Electromyographic lead positioning and stimulation titration in a nerve stimulation system for treatment of overactive bladder
First Claim
1. A system for improved positioning of an implantable lead in a patient, the system comprising:
- a clinician programmer having a lead connector configured for electrically connecting to an implantable lead having a plurality of electrodes, a signal generator configured for delivery of stimulation to the lead via the lead connector, a memory, a communication module and a graphical user interface,the clinician programmer being configured with a lead placement procedure recorded on the memory that is configured to perform steps of;
delivering a first test stimulation from the signal generator at a stimulation amplitude level from the clinician programmer to a nerve tissue of the patient with a principal electrode of the implantable lead, wherein the principal electrode is selected from the plurality of electrodes of the implantable lead;
delivering another test stimulation from the signal generator at a same stimulation amplitude level for a same period of time sequentially to each remaining electrode for the plurality of electrodes of the implantable lead from the clinician programmer, wherein the other test stimulations in the sequence occur directly after the first test;
receiving, with the clinician programmer by communication with an EMG sensing electrode or by an input via the graphical user interface, EMG response information based on a recording of a stimulation-induced EMG motor response, which is detected by at least one EMG sensing electrode minimally invasively positionable on a skin surface or within the patient, for each test stimulation, the EMG response information from the plurality of electrodes at the same stimulation amplitude levels corresponding to relative distances of each electrode from the target nerve so as to provide improved lateral and/or axial resolution of the plurality of electrodes relative to a target nerve for positioning of the implantable lead at a target stimulation region along the target nerve; and
output feedback on the graphical user interface of the clinician programmer during the lead placement procedure, the feedback based on the EMG information associated with the first test stimulation of the principal electrode and the other test stimulations of remaining electrodes, the feedback indicating proximity of the plurality of electrodes relative the target nerve so as to facilitate improved placement of the plurality of electrodes along the target nerve.
2 Assignments
0 Petitions
Accused Products
Abstract
The present invention provides improved methods for positioning of an implantable lead in a patient with an integrated EMG and stimulation clinician programmer. The integrated clinician programmer is coupled to the implantable lead, wherein the implantable lead comprises at least four electrodes, and to at least one EMG sensing electrode minimally invasively positioned on a skin surface or within the patient. The method comprises delivering a test stimulation at a stimulation amplitude level from the integrated clinician programmer to a nerve tissue of the patient with a principal electrode of the implantable lead. Test stimulations are delivered at a same stimulation amplitude level for a same period of time sequentially to each of the four electrodes of the implantable lead. A stimulation-induced EMG motor response is recorded with the integrated clinician programmer for each test stimulation on each electrode of the implantable lead via the at least one pair of EMG sensing electrodes so as to facilitate initial positioning of the implantable lead at a target stimulation region.
492 Citations
32 Claims
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1. A system for improved positioning of an implantable lead in a patient, the system comprising:
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a clinician programmer having a lead connector configured for electrically connecting to an implantable lead having a plurality of electrodes, a signal generator configured for delivery of stimulation to the lead via the lead connector, a memory, a communication module and a graphical user interface, the clinician programmer being configured with a lead placement procedure recorded on the memory that is configured to perform steps of; delivering a first test stimulation from the signal generator at a stimulation amplitude level from the clinician programmer to a nerve tissue of the patient with a principal electrode of the implantable lead, wherein the principal electrode is selected from the plurality of electrodes of the implantable lead; delivering another test stimulation from the signal generator at a same stimulation amplitude level for a same period of time sequentially to each remaining electrode for the plurality of electrodes of the implantable lead from the clinician programmer, wherein the other test stimulations in the sequence occur directly after the first test; receiving, with the clinician programmer by communication with an EMG sensing electrode or by an input via the graphical user interface, EMG response information based on a recording of a stimulation-induced EMG motor response, which is detected by at least one EMG sensing electrode minimally invasively positionable on a skin surface or within the patient, for each test stimulation, the EMG response information from the plurality of electrodes at the same stimulation amplitude levels corresponding to relative distances of each electrode from the target nerve so as to provide improved lateral and/or axial resolution of the plurality of electrodes relative to a target nerve for positioning of the implantable lead at a target stimulation region along the target nerve; and output feedback on the graphical user interface of the clinician programmer during the lead placement procedure, the feedback based on the EMG information associated with the first test stimulation of the principal electrode and the other test stimulations of remaining electrodes, the feedback indicating proximity of the plurality of electrodes relative the target nerve so as to facilitate improved placement of the plurality of electrodes along the target nerve. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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10. A system for improved positioning of an implantable lead in a patient, the system comprising:
