Systems and methods for selecting stimulation sites and applying treatment, including treatment of symptoms of Parkinson's disease, other movement disorders, and/or drug side effects

• US 20060106431A1
• Filed: 11/12/2004
• Published: 05/18/2006
• Est. Priority Date: 11/12/2004
• Status: Active Grant

• Current Assignee: Advanced Neuromodulation Systems Incorporated (Abbott Laboratories)
• Original Assignee: Advanced Neuromodulation Systems Incorporated (Abbott Laboratories)
• Inventors: Wyler, Allen, Fowler, Brad
• Granted Patent: US 7,565,200 B2
• Time in Patent Office: Days
• US Class Current: 607/48
• CPC Class Codes: A61N 1/0531 Brain cortex electrodes
• 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

Abstract

Methods and systems for treating movement disorders are disclosed. A method in accordance with one embodiment can include determining that the movement disorder affects the patient'"'"'s gait, oral functioning, and/or other functioning, and applying electrical stimulation proximate to the interhemispheric fissure, the Sylvian fissure, or between the two fissures, respectively. In another embodiment, the method can include selecting at least one neural process from among a plurality of processes sequentially carried out by a patient to cause a muscle movement in the patient (e.g., a planning process, an initiation process, and an execution process), and applying electrical stimulation to a location of the patient'"'"'s brain associated with the at least one neural process.

Claims

1. A method for treating movement disorders, comprising:

determining that the movement disorder affects a patient'"'"'s gait; and

applying electrical stimulation to a region of the patient'"'"'s brain that is proximate to the interhemispheric fissure of the patient'"'"'s brain.

2. The method of claim 1 wherein applying electrical stimulation includes at least reducing effects of the movement disorder on the patient'"'"'s gait.

3. The method of claim 1 wherein applying electrical stimulation includes applying electrical stimulation to a region of the patient'"'"'s brain that is closer to the interhemispheric fissure of the patient'"'"'s brain than to the Sylvian fissure of the patient'"'"'s brain.

4. The method of claim 1 wherein applying electrical stimulation includes applying electrical stimulation within the patient'"'"'s skull

5. The method of claim 1 wherein applying electrical stimulation includes applying electrical stimulation to an electrode positioned within the patient'"'"'s skull.

6. The method of claim 1 wherein applying electrical stimulation includes applying electrical stimulation at a first site located on a first side of the central sulcus of the patient'"'"'s brain, and at a second site located on a second side of the central sulcus.

7. The method of claim 1 wherein applying electrical stimulation includes applying electrical stimulation at a first site and a second site, with both the first and second sites located on the same side of the central sulcus of the patient'"'"'s brain.

8. The method of claim 1, further comprising determining a hemisphere of the brain from which signals related to the patient'"'"'s gait are transmitted, and wherein applying electrical stimulation includes applying electrical stimulation to the opposite hemisphere.

9. The method of claim 1, further comprising determining a hemisphere of the patient'"'"'s brain associated with the patient'"'"'s speech, and wherein applying electrical stimulation includes applying electrical stimulation to that hemisphere.

10. The method of claim 1 wherein applying electrical stimulation includes applying unipolar electrical stimulation.

11. The method of claim 1 wherein applying stimulation includes applying bipolar stimulation.

12. The method of claim 1 wherein applying stimulation includes applying stimulation at multiple sites located within the region of the patient'"'"'s brain.

13. The method of claim 1 wherein applying stimulation includes applying stimulation at a frequency of from about 1 Hz to about 2 Hz.

14. The method of claim 1 wherein applying stimulation includes applying stimulation at a frequency of 0.5 Hz or above.

15. The method of claim 1 wherein applying stimulation includes applying stimulation at from about 2 mA to about 20 mA.

16. The method of claim 1 wherein applying stimulation includes applying stimulation with a frequency that varies in at least one of a random, pseudorandom and aperiodic manner.

17. The method of claim 1 wherein applying stimulation includes applying stimulation with a frequency that varies and is centered on a value of approximately 5 Hz.

18. A method for treating movement disorders, comprising:

determining that the movement disorder affects a patient'"'"'s oral functioning; and

applying electrical stimulation to a region of the patient'"'"'s brain that is proximate to the Sylvian fissure of the patient'"'"'s brain.

19. The method of claim 18 wherein applying electrical stimulation includes at least reducing effects of the movement disorder on the patient'"'"'s oral functioning.

20. The method of claim 18 wherein applying electrical stimulation includes applying electrical stimulation to a region of the patient'"'"'s brain that is closer to the Sylvian fissure of the patient'"'"'s brain than to the interhemispheric fissure of the patient'"'"'s brain.

