Acute and chronic electrical signal therapy for obesity

• US 20020161414A1
• Filed: 12/11/2000
• Published: 10/31/2002
• Est. Priority Date: 12/11/2000
• Status: Active Grant

• Current Assignee: Tylerton International Inc.
• Original Assignee: Impulse Dynamics NV
• Inventors: Ben-Haim, Shlomo, Darvish, Nissim, Mika, Yuval, Belsky, Ziv, Ben Arie, Yaakov, Flesler, Melina
• Granted Patent: US 6,600,953 B2
• Time in Patent Office: Days
• US Class Current: 607/40
• CPC Class Codes: A61N 1/05 for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 1/08 Arrangements or circuits for monitoring, protecting, controlling or indicating for external stimulators A61N1/3603; for implantable neurostimulators A61N1/36128; for heart stimulators A61N1/37; for defibrillators A61N1/3925
• CPC Class Codes: A61N 1/306 Arrangements where at least part of the apparatus is introduced into the body
• CPC Class Codes: A61N 1/326 for promoting growth of cells, e.g. bone cells
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control

Abstract

Apparatus is provided for treating a condition such as obesity. The apparatus includes a set of one or more electrodes, which are adapted to be applied to one or more respective sites in a vicinity of a body of a stomach of a patient. A control unit is adapted to drive the electrode set to apply to the body of the stomach a signal, configured such that application thereof increases a level of contraction of muscle tissue of the body of the stomach, and decreases a cross-sectional area of a portion of the body of the stomach for a substantially continuous period greater than about 3 seconds.

Claims

1. Apparatus for treating a condition, comprising:

a set of one or more electrodes, adapted to be applied to one or more respective sites in a vicinity of a stomach of a patient; and

a control unit, adapted to drive the electrode set to apply an Excitable-Tissue Control (ETC) signal to the sites, configured such that application thereof decreases a cross-sectional area of at least a portion of the stomach.

2. Apparatus according to claim 1, wherein the set of one or more electrodes includes a first set of one or more electrodes, wherein the apparatus comprises a second set of one or more electrodes, adapted to be applied to one or more respective sites in a vicinity of a pyloric sphincter of the stomach, and wherein the control unit is adapted to drive the second electrode set to apply an ETC signal configured such that application thereof increases a contraction force of the sphincter and extends a period of time in which partially-digested food remains in the stomach.

3. Apparatus according to claim 1, wherein the control unit is adapted to configure the ETC signal such that application thereof decreases the cross-sectional area of the portion of the stomach by at least 20%, for a substantially continuous period greater than about one minute.

4. Apparatus according to claim 1, wherein the portion of the stomach includes a first portion of the stomach, and wherein the control unit is adapted to configure the ETC signal such that ingestion of food by the patient in conjunction with application of the ETC signal to the first portion induces stretching of a stretch-receptor in a second portion of the stomach that induces a sensation of satiety.

5. Apparatus according to claim 1, wherein the control unit is adapted to drive the electrode set to apply the signal over a sufficient time period so as to engender a long-term structural change of the stomach.

6. Apparatus according to claim 1, wherein the electrode set is adapted to be applied in contact with muscle tissue of the stomach.

7. Apparatus according to claim 1, wherein the control unit is adapted to configure the ETC signal such that the decreased cross-sectional area impedes passage of ingesta through the stomach.

8. Apparatus according to claim 1, wherein the control unit is adapted to configure the ETC signal such that application thereof decreases a volume of the stomach.

9. Apparatus according to claim 1, wherein the control unit is adapted to configure a timing parameter of the ETC signal responsive to timing of natural gastric electrical activity.

10. Apparatus according to claim 1, wherein the control unit is adapted to drive the electrode set to apply the ETC signal as a series of biphasic pulses.

11. Apparatus according to claim 1, wherein the control unit is adapted to configure the ETC signal to have a duration of at least about 1 second.

12. Apparatus according to claim 11, wherein the control unit is adapted to configure the ETC signal to have a duration of at least about 3 seconds.

13. Apparatus according to claim 1, and comprising at least one stimulating electrode, wherein the control unit is adapted to drive the stimulating electrode to apply an excitatory signal to muscle tissue of the stomach in conjunction with driving the electrode set to apply the ETC signal.

14. Apparatus according to claim 13, wherein the control unit is adapted to drive the stimulating electrode to apply gastric pacing pulses to the stomach.

15. Apparatus according to claim 1, wherein the control unit is adapted to receive a patient signal, input by the patient, and to drive the electrode set responsive to the patient signal.

16. Apparatus according to claim 15, wherein the control unit is adapted to withhold driving the electrode set responsive to the patient signal.

17. Apparatus according to claim 1, wherein the control unit is adapted to drive the electrode set in accordance with a schedule programmed into the control unit.

18. Apparatus according to claim 17, wherein the control unit is adapted to drive the electrode set during at least one meal eaten by the patient during a 24 hour period, and to withhold driving the electrode set during another meal eaten by the patient during the 24 hour period.

