Controlling electrical stimulation based on evoked compound muscle action potential

• US 10,213,604 B2
• Filed: 04/13/2016
• Issued: 02/26/2019
• Est. Priority Date: 04/14/2015
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Dinsmoor, David A., Cong, Peng, Vera-Portocarrero, Louis, Su, Xin
• Primary Examiner(s): Marlen, Tammie K
• Application Number:
  US15/097,990
• Publication Number:
  US 20160303376A1
• Time in Patent Office: 1,049 Days
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/395 Details of stimulation, e.g. nerve stimulation to elicit EMG response
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control
• CPC Class Codes: A61N 1/36139 with automatic adjustment

Abstract

An example system includes a stimulation generator configured to deliver electrical stimulation therapy to tissue of a patient in accordance with a stimulation therapy program. The stimulation therapy program may include a set of stimulation therapy parameters. The system may include at least one sensor configured to detect a signal including an evoked compound muscle action potential (eCMAP) in response to the application of stimulation according to the stimulation therapy program. The system may also include a processor configured to adjust one or more or the stimulation therapy parameters based on the detected signal that includes the eCMAP.

Claims

1. A method comprising:

applying, via one or more electrodes, stimulation therapy to a patient according to a set of stimulation therapy parameters;

detecting, using at least one electrode of the one or more electrodes used for applying the stimulation therapy to the patient, a signal including an evoked compound muscle action potential (eCMAP) in response to the application of the stimulation therapy;

detecting, using a posture state module, a posture state of the patient; and

adjusting, by a processor, one or more stimulation therapy parameters of the set of stimulation therapy parameters based on the detected signal and the detected posture state.

2. The method of claim 1, further comprising detecting the signal via a same set of the one or more electrodes used for applying the stimulation therapy to the patient.

3. The method of claim 1, further comprising:

detecting a change in the posture state of the patient from a first posture state to a second posture state; and

in response to detection of the change in the posture state, detecting a second signal including the eCMAP in response to the application of the stimulation therapy.

4. The method of claim 3, further comprising:

responsive to detecting the change in the posture state, applying the stimulation therapy according to a second set of stimulation therapy parameters associated with the second posture state;

detecting the second signal including the eCMAP in response to the application of stimulation therapy according to the second set of stimulation therapy parameters; and

adjusting one or more stimulation therapy parameters of the second set of stimulation therapy parameters based on the detected signal.

5. The method of claim 4, further comprising storing a third set of stimulation therapy parameters including the one or more stimulation therapy parameters of the second set of stimulation therapy parameters adjusted in association with the detected change in the posture state.

6. The method of claim 1, further comprising:

comparing one or more characteristics of the detected eCMAP to one or more corresponding characteristics of a reference eCMAP;

adjusting one or more stimulation therapy parameters of the set of stimulation therapy parameters based at least in part on the comparison; and

applying the stimulation therapy according to the set of stimulation therapy parameters adjusted based at least in part on the comparison.

7. The method of claim 6, wherein the reference eCMAP is a stored eCMAP.

8. The method of claim 1, further comprising detecting the signal including the eCMAP in response to the application of the stimulation therapy at a predetermined interval.

9. The method of claim 1, further comprising:

applying, via one or more electrodes and in response to a muscle paralytic being administered, the stimulation therapy to the patient according to the set of stimulation therapy parameters;

detecting a second signal; and

confirming the first detected signal is an eCMAP signal based on the second signal.

10. The method of claim 1, wherein the signal is a far-field signal.

11. The method of claim 1, wherein applying stimulation therapy to the patient comprises applying stimulation therapy to a sacral nerve of the patient.

12. The method of claim 11, wherein detecting the signal including the evoked compound muscle action potential (eCMAP) comprises detecting a far-field signal.

13. The method of claim 12, wherein detecting the signal including the evoked compound muscle action potential (eCMAP) comprises detecting a far-field signal via one or more electrodes located in a levator ani of the patient.

