System and method for optimized brain stimulation

• US 20010008972A1
• Filed: 03/07/2001
• Published: 07/19/2001
• Est. Priority Date: 11/05/1998
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gielen, Frans L.H.
• Granted Patent: US 6,484,059 B2
• Time in Patent Office: Days
• US Class Current: 607/45
• CPC Class Codes: A61N 1/0534 Electrodes for deep brain stimulation
• CPC Class Codes: A61N 1/36067 Movement disorders, e.g. tremor or Parkinson disease stimulating motor muscle A61N1/36003
• CPC Class Codes: A61N 1/36153 Voltage A61N1/3616 takes precedence
• CPC Class Codes: A61N 1/36167 Timing, e.g. stimulation onset
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration

Abstract

There is provided apparatus and a method for testing to optimally place a deep brain lead, particularly for stimulating the GPi or other deep brain target to treat neurological disorders such as Parkinson'"'"'s Disease and the like. The invention embraces determining the location of a feedback target such as the motor cortex, the location of the deep brain target, and inserting a test lead along a substantially linear trajectory so as to be able to stimulate both concurrently. The test lead has an electrode at about its distal end for stimulation of the deep brain target, and an electrode adjustably positioned 3-8 cm proximal for stimulation of the motor cortex. When stimulation is applied concurrently through both electrodes, the affected body portion, e.g., limb, can be made to move when and if the deep brain electrode is optimally positioned. The position can be checked during surgical implant of the system, and the lead position adjusted until the optimum position is found. By use of this invention, the best lead position for the permanently implanted lead can be determined during the surgical procedure.

Claims

1. A brain stimulation system, comprising a brain stimulator device and lead means for placement of electrodes at predetermined positions within a patient'"'"'s brain,

said brain stimulator device having first pulse means for generating feedback pulses for stimulating a feedback target in the patient'"'"'s brain and second pulse means for generating DBS pulses for stimulating a neuro-modulation target in said patient'"'"'s brain;

and

lead means connected to said device for conducting said pulses from said device to said respective targets, said lead means comprising a DBS electrode and a conductor for conducting said DBS pulses from said second pulse means to said DBS electrode, a feedback electrode and a conductor for connecting said feedback pulses from said first pulse means to said feedback electrode, and said DBS and feedback electrodes being positioned on said lead means relative to each other so that when said DBS electrode is positioned at said neuro-stimulation target said feedback electrode is positioned at said feedback target.

2. The system as described in

claim 1

, wherein said lead means is a single lead, and said DBS electrode is positioned near the lead distal end and said feedback electrode is positioned about 3-8 cm from said DBS electrode, whereby said lead can be inserted into the patient'"'"'s brain along a predetermined path to position said electrodes at said respective feedback and neuro-modulation targets.

3. The system as described in

claim 2

, wherein said lead comprises adjusting means for adjusting the position of said feedback electrode to be positioned at the patient'"'"'s motor cortex when said DBS electrode is positioned at said patient'"'"'s GPi.

4. The system as described in

claim 3

, wherein said lead has a lead body, and said adjusting means comprises a slidable tubing having a window, said tubing being slidable over said lead body to expose said feedback electrode at a desired position relative to the motor cortex.

5. The system as described in

claim 4

, wherein said feedback electrode has an effective surface area larger than the area of said window.

6. The system as described in

claim 1

, wherein said first pulse means comprises MC generator means for generating pulses at a rate of about 1-5 Hz for delivery to the patient'"'"'s motor cortex, and parameter means for controlling said generated pulses to have a duration of about 1-10 ms and a voltage of about 1-10 volts.

7. The system as described in

claim 1

, wherein said second pulse means comprises DBS target means for generating pulses at a rate of about 50-250 Hz, and parameter means for controlling generation of said pulses to have a duration in the range of about 60-120 μ

S and a voltage in the range of about 1-10 volts.