19. Apparatus according to claim 17, wherein the control unit is adapted to withhold driving the electrode set during time periods designated as times when the patient generally does not eat.

20. Apparatus according to claim 1, wherein the control unit is adapted to drive at least one of the electrodes to apply an excitatory pulse in conjunction with the ETC signal.

21. Apparatus according to claim 20, wherein the control unit is adapted to drive the at least one electrode to apply the excitatory pulse as a biphasic pulse.

22. Apparatus according to claim 20, wherein the control unit is adapted to drive the at least one electrode to initiate applying the ETC signal at least about 100 ms following a termination of the excitatory pulse.

23. Apparatus according to claim 20, wherein the control unit is adapted to drive the at least one electrode to initiate applying the ETC signal less than about 1000 ms following a termination of the excitatory pulse.

24. Apparatus according to claim 1, wherein the control unit is adapted to drive the electrode set while the patient is eating.

25. Apparatus according to claim 24, wherein the control unit is adapted to receive a patient signal, input by the patient, indicative of the patient eating.

26. Apparatus according to claim 25, wherein the control unit is adapted to receive by way of the patient signal an indication of a nutritional quality of food being eaten by the patient and to configure a parameter of the ETC signal responsive to the patient signal.

27. Apparatus according to claim 24, and comprising a sensor which is adapted to convey to the control unit a signal responsive to the patient eating.

28. Apparatus according to claim 27, wherein the sensor comprises a blood sugar sensor.

29. Apparatus according to claim 27, wherein the sensor comprises a mechanical sensor.

30. Apparatus according to claim 27, wherein the sensor comprises a sensing electrode, adapted to be coupled in a vicinity of a gastrointestinal tract of the patient.

31. Apparatus according to claim 30, wherein the sensing electrode comprises one of the one or more electrodes.

32. Apparatus according to claim 27, wherein the sensor is adapted to convey the signal responsive to a quantity of food ingested by the patient, and wherein the control unit is adapted to withhold driving the electrode set responsive to the quantity.

33. Apparatus according to claim 32, wherein the control unit is adapted to withhold driving the electrode set when the quantity is less than a threshold quantity.

34. Apparatus according to claim 1, wherein the control unit is adapted to configure the ETC signal such that application thereof decreases the cross-sectional area of a region of the stomach, and maintains the decreased cross-sectional area in the region for a duration greater than about 10 seconds.

35. Apparatus according to claim 1, wherein the control unit is adapted to configure the ETC signal such that application thereof increases intra-gastric pressure, thereby inducing a sensation of satiety.

36. Apparatus according to claim 1, and comprising a second set of one or more electrodes, adapted to be applied to one or more respective sites in a vicinity of a lower-esophageal sphincter of the patient, wherein the control unit is adapted to drive the second electrode set to apply a sphincter-control signal to the sphincter, configured such that application thereof increases a contraction force generated by the sphincter.

38. Apparatus according to claim 37, wherein the control unit is adapted to configure the ETC signal such that driving the electrode set to apply the ETC signal increases the contraction force for a substantially continuous period greater than about 1 minute.

39. Apparatus according to claim 37, wherein the electrode set is adapted to be applied in contact with muscle tissue of an antral portion of the stomach.

40. Apparatus according to claim 37, wherein the electrode set is adapted to be applied in contact with muscle tissue of the sphincter.

41. Apparatus according to claim 37, wherein the control unit is adapted to configure a timing parameter of the ETC signal responsive to timing of natural gastric electrical activity.

42. Apparatus according to claim 37, wherein the control unit is adapted to drive the electrode set to apply the ETC signal as a series of biphasic pulses.

43. Apparatus according to claim 37, and comprising at least one stimulating electrode, wherein the control unit is adapted to drive the stimulating electrode to apply an excitatory signal to at least one of the sites in conjunction with driving the electrode set to apply the ETC signal.

44. Apparatus according to claim 37, wherein the control unit is adapted to drive the electrode set in accordance with a schedule programmed into the control unit.

45. Apparatus according to claim 37, wherein the control unit is adapted to configure the ETC signal to have a duration of at least about 1 second.

46. Apparatus according to claim 45, wherein the control unit is adapted to configure the ETC signal to have a duration of at least about 3 seconds.

47. Apparatus according to claim 37, wherein the control unit is adapted to receive a patient signal, input by the patient, and to drive the electrode set responsive to the patient signal.

48. Apparatus according to claim 47, wherein the control unit is adapted to withhold driving the electrode set responsive to the patient signal.

49. Apparatus according to claim 37, wherein the control unit is adapted to drive at least one of the electrodes to apply an excitatory pulse in conjunction with the ETC signal.

50. Apparatus according to claim 49, wherein the control unit is adapted to drive the at least one electrode to apply the excitatory pulse as a biphasic pulse.