21. The method of claim 18 wherein applying electrical stimulation includes applying electrical stimulation at a first site located on a first side of the central sulcus of the patient'"'"'s brain, and at a second site located on a second side of the central sulcus.

22. The method of claim 18 wherein applying electrical stimulation includes applying electrical stimulation at a first site and a second site, with both the first and second sites located on the same side of the central sulcus of the patient'"'"'s brain.

23. The method of claim 18, further comprising determining a hemisphere of the brain from which signals related to the patient'"'"'s oral functioning are transmitted, and wherein applying electrical stimulation includes applying electrical stimulation to the opposite hemisphere.

24. The method of claim 18 wherein applying electrical stimulation includes applying unipolar electrical stimulation.

25. The method of claim 18 wherein applying stimulation includes applying bipolar stimulation.

26. The method of claim 18 wherein applying stimulation includes applying stimulation at multiple sites located within the region of the patient'"'"'s brain.

27. The method of claim 18 wherein applying stimulation includes applying stimulation at a frequency of 0.5 Hz or above.

28. The method of claim 18 wherein applying stimulation includes applying stimulation with a frequency that varies in at least one of a random, pseudorandom and aperiodic manner.

29. A method for treating movement disorders, comprising:

determining that the movement disorder affects an aspect of the patient'"'"'s movement other than the patient'"'"'s gait and the patient'"'"'s oral functioning; and

applying electrical stimulation to a region of the patient'"'"'s brain that is located between the interhemispheric fissure and the Sylvian fissure of the patient'"'"'s brain.

30. The method of claim 29 wherein applying electrical stimulation includes applying electrical stimulation to a region of the patient'"'"'s brain that is approximately midway between the Sylvian fissure of the patient'"'"'s brain and the interhemispheric fissure of the patient'"'"'s brain.

31. The method of claim 29 wherein applying electrical stimulation includes applying electrical stimulation at a first site located on a first side of the central sulcus of the patient'"'"'s brain, and at a second site located on a second side of the central sulcus.

32. The method of claim 29 wherein applying electrical stimulation includes applying electrical stimulation at a first site and a second site, with both the first and second sites located on the same side of the central sulcus of the patient'"'"'s brain.

33. The method of claim 29 wherein applying electrical stimulation includes applying unipolar electrical stimulation.

34. The method of claim 29 wherein applying stimulation includes applying bipolar stimulation.

35. The method of claim 29 wherein applying stimulation includes applying stimulation at multiple sites located within the region of the patient'"'"'s brain.

36. The method of claim 29 wherein applying stimulation includes applying stimulation at a frequency of 0.5 Hz or above.

37. The method of claim 29 wherein applying stimulation includes applying stimulation with a frequency that varies in at least one of a random, pseudorandom and aperiodic manner.

38. A method for treating movement disorders, comprising:

selecting at least one neural process from among a plurality of processes sequentially carried out by a patient to cause a muscle movement in the patient; and

applying electrical stimulation to a location of the patient'"'"'s brain associated with the at least one neural process.

39. The method of claim 38 wherein applying electrical stimulation includes applying electrical stimulation to a location of the brain ipsilateral to the location of the muscle movement.

40. The method of claim 38 wherein applying electrical stimulation includes applying electrical stimulation to a location of the brain contralateral to the location of the patient'"'"'s muscle movement.

41. The method of claim 38 wherein the at least one neural process includes a first neural process and the location includes a first location, and wherein the method further comprises:

selecting a second neural process associated with causing the muscle movement; and

applying electrical stimulation to a location of the patient'"'"'s brain associated with the second neural process.

42. The method of claim 38 wherein selecting at least one neural process includes selecting a plurality of neural processes and wherein applying electrical stimulation includes applying electrical stimulation to a corresponding plurality of locations of the patient'"'"'s brain, in at least one of a sequential, simultaneous, alternating, random, pseudorandom and intermittent manner.

43. The method of claim 38 wherein selecting at least one neural process from a plurality of sequential neural processes includes selecting the at least one neural process from among a planning process, an initiation process and an execution process.

44. The method of claim 38 wherein selecting at least one neural process includes selecting a planning process, and wherein applying electrical stimulation includes applying electrical stimulation to the dorsal lateral prefrontal cortex of the patient'"'"'s brain.

45. The method of claim 38 wherein selecting at least one process includes selecting an initiation process, and wherein applying electrical stimulation includes applying electrical stimulation at least proximate to the interhemispheric fissure of the patient'"'"'s brain.

