to get there with the patient being under general anesthesia if they're afraid of being awake.

Exactly. Yes, it's evolved a lot over the last 30 years. That's, that's an incredible accomplishment. Now once you implant this device, the Brain Sense Adbs device, does it work right away after the surgery? And what's the recovery like after this type of surgery? So typically what people will feel is immediately after surgery, they feel better, Although the device is typically not turned on for four to 8 weeks until after the surgery has been completed. They experience what the physicians will describe as a micro lesion effect or the target in the brain has been impacted.

And for a while they feel much, much better. But as the brain heals from the surgery, the symptoms return. And interestingly, when the symptoms start to return, then you know it's time to start programming the device. We also can sense a signal in the brain, that same signal that we've been talking about earlier. And if you track it after the surgery, you see that signal start to come back. And when it reaches the level that was there prior to the surgery, then clinicians can begin to know that it's that it's time to program the patient.

So symptoms return and the brain signal returns, and then it's time to start programming. Typically for patients with Parkinson's, they may have 2-3 or four visits where they're optimizing the balance between stimulation and side effects. With every treatment there are known side effects and so the patient and the doctor will work together to optimize that setting. Now, adaptive DBS can sometimes be used at that stage, but often, at least as we're introducing it here, it's used later as patients symptoms begin to fluctuate.

Because as we know, Parkinson's is a relentlessly progressive disease, which we hope in the future can be cured, but at the moment it it remains relentlessly progressive. But the nice thing with DBS and adaptive DBS is that the programming can be adjusted as the person's symptoms change or as the medications are changed. So it's a balance of effect, side effect, managing medications if needed to try to get to the optimal condition for a patient. You know, complex interaction. Now, do you sense the brain waves through the device that's implanted in the chest, similar to heart pipe pacemakers that Medtronic makes?

It is similar, the signal is coming from the tip of the lead that's located deep in the brain and then the signal is sent to the device which has a tiny computer embedded in it which can interpret the signal in much the same way that cardiac pacemakers work. I I appreciated how you described it. You really can think of this as a pacemaker for the brain, and adaptive DBS is rate responsive pacemaking for the brain. That that's really incredible technology. Now, once this is all figured out and that eight week period goes by and everything is stabilized, the brain inflammation from the surgery and so on, does this device work automatically or does the patient have to press the button or do something to get it to work to get rid of the tremors?

No. So we try to get them to a condition where it's a set it and forget it and they don't have to think about it. Wow. That's that said, patients are often offered the option to adjust their stimulation up and down throughout the day. And this was historically because the device couldn't adapt in real time. It was one of the the signs actually that we believe that adaptive DBS would be useful is because many patients were autumn were self adjusting their therapy up or down based on the timing of their medication or whether they're getting ready to go to sleep.

So for example, they wanted less stimulation at night. With adaptive DBS, now that adjustment happens automatically on behalf of the patient. And it's interesting when you talk to people who have had both manually adjusting and now automatically adjusting, they feel so much more confident and they feel that anxiety go down because the device is automatically responding, responding and they don't have to mess around with their patient programmer. Right now, let's say a tremor starts in the Parkinson's patient.

They can kind of come and go and vary. I'm an ophthalmologist, but I take care of many patients with Parkinson's because they have eye conditions and problems, and I noticed that as I'm talking to them, tremors kind of come and go. Maybe it's because you're making them nervous. I try not to, I keep them all happy and healthy. But does this device actually catch the tremor even before it starts by reading the brain waves and then it inhibits the brain waves? Or does the tremor actually start and then the device kind of gets rid of the tremors?

Well, the device is always working in the background and what we hope is that we've got it dialed into a level where the tremor doesn't start, but some tremor can breakthrough. And in those cases, sometimes patients would adjust their therapy up or down or with adaptive DBS turned on. We hope that it will adjust and catch the tremor and interest it. Right. So it yeah, it sort of works in concert. Right now you said patients can adjust this. How? How do they do that? Is this connected to an iPhone app or or do they have to go to a doctor's office or is it done via telemedicine?