51. Apparatus according to claim 49, wherein the control unit is adapted to drive the at least one electrode to initiate applying the ETC signal at least about 100 ms following a termination of the excitatory pulse.

52. Apparatus according to claim 49, wherein the control unit is adapted to drive the at least one electrode to initiate applying the ETC signal less than about 1000 ms following a termination of the excitatory pulse.

37. Apparatus for treating a condition, comprising:

a set of one or more electrodes, adapted to be applied to one or more respective sites in a vicinity of a pyloric sphincter of a stomach of a patient; and

a control unit, adapted to drive the electrode set to apply an Excitable-Tissue Control (ETC) signal to the sites, configured such that application thereof increases a contraction force of the sphincter and extends a period of time in which partially-digested food remains in the stomach.

53. Apparatus for treating a condition, comprising:

a set of one or more electrodes, adapted to be applied to one or more respective sites in a vicinity of a body of a stomach of a patient; and

a control unit, adapted to drive the electrode set to apply to the body of the stomach a signal configured such that application thereof increases a level of contraction of muscle tissue of the body of the stomach, and decreases a cross-sectional area of a portion of the body of the stomach for a substantially continuous period greater than about 3 seconds.

54. Apparatus according to claim 53, wherein the control unit is adapted to configure the signal such that application thereof decreases the cross-sectional area of the portion for a substantially continuous period greater than about 10 seconds.

55. Apparatus according to claim 53, wherein the portion of the stomach includes a first portion of the stomach, and wherein the control unit is adapted to configure the signal such that ingestion of food by the patient in conjunction with application of the signal induces stretching of a stretch-receptor in a second portion of the stomach that induces a sensation of satiety.

56. Apparatus according to claim 53, wherein the control unit is adapted to drive the electrode set to apply the signal over a sufficient time period so as to engender a long-term structural change of the stomach.

57. Apparatus according to claim 53, wherein the electrode set is adapted to be applied in contact with muscle tissue of the stomach.

58. Apparatus according to claim 53, wherein the control unit is adapted to configure the signal such that the decreased cross-sectional area impedes passage of ingesta through the stomach.

59. Apparatus according to claim 53, wherein the control unit is adapted to configure the signal such that application thereof decreases a volume of the stomach.

60. Apparatus according to claim 53, wherein the control unit is adapted to configure the signal such that application thereof decreases the cross-sectional area of a region of the body of the stomach, and maintains the decreased cross-sectional area in the region for a duration greater than about 10 seconds.

61. Apparatus according to claim 53, wherein the control unit is adapted to configure the signal such that application thereof increases intra-gastric pressure, thereby inducing a sensation of satiety.

62. Apparatus according to claim 53, and comprising a second set of one or more electrodes, adapted to be applied to one or more respective sites in a vicinity of a lower-esophageal sphincter of the patient, wherein the control unit is adapted to drive the second electrode set to apply a sphincter-control signal to the sphincter, configured such that application thereof increases a contraction force generated by the sphincter.

63. Apparatus according to claim 53, wherein the control unit is adapted to receive a patient signal, input by the patient, and to drive the electrode set responsive to the patient signal.

64. Apparatus according to claim 63, wherein the control unit is adapted to withhold driving the electrode set responsive to the patient signal.

65. Apparatus according to claim 53, wherein the control unit is adapted to drive the electrode set in accordance with a schedule programmed into the control unit.

66. Apparatus according to claim 65, wherein the control unit is adapted to drive the electrode set during at least one meal eaten by the patient during a 24 hour period, and to withhold driving the electrode set during another meal eaten by the patient during the 24 hour period.

67. Apparatus according to claim 65, wherein the control unit is adapted to withhold driving the electrode set during time periods designated as times when the patient generally does not eat.

68. Apparatus according to claim 53, wherein the control unit is adapted to drive the electrode set while the patient is eating.

69. Apparatus according to claim 68, wherein the control unit is adapted to receive a patient signal, input by the patient, indicative of the patient eating.

70. Apparatus according to claim 69, wherein the control unit is adapted to receive by way of the patient signal an indication of a nutritional quality of food being eaten by the patient and to configure a parameter of the signal applied to the body of the stomach responsive to the patient signal.

71. Apparatus according to claim 68, and comprising a sensor which is adapted to convey to the control unit a signal responsive to the patient eating.

72. Apparatus according to claim 71, wherein the sensor comprises a blood sugar sensor.

73. Apparatus according to claim 71, wherein the sensor comprises a mechanical sensor.

74. Apparatus according to claim 71, wherein the sensor comprises a sensing electrode, adapted to be coupled in a vicinity of a gastrointestinal tract of the patient.

75. Apparatus according to claim 74, wherein the sensing electrode comprises one of the one or more electrodes.

76. Apparatus according to claim 71, wherein the sensor is adapted to convey the signal responsive to a quantity of food ingested by the patient, and wherein the control unit is adapted to withhold driving the electrode set responsive to the quantity.