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a clinician programmer having a lead connector configured and a signal generator configured for delivery of stimulation via the lead connector, a memory and a graphical user interface; an implantable lead coupleable to the clinician programmer via the lead connector, wherein the implantable lead comprises a plurality of electrodes; at least one EMG sensing electrode minimally invasively positionable on a skin surface or within the patient, the EMG sensing electrode; wherein the clinician programmer is configured with a lead placement procedure recorded on the memory that is configured to perform steps of; delivering a first test stimulation at a stimulation amplitude level to a nerve tissue of the patient with a principal electrode of the implantable lead, wherein the principal electrode is selected from the plurality of electrodes of the implantable lead automatically by the clinician programmer or in response to a user input received via the graphical user interface of the clinician programmer; delivering another test stimulation at a same stimulation amplitude level for a same period of time sequentially to each other electrode of the plurality of electrodes of the implantable lead, wherein the other test stimulations within the sequence occur directly after the first test stimulation; and receiving EMG response information based on a recording of a stimulation-induced EMG motor response with the clinician programmer for each test stimulation on each electrode of the implantable lead as sensed via the at least one EMG sensing electrode, the EMG response information for each electrode at the same stimulation amplitude levels corresponding to relative distances of each electrode from the target nerve so as to provide improved lateral and/or axial resolution of the plurality of electrodes relative to a target nerve to facilitate positioning of the implantable lead at a target stimulation region along the target nerve. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25)
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26. A system for improved positioning of an implantable lead in a patient, the system comprising:
a clinician programmer having a lead connector configured for electrically connecting to an implantable lead having a plurality of electrodes, a signal generator configured for delivery of stimulation to the lead via the lead connector, a communication module, a memory and a graphical user interface, the clinician programmer being configured to receive electromyography (EMG) information obtained from at least first and second EMG sensing electrodes coupled with the patient, wherein the clinician programmer is further configured with a lead placement procedure recorded on the memory that is configured to; perform a sweeping cycle during the lead placement procedure, the sweeping cycle comprising; delivering a test stimulation at a plurality of stimulation amplitude levels from the clinician programmer to the sacral nerve tissue of the patient with a principal electrode of the implantable lead when connected to the lead connector until the clinician programmer receives an indication that a desired stimulation-induced EMG motor response indicated by the EMG information corresponds to the principal electrode being positioned in a target stimulation region adjacent the sacral nerve, wherein the principal electrode is selected from the plurality of electrodes of the implantable lead; recording on the memory of the clinician programmer the stimulation amplitude level at which the desired stimulation-induced EMG motor response is indicated when stimulating with the principal electrode; delivering test stimulations at a same stimulation amplitude level as the recorded stimulation amplitude level for a same period of time sequentially to each remaining electrode of the plurality of electrodes of the implantable lead via the lead connector, wherein the test stimulations to the remaining electrodes are delivered in sequential order without any intervening stimulations at other stimulation amplitude levels, and receive EMG response information, by communication with the first and second EMG sensing electrodes or by an input via the graphical user interface, the EMG information based on a first stimulation-induced EMG motor response associated with a big toe of the patient obtained from the first EMG electrode and a second stimulation-induced EMG motor response associated with an anal bellows of the patient obtained from the second EMG electrode that are simultaneously recorded for the same level test stimulation on each electrode of the implantable lead via the lead connector during the sweeping cycle, the EMG response information from the plurality of electrodes at the same stimulation amplitude levels corresponding to relative distances of each electrode from the target nerve so as to facilitate positioning of the implantable lead at the target stimulation region along the sacral nerve. - View Dependent Claims (27, 28, 29, 30, 31, 32)
Specification