46. The method of claim 38 wherein selecting at least one process includes selecting an execution process associated with fine motor control, and wherein applying electrical stimulation includes applying electrical stimulation at least proximate to the primary motor strip of the patient'"'"'s brain.

47. The method of claim 38 wherein selecting at least one process includes selecting an execution process associated with general motor control, and wherein applying electrical stimulation includes applying electrical stimulation at least proximate to the premotor cortex of the patient'"'"'s brain.

48. The method of claim 38 wherein selecting at least one neural process from among a plurality of sequential neural processes includes selecting a first process and a second process, and wherein applying electrical stimulation to a location of the patient'"'"'s brain includes applying electrical stimulation to a first location of the patient'"'"'s brain associated with the first process, and applying electrical stimulation to a second location of the patient'"'"'s brain associated with the second process.

49. The method of claim 38 wherein applying the electrical stimulation includes applying the electrical stimulation to one hemisphere of the patient'"'"'s brain.

50. The method of claim 49 wherein applying electrical stimulation includes applying electrical stimulation to the hemisphere that is ipsilateral to the location of the muscle movement.

51. The method of claim 49 wherein applying electrical stimulation includes applying electrical stimulation to the hemisphere that is contralateral to the location of the muscle movement.

52. The method of claim 38 wherein applying the electrical stimulation includes applying the electrical stimulation to both hemispheres of the patient'"'"'s brain.

53. The method of claim 38 wherein the location includes a first location associated with a first one of the neural processes, and wherein the method further comprises:

implanting at least one electrode proximate to the first location in a first procedure; and

implanting at least one second electrode proximate to a second location associated with a second one of the neural processes in a second procedure subsequent to the first procedure.

54. The method of claim 38 wherein the location includes a first location associated with a first one of the neural processes, and wherein the method further comprises:

implanting at least one electrode proximate to the first location in a first procedure;

determining that a response by the patient to stimulating at the first location is complete or inadequate; and

implanting at least one second electrode proximate to a second location in a second procedure subsequent to the first procedure.

55. A method for treating the effects of drugs on a patient, comprising:

determining an aspect of a patient'"'"'s functioning that is affected by the patient'"'"'s drug intake; and

applying electrical stimulation to a region of the patient'"'"'s brain that is associated with the functioning.

56. The method of claim 55 wherein determining an aspect of a patient'"'"'s functioning includes determining an aspect of the patient'"'"'s motor functioning that is influenced by the patient'"'"'s intake of drugs directed at controlling symptoms of Parkinson'"'"'s disease.

57. The method of claim 55 wherein determining an aspect of a patient'"'"'s functioning includes determining an aspect of the patient'"'"'s cognitive functioning that is influenced by the patient'"'"'s intake of drugs directed at controlling symptoms of Parkinson'"'"'s disease.

58. The method of claim 55 wherein determining an aspect of a patient'"'"'s functioning includes determining an aspect of the patient'"'"'s motor functioning that is influenced by the patient'"'"'s intake of drugs directed at controlling symptoms of a movement disorder.

59. The method of claim 55 wherein determining an aspect of a patient'"'"'s functioning includes determining an aspect of the patient'"'"'s cognitive functioning that is influenced by the patient'"'"'s intake of drugs directed at controlling symptoms of a movement disorder.

60. The method of claim 55 wherein determining an aspect of a patient'"'"'s functioning that is affected by the patient'"'"'s drug intake includes determining an aspect of the patient'"'"'s functioning that is affected as a side effect of the drug.

61. The method of claim 55 wherein applying electrical stimulation includes applying electrical stimulation to at least one of the patient'"'"'s primary motor cortex, premotor cortex and supplementary motor area.

62. The method of claim 55 wherein applying electrical stimulation includes applying electrical stimulation to the patient'"'"'s prefrontal cortex.

63. A method for treating a neurological dysfunction, comprising:

implanting at least one electrode device so that a first electrical contact is at least proximate to one of the motor cortex, the prefrontal cortex and the supplementary motor area of a patient'"'"'s brain, and a second electrical contact is at least proximate to another of the motor cortex, the prefrontal cortex and the supplementary motor area; and

applying electrical stimulation to at least one of the first and second contacts.

64. The method of claim 63 wherein applying electrical stimulation includes applying electrical stimulation to one hemisphere of the patient'"'"'s brain.

65. The method of claim 63 wherein applying electrical stimulation includes applying electrical stimulation to both hemispheres of the patient'"'"'s brain.

66. The method of claim 63 wherein applying electrical stimulation includes applying electrical stimulation simultaneously via the first and second contacts.

67. The method of claim 63 wherein applying electrical stimulation includes applying electrical stimulation sequentially via the first and second contacts.