77. Apparatus according to claim 76, wherein the control unit is adapted to withhold driving the electrode set when the quantity is less than a threshold quantity.

79. Apparatus according to claim 78, wherein the electrode set is adapted to be applied in contact with muscle tissue of the stomach.

80. Apparatus according to claim 78, wherein the control unit is adapted to drive the electrode set to apply the signal to a body of the stomach, and to configure a parameter of the signal such that the increased level of contraction of the muscle tissue impedes passage of ingesta through the stomach and increases a level of tension in a fundic wall of the stomach.

81. Apparatus according to claim 78, wherein the control unit is adapted to receive a patient signal, input by the patient, and to drive the electrode set responsive to the patient signal.

82. Apparatus according to claim 81, wherein the control unit is adapted to withhold driving the electrode set responsive to the patient signal.

83. Apparatus according to claim 78, wherein the control unit is adapted to drive the electrode set in accordance with a schedule programmed into the control unit.

84. Apparatus according to claim 83, wherein the control unit is adapted to drive the electrode set during at least one meal eaten by the patient during a 24 hour period, and to withhold driving the electrode set during another meal eaten by the patient during the 24 hour period.

85. Apparatus according to claim 83, wherein the control unit is adapted to withhold driving the electrode set during time periods designated as times when the patient generally does not eat.

86. Apparatus according to claim 78, wherein the control unit is adapted to drive the electrode set while the patient is eating.

87. Apparatus according to claim 86, wherein the control unit is adapted to receive a patient signal, input by the patient, indicative of the patient eating.

88. Apparatus according to claim 87, wherein the control unit is adapted to receive by way of the patient signal an indication of a nutritional quality of food being eaten by the patient and to configure a parameter of the signal applied to the stomach responsive to the patient signal.

89. Apparatus according to claim 86, and comprising a sensor which is adapted to convey to the control unit a signal responsive to the patient eating.

90. Apparatus according to claim 89, wherein the sensor comprises a blood sugar sensor.

91. Apparatus according to claim 89, wherein the sensor comprises a mechanical sensor.

92. Apparatus according to claim 89, wherein the sensor comprises a sensing electrode, adapted to be coupled in a vicinity of a gastrointestinal tract of the patient.

93. Apparatus according to claim 92, wherein the sensing electrode comprises one of the one or more electrodes.

94. Apparatus according to claim 89, wherein the sensor is adapted to convey the signal responsive to a quantity of food ingested by the patient, and wherein the control unit is adapted to withhold driving the electrode set responsive to the quantity.

95. Apparatus according to claim 94, wherein the control unit is adapted to withhold driving the electrode set when the quantity is less than a threshold quantity.

78. Apparatus for treating a condition, comprising:

a set of one or more electrodes, adapted to be applied to one or more respective sites in a vicinity of a first portion of a stomach of a patient; and

a control unit, adapted to drive the electrode set to apply to the portion of the stomach a signal configured such that application thereof increases a level of contraction of muscle tissue of the portion, and configured such that ingestion of food by the patient in conjunction with application of the signal induces stretching of a stretch-receptor in a second portion of the stomach.

96. Apparatus for treating a condition, comprising:

a set of one or more electrodes, adapted to be applied to one or more respective sites on an arterial supply of small intestine of a patient; and

a control unit, adapted to drive the electrode set to apply a signal to the sites, configured such that application thereof induces constriction of one or more arteries in the arterial supply and decreases a quantity of digestion products which are absorbed into blood of the patient from the small intestine.

97. Apparatus according to claim 96, wherein the control unit is adapted to configure the signal as an Excitable-Tissue Control (ETC) signal.

98. Apparatus according to claim 96, wherein the control unit is adapted to receive a patient signal, input by the patient, and to drive the electrode set responsive to the patient signal.

99. Apparatus according to claim 98, wherein the control unit is adapted to withhold driving the electrode set responsive to the patient signal.

100. Apparatus according to claim 96, wherein the control unit is adapted to drive the electrode set in accordance with a schedule programmed into the control unit.

101. Apparatus according to claim 100, wherein the control unit is adapted to drive the electrode set subsequent to initiation of at least one meal eaten by the patient during a 24 hour period, and to withhold driving the electrode set subsequent to initiation of another meal eaten by the patient during the 24 hour period.

102. Apparatus according to claim 96, wherein the control unit is adapted to determine an approximate time of initiation of eating, and to initiate driving the electrode set to apply the signal at least ten minutes subsequent thereto.

103. Apparatus according to claim 102, wherein the control unit is adapted to determine the approximate time of initiation of eating responsive to receiving a patient signal, input by the patient.

104. Apparatus according to claim 96, and comprising a sensor which is adapted to convey to the control unit a signal indicative of food being in a gastrointestinal tract of the patient.

105. Apparatus according to claim 104, wherein the sensor comprises a blood sugar sensor.

106. Apparatus according to claim 104, wherein the sensor comprises a mechanical sensor.

107. Apparatus according to claim 104, wherein the sensor comprises a sensing electrode, adapted to be coupled in a vicinity of the gastrointestinal tract.