How does a patient adjust the settings? So some patients are given a little program of the that is a phone, it's actually a Samsung phone with Medtronic and they have little commands that they can put in on it where they can switch between programming groups or turn their simulation up and down. Wow, that, that's incredible. Now you mentioned that this device has rechargeable batteries so it it can last pretty much forever. I know your Medtronic pacemakers last for 10/15/20 years with the same batteries.

How did how did the batteries work here? So there are two different battery types that you can get recharge. Our rechargeable batteries will last 15 years or more and it's you can we've been testing them now for you know, the better part of two decades. We're labeled for 15 years, but there's no reason to think that they wouldn't last longer than that. Again, it's just on label 15 years. Our recharge free devices are our primary cell devices on average last three to five years depending on the patient settings.

There's a wide variety in electricity needs with different patients. And so it really depends on your settings and how much stimulation you need. Now in our ADAPT study, we did find that with adaptive stimulation there was lower energy delivered. And so we're hopeful that that means the batteries would last longer either between recharge intervals or between replacement intervals. So fewer surgeries may be needed in the future. Right now, even if you have to replace the device after 15 years, we're talking about just replacing the device that's in the chest, under the skin, the.

Try not to touch anything in the head. Leave that alone. So the brain electrodes just stay there forever. You you can just change the device so that in the future if you have even better devices that work better, you can just exchange them. A relatively simple surgery. Most patients don't think any surgery is simple, but this one is about as simple as it gets, right? It's right under the skin. Exactly. Now, do patients sense anything in their brain or otherwise when when the device goes off or they just notice there's a reduction in the tremor?

It varies by patient. Most of our patients just feel a change in their symptoms as in some of the patients when they were getting their stimulation optimized, they could feel that stimulation increasing. And So what we typically expect is that they won't feel it or we want them not to feel it, but some did during the optimization process. And so it's, you know, we try to get it to a comfortable level where if you do feel it, it's not uncomfortable. That's good. Now is this device OK to use if you're having Mris, for example, if you're having an abdominal MRI for some other issues?

I know the Medtronic cardiac or heart pacemakers are MRI safe. What about the ADBS device? It's the same for our DBS devices. So we have conditional safety for 1.5 and three Tesla mode. Medtronic DBS devices are the only ones that can be left in a therapy on condition during an MRI, which is a huge benefit for someone with a movement disorder. If you've ever seen someone have their device turned off, the tremors come back or the the movement comes back. But there is a mode of setting with Medtronic devices where you can keep the therapy on during an in an MRI safe mode during a scan, which it can improve the scan quality.

So it's one of the things that we're really proud of in the way the device was designed. That's really incredible because Mris require the patient to lie still and not move. Exactly. Quality images. So if you. Think exactly. If you can keep the device working during the MRI, that's a huge accomplishment. So that that's you, you've thought of everything now we. Also, not everything. There's still lots to be. It's always something new, but that's. A pretty, but at least that, yeah. Now there's about a million patients with Parkinson's in the USA.

Unfortunately it's it's not an uncommon condition. How many of them are sufficiently treated with medications and at what point do they decide or doctors decide to use the DBS Brain Sense device? Well, one of the greatest challenges on one of my personal missions is to help people first of all become aware of DBS therapy earlier. So it's indicated for people who are four years post diagnosis and with continuing motor fluctuations. Now on average people are waiting 7810 years because I mean, frankly, brain surgery is terrifying.

So they either don't know about it or they're scared of it. This is a rational fear, by the way. But one of my missions and one of the reasons I'm grateful that we're talking is because if I can get no other message out, it's to begin talking with your doctor as soon as you get diagnosed about when advanced therapies like this may be right for you. Because I've yet to meet a patient who says anything other than I wish I'd known about it sooner or I wish I'd done it sooner. Because it helps manage the symptoms and in many cases, helps people reduce the amount of medication that they're able to take, which in turn can reduce the side effects associated with those medications.

