Determining nerve location relative to electrodes

• US 10,448,889 B2
• Filed: 04/26/2012
• Issued: 10/22/2019
• Est. Priority Date: 04/29/2011
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gerber, Martin T., Goetz, Steven M., Poletto, Christopher
• Primary Examiner(s): Fernandes, Patrick
• Application Number:
  US13/456,829
• Publication Number:
  US 20120277621A1
• Time in Patent Office: 2,735 Days
• Field of Search: 600554
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/4058 for evaluating the central nervous system A61B5/4806, A61B5/4821 take precedence
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/6868 Brain
• CPC Class Codes: A61B 5/6877 Nerve
• CPC Class Codes: A61N 1/0529 Electrodes for brain stimulation
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/36128 Control systems
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

An implantable nerve stimulator is implanted in a patient near a nerve target. The implantable nerve stimulator has a plurality of electrodes through which stimulation is provided to the nerve target. The relative location of the nerve target and the electrodes may be determined by applying stimulation to the nerves via each of the electrodes, determining an effect of the stimulation for each of the electrodes, and mapping a location of the nerve relative to the electrodes based on the effect of the stimulation for each of the electrodes.

Claims

1. A method comprising:

applying electrical stimulation to a nerve of a patient via each of a plurality of implantable electrodes arranged in at least one row and at different axial positions along an axial length of a lead, the lead and the plurality of implantable electrodes having an orientation transverse to the nerve and crossing proximate to the nerve to position one or more of the plurality of implantable electrodes in proximity to the nerve, wherein each of the plurality of implantable electrodes is coupled to an implantable electrical stimulator configured to generate the electrical stimulation to deliver stimulation therapy via at least some of the plurality of implantable electrodes;

determining, respective intensity threshold levels for each of the plurality of implantable electrodes, the respective intensity threshold levels for each of the plurality of implantable electrodes including a first intensity threshold level corresponding to at least one of a perception stimulation threshold or a paresthesia stimulation threshold and a second intensity threshold level corresponding to an upper stimulation threshold of the nerve for electrical stimulation delivered by that respective electrode of the plurality of implantable electrodes, the determining comprising adjusting intensities of the electrical stimulation applied via each of the plurality of implantable electrodes to the first intensity threshold level corresponding to the at least one of the perception stimulation threshold or the paresthesia stimulation threshold and the second intensity threshold level corresponding to the upper stimulation threshold of the nerve; and

mapping a location of the nerve relative to each of the plurality of implantable electrodes based at least in part on the respective intensity threshold levels determined for each of the plurality of implantable electrodes.

2. The method of claim 1, wherein adjusting intensities comprises increasing the intensities of the electrical stimulation applied via each respective electrode of the plurality of implantable electrodes from a base level to each of the respective intensity threshold levels.

3. The method of claim 1, wherein mapping the location of the nerve relative to each of the plurality of implantable electrodes comprises mapping the location of the nerve relative to each of the plurality of implantable electrodes based on a usability range for the respective electrode of the plurality of implantable electrodes, wherein the usability range for the respective electrode of the plurality of implantable electrodes is defined as the difference between the first intensity threshold level corresponding to the at least one of the perception stimulation threshold or the paresthesia stimulation threshold and the second intensity threshold level corresponding to the upper stimulation threshold of the nerve for electrical stimulation delivered by that respective electrode of the plurality of implantable electrodes.

4. The method of claim 1, wherein mapping the location of the nerve relative to each of the plurality of implantable electrodes comprises mapping a relative location derived in both an X and a Y direction between the nerve and the respective electrode of the plurality of implantable electrodes.

5. The method of claim 1, wherein mapping the location of the nerve relative to the each of the plurality of implantable electrodes comprises mapping a relative orientation between the nerve and the respective electrode of the plurality of implantable electrodes.

6. The method of claim 1, further comprising automatically selecting one or more of the plurality of implantable electrodes to apply chronic electrical stimulation to a tissue adjacent the nerve based on the location of the nerve relative to the one or more of the plurality of implantable electrodes.

7. The method of claim 1, further comprising automatically selecting one or more of the plurality of implantable electrodes to apply chronic electrical stimulation to a tissue adjacent the nerve based on at least one of the first intensity threshold level corresponding to the at least one of the perception stimulation threshold or the paresthesia stimulation threshold and the second intensity threshold level corresponding to the upper stimulation threshold for each of the plurality of implantable electrodes.

8. The method of claim 1, further comprising:

displaying a graphical representation of the location of the nerve relative to the electrodes.

9. The method of claim 1, wherein the upper stimulation threshold corresponds to a pain threshold or a discomfort threshold.

10. The method of claim 6, further comprising:

delivering the chronic electrical stimulation to the tissue adjacent the nerve based on the selection of the one or more of the plurality of implantable electrodes.

11. The method of claim 7, further comprising:

delivering the chronic electrical stimulation to the tissue adjacent the nerve based on the selection of the one or more of the plurality of implantable electrodes.

12. The method of claim 1, wherein mapping the location of the nerve further comprises determining that an electrode of the plurality of implantable electrodes with a lowest respective first intensity threshold level corresponding to the at least one of the perception stimulation threshold or the paresthesia stimulation threshold is the electrode of the plurality of implantable electrodes that is closest to the nerve.

13. The method of claim 1, wherein the at least one row of the plurality of implantable electrodes comprises only a single row extending along the axial length of the lead.

14. The method of claim 1, wherein the at least one row of the plurality of implantable electrodes comprises a plurality of rows arranged on an implantable paddle lead.