108. Apparatus according to claim 107, wherein the sensing electrode comprises one of the one or more electrodes.

109. Apparatus according to claim 104, wherein the sensor is adapted to convey the signal responsive to a quantity of food ingested by the patient, and wherein the control unit is adapted to withhold driving the electrode set responsive to the quantity.

110. Apparatus according to claim 109, wherein the control unit is adapted to withhold driving the electrode set when the quantity is less than a threshold quantity.

111. Apparatus for treating a condition, comprising:

a set of one or more electrodes, adapted to be applied to one or more respective sites of a stomach of a patient; and

a control unit, adapted to drive the electrode set to apply to the stomach, over a sufficient time period, a sequence of pulses configured so as to engender a long-term structural change of the stomach.

112. Apparatus according to claim 111, wherein the control unit is adapted to configure the sequence of pulses as an Excitatory-Tissue Control (ETC) signal.

113. Apparatus according to claim 111, wherein the control unit is adapted to configure a parameter of the sequence of pulses such that the application of the pulses over the time period is such as to engender a continuation of the structural change for at least two days following a termination of the application of the pulses.

114. Apparatus according to claim 111, wherein the control unit is adapted to configure a parameter of the sequence of pulses such that the application of the pulses over the time period is such as to reduce a characteristic length of muscle fibers of the stomach.

115. Apparatus according to claim 111, wherein the control unit is adapted to configure a parameter of the sequence of pulses such that the application of the pulses over the time period is such as to reduce a characteristic size of the stomach.

116. Apparatus according to claim 111, wherein the control unit is adapted to drive the electrode set to apply the pulses for at least two days.

117. Apparatus according to claim 116, wherein the control unit is adapted to drive the electrode set to apply the pulses for at least two weeks.

118. Apparatus according to claim 111, wherein the control unit is adapted to drive the electrode set in accordance with a schedule programmed into the control unit.

119. Apparatus according to claim 118, wherein the control unit is adapted to drive the electrode set at times when the patient'"'"'s stomach is generally empty.

120. Apparatus according to claim 118, wherein the control unit is adapted to drive the electrode set during a meal eaten by the patient.

122. A method according to claim 121, and comprising:

applying an ETC signal to one or more sites in a vicinity of a pyloric sphincter of the stomach; and

configuring the ETC signal applied to the sites in the vicinity of the sphincter such that application thereof increases a contraction force of the sphincter and extends a period of time in which partially-digested food remains in the stomach.

123. A method according to claim 121, wherein configuring the signal comprises configuring the signal such that application thereof decreases the cross-sectional area of the portion of the stomach for a substantially continuous period greater than about 1 minute.

124. A method according to claim 121, wherein the portion of the stomach includes a first portion of the stomach, and wherein configuring the signal comprises configuring the signal such that, during application of the signal, ingestion of food by the patient stretches a stretch-receptor in a second portion of the stomach and induces a sensation of satiety.

125. A method according to claim 121, wherein configuring the signal comprises configuring the signal such that application thereof over a sufficient time period engenders a long-term structural change of the stomach.

126. A method according to claim 121, wherein applying the signal comprises applying the signal to muscle tissue of the stomach.

127. A method according to claim 121, wherein configuring the signal comprises configuring the signal such that the decreased cross-sectional area impedes passage of ingesta through the stomach.

128. A method according to claim 121, wherein configuring the signal comprises configuring the signal such that application thereof decreases a volume of the stomach.

129. A method according to claim 121, wherein configuring the signal comprises configuring a timing parameter of the signal responsive to timing of natural gastric electrical activity.

130. A method according to claim 121, wherein configuring the signal comprises configuring the signal as a series of biphasic pulses.

131. A method according to claim 121, wherein configuring the ETC signal comprises configuring the signal such that application thereof decreases the cross-sectional area of a region of the stomach, and maintains the decreased cross-sectional area in the region for a duration greater than about 10 seconds.

132. A method according to claim 121, wherein configuring the ETC signal comprises configuring the signal such that application thereof increases intra-gastric pressure, thereby inducing a sensation of satiety.

133. A method according to claim 121, and comprising:

applying a sphincter-control signal to one or more sites in a vicinity of a lower-esophageal sphincter of the patient; and

configuring the sphincter-control signal such that application thereof increases a contraction force generated by the sphincter.

134. A method according to claim 121, wherein configuring the signal comprises configuring the signal to have a duration of at least about 1 second.

135. A method according to claim 134, wherein configuring the signal comprises configuring the signal to have a duration of at least about 3 seconds.

136. A method according to claim 121, and comprising applying an excitatory signal to muscle tissue of the stomach in conjunction with applying the ETC signal.

137. A method according to claim 136, wherein applying the excitatory signal comprises applying gastric pacing pulses to the stomach.