So DBS is not for everyone. You want to be seen by an expert movement disorder neurologist who can diagnose your condition, optimize your medication. But I also encourage people to advocate for themselves and ask for the options that are available to you, including something like adaptive DBS, because for people who benefit, it really is amazing. And, and so, you know, thank you for helping me make sure that people just have that conversation with their physician. Yeah, I as I mentioned, I have patients with Parkinson's who complain to me all the time that their medication side effects sometimes are worse than than the Parkinson's.

So exactly. Yeah, I'm going to mention this to them. I wasn't really. I had heard about it, but was not aware of it enough to really recommend it. So I'm going to recommend that. Maybe bring it. To their DBS is done in every single state that we there are qualified movement disorder neurologists and qualified functional neurosurgeons all around the country and it's well covered by insurance. There's there's no reason to wait to have that conversation. Right. That's important. Now, what's the success rate of this from the perspective of reducing the frequency or severity of of tremors?

Overall for DBS the success rate is extremely high. I, I don't know if there's a published rate, but DBS for Parkinson's works In the Adapt PD study where we studied adaptive PD, adaptive DBS for Parkinson's, 44 of the 45 patients who were programmed on DBS chose to continue with adaptive following the study. So beginning. The only reason that the 45th patient chose not to was that they would have had to continue coming for study visits and they lived quite a long ways from their clinic. So I'm not here telling you adaptive DBS works for everyone.

Right. But many people who try it do see a benefit and so DBS is extremely effective and adaptive DBS we believe, is even better. Now you mentioned there's been about 1500 adaptive DBS brain sense devices implanted. Let me let me make one minor correction. So we have over 42,000 devices that are implanted worldwide that are capable of adaptive. I see every single Percept device implanted is capable of adaptive stimulation. That feature has been turned on for over 1500 patients without the need for an additional surgery.

So if you have a Percept device and you have Parkinson's, it's adaptive capable. No, it's the physician's option whether or not to turn it on, but the device is capable. So potentially 10s of thousands of people could have it turned down and probably that'll happen as word gets out. We also at least if it can benefit you. Right. Do some of these devices occasionally have to be removed because of side effects or problems, or is that very rare? It's rare. Obviously it can happen and but it but it is exceedingly rare.

That's good. Sounds sounds like a low risk procedure for something that would benefit the patient greatly. Now looking ahead, what possibilities does adaptive sensing enable technology open up for other neurologic conditions? And how do you see Medtronic continuing to partner with doctors and researchers and engineers to to push the field forward? That's such a great question. So we have over 30 research studies ongoing now around the world with academic institutions all over the world. And we're looking at things like other signals that may be useful for other symptoms of Parkinson's, signals that might be useful in other conditions like essential tremor or epilepsy or dystonia, which are the other approved on label indications.

And then there are also researchers looking at whether signals are correlated with conditions that are currently off label like treatment resistant depression. The world is our oyster right now having a commercial scale device that can sense brain signals. You mentioned in your opening, you know, the this is the first commercial scale brain computer interface release. And, and again, researchers are learning so much every single day about the mysteries of the brain, and the best is yet to come. Right.

If you can pick up brain signals in different parts of the brain and figure out how to maybe send a message to the brain to get rid of problems, that would be incredible. Now on that topic, are you possibly working with Elon Musk and his newer link companies since there may be some technology sharing opportunities which may be synergistic for both of you? We have ongoing conversations with many of the other companies that are working on brain computer interface, and we continue to be open to collaboration with companies like that all around the world.

We don't have an active collaboration with Elon Musk at the moment, but of course he's welcome to call us. All right, I'll send him an e-mail and tell tell him to give you a buzz. Sounds great. But there's phenomenal innovation happening with, you know, all around the world, and we would love to collaborate with companies. Right, that, that would be amazing. So I, I want to thank you very much for taking the time to educate us about this and educating me as well, because I'm going to bring this up now to all my Parkinson's patients and tell them to start the discussion.

Thank you, you are the best. Well, I'm trying to help them out as as much as possible. So thank you again for all your expertise and and sharing your your knowledge and wisdom about this. We all appreciate it. It's been a delight, Robert. Thank you so much for the opportunity. My pleasure.

In this episode