15. A system comprising:

an implantable lead;

a plurality of implantable electrodes arranged in at least one row and at different axial positions along an axial length of the implantable lead, the lead and the plurality of implantable electrodes having an orientation transverse to a nerve of a patient and crossing proximate to the nerve to position one or more of the plurality of implantable electrodes in proximity to the nerve;

an implantable electrical stimulator connected to the plurality of implantable electrodes and configured to generate electrical stimulation to deliver stimulation therapy via at least some of the plurality of implantable electrodes; and

a processor configured to control the implantable electrical stimulator to;

apply electrical stimulation to the nerve of the patient via each of the plurality of implantable electrodes;

determine, respective intensity threshold levels for each of the plurality of implantable electrodes, the respective intensity threshold levels for each of the plurality of implantable electrodes including a first intensity threshold level corresponding to at least one of a perception stimulation threshold or a paresthesia stimulation threshold and a second intensity threshold level corresponding to an upper stimulation threshold of the nerve for electrical stimulation delivered by that respective electrode of the plurality of implantable electrodes, the determination comprising adjusting intensities of the electrical stimulation applied via each of the plurality of implantable electrodes to the first intensity threshold level corresponding to the at least one of the perception stimulation threshold or the paresthesia stimulation threshold and the second intensity threshold level corresponding to an upper stimulation threshold of the nerve; and

map a location of the nerve relative to each of the plurality of implantable electrodes based at least in part on the respective intensity threshold levels determined for each of the plurality of implantable electrodes.

16. The system of claim 15, wherein the at least one row of the plurality of implantable electrodes comprises a plurality of rows arranged on an implantable paddle lead.

17. The system of claim 15, wherein the at least one row of the plurality of implantable electrodes comprises only a single row extending along the axial length of the lead.

18. The system of claim 15, wherein to adjust the intensities, the processor is configured to increase the intensities of the electrical stimulation applied via each respective electrode of the plurality of implantable electrodes from a base level to each of the respective intensity threshold levels.

19. The system of claim 15, wherein the processor is configured to map the location of the nerve relative to each of the plurality of implantable electrodes based on a usability range for the respective electrode of the plurality of implantable electrodes, wherein the usability range for each of the plurality of implantable electrodes is defined as the difference between the first intensity threshold level corresponding to the at least one of the perception stimulation threshold or the paresthesia stimulation threshold and the second intensity threshold level corresponding to the upper stimulation threshold of the nerve for electrical stimulation delivered by that respective electrode of the plurality of implantable electrodes.

20. The system of claim 15, wherein the processor is configured to map the location of the nerve relative to each of the plurality of implantable electrodes by mapping a relative location derived in both an X and a Y direction between the nerve and the respective electrode of the plurality of implantable electrodes.

21. The system of claim 15, wherein the processor is configured to map the location of the nerve relative to each of the plurality of implantable electrodes by mapping a relative orientation between the nerve and the respective electrode of the plurality of implantable electrodes.

22. The system of claim 15, wherein the processor is configured to automatically select one or more of the plurality of implantable electrodes to apply chronic electrical stimulation to a tissue adjacent the nerve based on the location of the nerve relative to the one or more of the plurality of implantable electrodes.

23. The system of claim 15, wherein the processor is configured to control a graphical user interface to:

display a graphical representation of the location of the nerve relative to the electrodes.

24. The system of claim 15, wherein the upper stimulation threshold corresponds to a pain threshold or a discomfort threshold.

25. The system of claim 22, wherein the processor is configured to:

deliver the chronic electrical stimulation to the tissue adjacent the nerve based on the selection of the one or more of the plurality of implantable electrodes.

26. The system of claim 15, wherein the processor is configured to map the location of the nerve relative to each of the plurality of implantable electrodes by determining that an electrode of the plurality of implantable electrodes with a lowest respective first intensity threshold level corresponding to the at least one of the perception stimulation threshold or the paresthesia stimulation threshold is the electrode of the plurality of implantable electrodes that is closest to the nerve.

27. A computer-readable storage medium comprising instructions for causing a programmable processor to:

control an implantable electrical stimulator to apply electrical stimulation to a nerve of a patient via each of a plurality of implantable electrodes arranged in at least one row and at different axial positions along an axial length of a lead, the lead and the plurality of implantable electrodes having an orientation transverse to the nerve and crossing proximate to the nerve to position one or more of the plurality of implantable electrodes in proximity to the nerve, wherein each of the plurality of implantable electrodes is coupled to an implantable stimulation generator configured to generate the electrical stimulation to deliver stimulation therapy via at least some of the plurality of implantable electrodes;

determine, respective intensity threshold levels for each of the plurality of implantable electrodes, the respective intensity threshold levels for each of the plurality of implantable electrodes including a first intensity threshold level corresponding to at least one of a perception stimulation threshold or a paresthesia stimulation threshold and a second intensity threshold level corresponding to an upper stimulation threshold of the nerve for electrical stimulation delivered by that respective electrode of the plurality of implantable electrodes, the determination comprising adjusting intensities of the electrical stimulation applied via each of the plurality of implantable electrodes to the first intensity threshold level corresponding to the at least one of the perception stimulation threshold or the paresthesia stimulation threshold and the second intensity threshold level corresponding to the upper stimulation threshold of the nerve; and

map a location of the nerve relative to each of the plurality of implantable electrodes based at least in part on the respective intensity threshold levels determined for each of the plurality of implantable electrodes.