138. A method according to claim 121, and comprising receiving a patient signal input by the patient, wherein configuring the ETC signal comprises configuring the ETC signal responsive to the patient signal.

139. A method according to claim 138, wherein configuring the ETC signal responsive to the patient signal comprises withholding application of the ETC signal responsive to the patient signal.

140. A method according to claim 121, wherein configuring the signal comprises configuring the signal in accordance with a schedule.

141. A method according to claim 140, wherein applying the signal comprises:

applying the signal during at least one meal eaten by the patient during a 24 hour period; and

withholding applying the signal during another meal eaten by the patient during the 24 hour period.

142. A method according to claim 140, wherein applying the signal comprises withholding applying the signal during time periods designated as times when the patient generally does not eat.

143. A method according to claim 121, and comprising applying excitatory pulses to one or more of the sites in conjunction with applying the ETC signal.

144. A method according to claim 143, wherein applying the excitatory pulses comprises applying the excitatory pulses as biphasic pulses.

145. A method according to claim 143, wherein applying the ETC signal comprises initiating application of the ETC signal at one of the sites at least about 100 ms following a termination of an excitatory pulse at the one of the sites.

146. A method according to claim 143, wherein applying the ETC signal comprises initiating application of the ETC signal at one of the sites less than about 1000 ms following a termination of an excitatory pulse at the one of the sites.

147. A method according to claim 121, wherein applying the signal comprises applying the signal while the patient is eating.

148. A method according to claim 147, and comprising receiving a patient signal, input by the patient, indicative of the patient eating.

149. A method according to claim 148, wherein receiving the patient signal comprises receiving an indication of a nutritional quality of food being eaten by the patient.

150. A method according to claim 149, and comprising receiving a sensor signal responsive to the patient eating.

151. A method according to claim 150, wherein receiving the sensor signal comprises receiving an indication of a blood sugar level of the patient.

152. A method according to claim 150, wherein receiving the sensor signal comprises receiving the sensor signal responsive to a measurement of a mechanical disposition of a gastrointestinal tract of the patient.

153. A method according to claim 150, wherein receiving the sensor signal comprises detecting current generated by muscle tissue of a gastrointestinal tract of the patient.

154. A method according to claim 150, wherein receiving the sensor signal comprises receiving an indication of a quantity of food ingested by the patient, and wherein applying the ETC signal comprises applying the ETC signal if the sensor signal is indicative of the quantity of food being greater than a threshold value.

156. A method according to claim 155, wherein configuring the signal comprises configuring the signal such that application thereof increases the contraction force for a substantially continuous period greater than about 1 minute.

157. A method according to claim 155, wherein applying the signal comprises applying the signal to a site of an antral portion of the stomach.

158. A method according to claim 135, wherein applying the signal comprises applying the signal to muscle tissue of the sphincter.

159. A method according to claim 155, wherein configuring the signal comprises configuring a timing parameter of the signal responsive to timing of natural gastric electrical activity.

160. A method according to claim 155, wherein configuring the signal comprises configuring the signal as a series of biphasic pulses.

161. A method according to claim 155, wherein configuring the signal comprises configuring the signal in accordance with a schedule.

162. A method according to claim 155, wherein configuring the signal comprises configuring the signal to have a duration of at least about 1 second.

163. A method according to claim 162, wherein configuring the signal comprises configuring the signal to have a duration of at least about 3 seconds.

164. A method according to claim 155, and comprising receiving a patient signal input by the patient, wherein configuring the ETC signal comprises configuring the ETC signal responsive to the patient signal.

165. A method according to claim 164, wherein configuring the ETC signal responsive to the patient signal comprises withholding application of the ETC signal responsive to the patient signal.

166. A method according to claim 155, and comprising applying excitatory pulses to one or more of the sites in conjunction with applying the ETC signal.

167. A method according to claim 166, wherein applying the excitatory pulses comprises applying the excitatory pulses as biphasic pulses.

168. A method according to claim 166, wherein applying the ETC signal comprises initiating application of the ETC signal at one of the sites at least about 100 ms following a termination of an excitatory pulse at the one of the sites.

169. A method according to claim 166, wherein applying the ETC signal comprises initiating application of the ETC signal at one of the sites less than about 1000 ms following a termination of an excitatory pulse at the one of the sites.

171. A method according to claim 170, wherein configuring the signal comprises configuring the signal so as to decrease the cross-sectional area of the portion for a substantially continuous period greater than about 10 seconds.

172. A method according to claim 170, wherein the portion of the stomach includes a first portion of the stomach, and wherein configuring the signal comprises configuring the signal such that, during application of the signal, ingestion of food by the patient stretches a stretch-receptor in a second portion of the stomach and induces a sensation of satiety.

173. A method according to claim 170, wherein configuring the signal comprises configuring the signal such that application thereof over a sufficient time period engenders a long-term structural change of the stomach.