14. A system comprising:

a posture state module configured to detect a posture state;

a stimulation generator;

one or more electrodes configured to apply stimulation therapy from the stimulation generator based on a set of stimulation therapy parameters; and

a processor configured to;

receive, using at least one electrode of the one or more electrodes configured to apply the stimulation therapy, a detected signal including an evoked compound muscle action potential (eCMAP) in response to the application of the stimulation therapy;

receive, from the posture state module, an indication of the detected posture state;

analyze the detected signal; and

adjust at least one stimulation therapy parameter of the set of stimulation therapy parameters based on the analysis of the detected signal and the indication of the detected posture state.

15. The system of claim 14, wherein the signal is detected via a same set of the one or more electrodes configured to apply the stimulation therapy.

16. The system of claim 14,

wherein the processor is further configured to detect a change in the posture state from a first posture state to a second posture state based on the indication received from the posture state module, and in response to detection of the change in posture state of the patient from the first posture state to the second posture state, detect the signal including an eCMAP in response to the application of the stimulation therapy.

17. The system of claim 16, further comprising:

wherein the one or more electrodes are further configured to provide stimulation according to a second set of stimulation therapy parameters associated with the second posture state; and

wherein the processor is further configured to;

detect the signal including an eCMAP in response to the application of stimulation therapy according to the second set of stimulation therapy parameters; and

adjust at least one stimulation therapy parameter of the second set of stimulation therapy parameters based at least in part on the detected signal.

18. The system of claim 17, further comprising a memory configured to store stimulation parameters, wherein the processor is configured to generate a third set of stimulation therapy parameters including the at least one stimulation therapy parameter of the second set of stimulation therapy parameters adjusted based on the detected signal in association with the change in posture state, and store the third set of stimulation parameters in the memory.

19. The system of claim 14, wherein the processor is further configured to:

compare one or more characteristics of the detected eCMAP to one or more corresponding characteristics of a reference eCMAP;

adjust at least one stimulation therapy parameter of the set of stimulation therapy parameters based at least in part on the comparison; and

wherein the one or more electrodes are further configured to provide stimulation therapy based on the set of stimulation therapy parameters adjusted based on the comparison.

20. The system of claim 14, wherein the processor is further configured to detect the signal including an eCMAP in response to the application of the stimulation therapy at a predetermined interval.

21. The system of claim 14, further comprising a memory configured to store the set of stimulation therapy parameters including the at least one stimulation therapy parameter adjusted based on the analysis.

22. The system of claim 14, wherein the one or more electrodes is further configured to detect a far-field signal.

23. The system of claim 14, wherein the one or more electrodes are further configured to apply the stimulation therapy to a sacral nerve of a patient.

24. The system of claim 23, wherein the processor is configured to receive the detected signal including the evoked compound muscle action potential (eCMAP) in response to the application of the stimulation therapy by receiving a signal sensed as a far-field signal.

25. A system comprising:

means for applying, through one or more electrodes, stimulation therapy to a patient according to a set of stimulation therapy parameters;

means for detecting, using at least one electrode of the one or more electrodes used for applying the stimulation therapy, a signal including an evoked compound muscle action potential (eCMAP) in response to the application of the stimulation therapy;

means for detecting a posture state of the patient; and

means for adjusting one or more stimulation therapy parameter of the set of stimulation therapy parameters based on the detected signal and the detected posture state.

26. The system of claim 25, wherein the means for applying stimulation therapy to the patient comprises means for applying stimulation therapy to a nerve of the patient at a first location;

and wherein the means for detecting the signal including the eCMAP comprises means for detecting a far-field signal.

27. The system of claim 26, wherein the means for applying stimulation therapy to the nerve of the patient comprises means for applying stimulation therapy to a sacral nerve of the patient.

28. The system of claim 27, wherein the means for detecting the signal including the eCMAP comprises means for detecting the signal as the far-field signal from a levator ani of the patient.