8. The system as described in

claim 1

, wherein said brain stimulator device further comprises means for receiving signals from at least one of said electrodes and means for recording such signals.

9. A method of testing to determine postioning of a brain stimulation lead for optimal deep brain stimulation to treat a movement disorder, said lead having MC electrode means for delivering stimulation to the motor cortex and DBS electrode means for delivering stimulation to a predetermined deep brain target, said method being carried out while said patient is under surgery for implantation of said lead, comprising:

positioning said lead along a substantially linear trajectory which includes both the patient'"'"'s motor cortex and said predetermined deep brain target;

stimulating said motor cortex and said deep brain target concurrently, and observing movement of a predetermined body part corresponding to said disorder; and

adjusting said lead to stimulate said deep brain target at a location which provides optimal stimulation for movement of said body part.

10. The method as described in

claim 9

, wherein said positioning comprises positioning said MC electrode means in the area of the patient'"'"'s motor cortex and positioning said DBS electrode means in the area of said patient'"'"'s deep brain target.

11. The method as described in

claim 9

, comprising providing said lead with a first electrode for delivering stimulus pulses to the patient'"'"'s motor cortex, said providing including adjusting the position of said electrode relative to the DBS electrode.

12. The method as described in

claim 9

, comprising first determining approximately a linear trajectory that encompasses both said motor cortex and said deep brain target, and drilling a burr hole in the patient'"'"'s skull along said trajectory.

13. The method as described in

claim 9

, comprising inserting said lead stereotactically along said trajectory.

14. The method as described in

claim 9

, comprising selecting the GPi as said deep brain target.

15. A method of testing to determine the optimal location of a deep brain target for stimulation of said target so as to treat a neurological disorder affecting a body part, said method comprising use of test lead means for delivering respective stimulation to a predetermined patient feedback target as well as to said deep brain target, comprising:

positioning said test lead means within a patient'"'"'s skull so that stimulation can be delivered concurrently to each of said targets;

generating first stimulation pulses and connecting said first stimulation pulses to said test lead means so as to stimulate said feedback target, and concurrently generating DBS stimulation pulses and connecting said DBS stimulation pulses to said test lead means so as to stimulate said deep brain target;

determining the movement of said body part during said concurrent stimulating;

adjusting the position of said lead means relative to said deep brain target, so as to change the efficiency of stimulation of said deep brain target, and observing the resulting movement of said body part; and

determining the optimal deep brain target location by determining when said concurrent stimulation evokes the best response of said body part.

16. The method as described in

claim 15

, comprising providing a single lead having MC electrode means positioned thereon for stimulating said motor cortex and DBS electrode means positioned thereon for stimulating said deep brain target, and inserting said lead into said patient'"'"'s head along a substantially linear trajectory for stimulating said motor cortex and said target.

17. The method as described in

claim 15

, comprising providing a first lead having MC electrode means positioned thereon for stimulating said motor cortex and inserting said first lead into said patient'"'"'s head so as to position said MC electrode means at said motor cortex, and providing a second lead having deep brain electrode means positioned thereon for stimulating said deep brain target and inserting said second lead into said patient'"'"'s head so as to position said deep brain electrode means at said deep brain target.

18. A lead for providing stimulation of both a feedback target in a patient'"'"'s brain and a neuro-modulation target in the patient'"'"'s brain, said lead also providing for recording of brains signals from either of said targets, said lead having proximal and distal ends, comprising:

a first deep brain electrode positioned toward the distal end of said lead, and conductor means for conducting signals between said deep brain electrode and said lead proximal end; and

a second feedback electrode positioned proximally from said deep brain electrode, and second conductor means for conducting signals between said feedback electrode and said lead proximal end.

19. The lead as described in

claim 18

, wherein said feedback electrode is positioned about 3-8 cm from said deep brain electrode.

20. The lead as described in

claim 18

, further comprising adjusting means for adjusting the position of said feedback electrode relative to said deep brain electrode.