174. A method according to claim 170, wherein applying the signal comprises applying the signal to muscle tissue of the body of the stomach.

175. A method according to claim 170, wherein configuring the signal comprises configuring the signal such that the decreased cross-sectional area impedes passage of ingesta through the body of the stomach.

176. A method according to claim 170, wherein configuring the signal comprises configuring the signal such that application thereof decreases a volume of the body of the stomach.

177. A method according to claim 170, wherein configuring the signal comprises configuring the signal such that application thereof decreases the cross-sectional area of a region of the stomach, and maintains the decreased cross-sectional area in the region for a duration greater than about 10 seconds.

178. A method according to claim 170, wherein configuring the signal comprises configuring the signal such that application thereof increases intra-gastric pressure, thereby inducing a sensation of satiety.

179. A method according to claim 170, and comprising:

applying a sphincter-control signal to one or more sites in a vicinity of a lower-esophageal sphincter of the patient; and

configuring the sphincter-control signal such that application thereof increases a contraction force generated by the sphincter.

180. A method according to claim 170, and comprising receiving a patient signal input by the patient, wherein configuring the signal comprises configuring the signal responsive to the patient signal.

181. A method according to claim 180, wherein configuring the signal responsive to the patient signal comprises withholding application of the signal responsive to the patient signal.

182. A method according to claim 170, wherein configuring the signal comprises configuring the signal in accordance with a schedule.

183. A method according to claim 182, wherein applying the signal comprises:

applying the signal during at least one meal eaten by the patient during a 24 hour period; and

withholding applying the signal during another meal eaten by the patient during the 24 hour period.

184. A method according to claim 182, wherein applying the signal comprises withholding applying the signal during time periods designated as times when the patient generally does not eat.

185. A method according to claim 170, wherein applying the signal comprises applying the signal while the patient is eating.

186. A method according to claim 185, and comprising receiving a patient signal, input by the patient, indicative of the patient eating.

187. A method according to claim 186, wherein receiving the patient signal comprises receiving an indication of a nutritional quality of food being eaten by the patient.

188. A method according to claim 185, and comprising receiving a sensor signal responsive to the patient eating.

189. A method according to claim 188, wherein receiving the sensor signal comprises receiving an indication of a blood sugar level of the patient.

190. A method according to claim 188, wherein receiving the sensor signal comprises receiving the sensor signal responsive to a measurement of a mechanical disposition of a gastrointestinal tract of the patient.

191. A method according to claim 188, wherein receiving the sensor signal comprises detecting current generated by muscle tissue of a gastrointestinal tract of the patient.

192. A method according to claim 188, wherein receiving the sensor signal comprises receiving an indication of a quantity of food ingested by the patient, and wherein applying the signal comprises applying the signal if the sensor signal is indicative of the quantity of food being greater than a threshold value.

194. A method according to claim 193, wherein applying the signal comprises applying the signal to muscle tissue of the stomach.

195. A method according to claim 193, wherein applying the signal comprises applying the signal to a body of the stomach, and wherein configuring the signal comprises configuring a parameter of the signal such that the increased level of contraction of the muscle tissue impedes passage of ingesta through the stomach and increases a level of tension in a fundic wall of the stomach.

196. A method according to claim 193, and comprising receiving a patient signal input by the patient, wherein configuring the signal comprises configuring the signal responsive to the patient signal.

197. A method according to claim 196, wherein configuring the signal responsive to the patient signal comprises withholding application of the signal responsive to the patient signal.

198. A method according to claim 193, wherein configuring the signal comprises configuring the signal in accordance with a schedule.

199. A method according to claim 198, wherein applying the signal comprises:

applying the signal during at least one meal eaten by the patient during a 24 hour period; and

withholding applying the signal during another meal eaten by the patient during the 24 hour period.

200. A method according to claim 198, wherein applying the signal comprises withholding applying the signal during time periods designated as times when the patient generally does not eat.

201. A method according to claim 193, wherein applying the signal comprises applying the signal while the patient is eating.

202. A method according to claim 201, and comprising receiving a patient signal, input by the patient, indicative of the patient eating.

203. A method according to claim 202, wherein receiving the patient signal comprises receiving an indication of a nutritional quality of food being eaten by the patient.

204. A method according to claim 201, and comprising receiving a sensor signal responsive to the patient eating.

205. A method according to claim 204, wherein receiving the sensor signal comprises receiving an indication of a blood sugar level of the patient.

206. A method according to claim 204, wherein receiving the sensor signal comprises receiving the sensor signal responsive to a measurement of a mechanical disposition of a gastrointestinal tract of the patient.

207. A method according to claim 204, wherein receiving the sensor signal comprises detecting current generated by muscle tissue of a gastrointestinal tract of the patient.

208. A method according to claim 204, wherein receiving the sensor signal comprises receiving an indication of a quantity of food ingested by the patient, and wherein applying the signal comprises applying the signal if the sensor signal is indicative of the quantity of food being greater than a threshold value.

121. A method for treating a condition, comprising:

applying an Excitable-Tissue Control (ETC) signal to one or more sites in a vicinity of a stomach of a patient; and

configuring the ETC signal such that application thereof to the one or more sites decreases a cross-sectional area of at least a portion of the stomach.

155. A method for treating a condition, comprising:

applying an Excitable-Tissue Control (ETC) signal to one or more sites in a vicinity of a pyloric sphincter of a stomach of a patient; and

configuring the ETC signal such that application thereof to the one or more sites increases a contraction force of the sphincter and extends a period of time in which partially-digested food remains in the stomach.

170. A method for treating a condition, comprising:

applying a signal to one or more sites in a vicinity of a body of a stomach of a patient; and

configuring the signal such that application thereof to the one or more sites increases a level of contraction of muscle tissue of a portion of the body of the stomach, and decreases a cross-sectional area of the portion for a substantially continuous period greater than about 3 seconds.

193. A method for treating a condition, comprising:

applying a signal to one or more sites in a vicinity of a first portion of a stomach of a patient; and

configuring the signal such that the application thereof increases a level of contraction of muscle tissue of the portion and stretches a stretch-receptor in a second portion of the stomach.

209. A method for treating a condition, comprising:

applying a signal to one or more sites on an arterial supply of small intestine of a patient; and

configuring the signal such that application thereof to the sites induces constriction of one or more arteries in the arterial supply and decreases a quantity of digestion products which are absorbed into blood of the patient from the small intestine.

210. A method according to claim 209, applying the signal comprises applying an Excitable-Tissue Control (ETC) signal.

211. A method according to claim 209, and comprising receiving a patient signal input by the patient, wherein configuring the signal comprises configuring the signal responsive to the patient signal.

212. A method according to claim 211, wherein configuring the signal responsive to the patient signal comprises withholding application of the signal responsive to the patient signal.

213. A method according to claim 209, wherein configuring the signal comprises configuring the signal, in accordance with a schedule.

214. A method according to claim 213, wherein applying the signal comprises:

applying the signal subsequent to initiation of at least one meal eaten by the patient during a 24 hour period; and

withholding applying the signal subsequent to initiation of another meal eaten by the patient during the 24 hour period.

215. A method according to claim 209, and comprising determining an approximate time of initiation of eating, wherein applying The signal comprises initiating application of the signal at least ten minutes subsequent to the approximate time of initiation of eating.

216. A method according to claim 215, and comprising receiving a patient signal, input by the patient, indicative of the approximate time of initiation of eating.

217. A method according to claim 209, and comprising receiving a sensor signal indicative of food being in a gastrointestinal tract of the patient.

218. A method according to claim 217, wherein receiving the sensor signal comprises receiving an indication of a blood sugar level of the patient.

219. A method according to claim 217, wherein receiving the sensor signal comprises receiving the sensor signal responsive to a measurement of a mechanical disposition of the gastrointestinal tract.

220. A method according to claim 217, wherein receiving the sensor signal comprises detecting current generated by muscle tissue of the gastrointestinal tract.

221. A method according to claim 217, wherein receiving the sensor signal comprises receiving an indication of a quantity of food ingested by the patient, and wherein applying the signal comprises applying the signal if the sensor signal is indicative of the quantity of food being greater than a threshold value.

222. A method for treating a condition, comprising:

applying a sequence of pulses over a time period to one or more sites of a stomach of a patient; and

configuring the sequence of pulses such that application thereof to the one or more sites engenders a long-term structural change of the stomach.

223. A method according to claim 222, wherein applying the sequence of pulses comprises applying an Excitatory-Tissue Control (ETC) signal.

224. A method according to claim 222, wherein configuring the sequence of pulses comprises configuring a parameter of the sequence of pulses such that the application of the pulses over the time period is such as to engender a continuation of the structural change for at least two days following a termination of the application of the pulses.

225. A method according to claim 222, wherein configuring the sequence of pulses comprises configuring a parameter of the sequence of pulses such that the application of the pulses over the time period is such as to reduce a characteristic length of muscle fibers of the stomach.

226. A method according to claim 222, wherein configuring the sequence of pulses comprises configuring a parameter of the sequence of pulses such that the application of the pulses over the time period is such as to reduce a characteristic size of the stomach.

227. A method according to claim 222, wherein applying the sequence of pulses over the time period comprises applying the sequence of pulses for at least two days.

228. A method according to claim 227, wherein applying the sequence of pulses over the time period comprises applying the sequence of pulses for at least two weeks.

229. A method according to claim 222, wherein configuring the sequence of pulses comprises configuring the sequence of pulses in accordance with a schedule.

230. A method according to claim 229, wherein applying the sequence of pulses comprises applying the sequence of pulses at times when the patient'"'"'s stomach is generally empty.

231. A method according to claim 229, wherein applying the sequence of pulses comprises applying the sequence of pulses during a meal eaten by the patient.