Differential neurostimulation therapy driven by physiological therapy

• US 20060212093A1
• Filed: 05/16/2006
• Published: 09/21/2006
• Est. Priority Date: 04/05/2000
• Status: Active Grant

• Current Assignee: Neuropace Inc.
• Original Assignee: Neuropace Inc.
• Inventors: Tcheng, Thomas K., Pless, Benjamin D.
• Granted Patent: US 7,966,073 B2
• Time in Patent Office: Days
• US Class Current: 607/45
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/0022 Monitoring a patient using a global network, e.g. telephone networks, internet
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/026 Measuring blood flow A61B3/1233, A61B3/1241 take precedence
• CPC Class Codes: A61B 5/076 Permanent implantations telemetry using implanted circuitry A61B5/0031; implanted stimulators for therapy A61N1/3605, A61N1/362, A61N1/372
• CPC Class Codes: A61B 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61B 5/14546 for measuring analytes not otherwise provided for, e.g. ions, cytochromes
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/369 Electroencephalography [EEG] devices for psychotechnics A61B5/16
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4812 Detecting sleep stages or cycles
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/743 Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61N 1/0529 Electrodes for brain stimulation
• CPC Class Codes: A61N 1/0531 Brain cortex electrodes
• CPC Class Codes: A61N 1/0539 Anchoring of brain electrode systems, e.g. within burr hole
• CPC Class Codes: A61N 1/36064 Epilepsy
• CPC Class Codes: A61N 1/36067 : Movement disorders, e.g. tremor or Parkinson disease stimulating motor muscle A61N1/36003
• CPC Class Codes: A61N 1/36078 : Inducing or controlling sleep or relaxation non-implantable stimulator A61M21/00
• CPC Class Codes: A61N 1/36135 : using physiological parameters
• CPC Class Codes: A61N 1/36139 : with automatic adjustment

Abstract

An implantable neurostimulator system adapted to provide therapy for various neurological disorders is capable of varying therapy delivery strategies based on the context, physiological or otherwise, into which the therapy is to be delivered. Responsive and scheduled therapies can be varied depending on various sensor measurements, calculations, inferences, and device states (including elapsed times and times of day) to deliver an appropriate course of therapy under the circumstances.

Claims

1. A method for using an implantable device to treat a neurological disorder, the method comprising the steps of:

detecting a neurological event;

analyzing a parameter observed by the implantable device, wherein the parameter is representative of a characteristic of the neurological event;

selecting a therapy based at least in part on the parameter; and

delivering the therapy.

2. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the parameter is at least somewhat representative of a physiological condition.

3. The method for using an implantable device to treat a neurological disorder of claim 2, wherein the parameter comprises an EEG characteristic, an EMG characteristic, a blood pressure measurement, a blood flow measurement, a blood oxygenation measurement, a drug concentration measurement, a neurotransmitter concentration measurement, a measurement of electrophysiological excitability, a measurement of electrophysiological refractoriness, an orientation of the patient, or a sleep state of the patient.

4. The method for using an implantable device to treat a neurological disorder of claim 2, wherein the parameter comprises a feature derived from an EEG characteristic, an EMG characteristic, a blood pressure measurement, a blood flow measurement, a blood oxygenation measurement, a drug concentration measurement, a measurement of electrophysiological excitability, a measurement of electrophysiological refractoriness, an orientation of the patient, or a sleep state of the patient.

5. The method for using an implantable device to treat a neurological disorder of claim 4, wherein the feature comprises a recent value compared to a trend value.

6. The method for using an implantable device to treat a neurological disorder of claim 4, wherein the feature comprises a half wave measurement, a line length measurement, or an area measurement of a waveform defined by a plurality of measurements.

7. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the parameter is representative of a system state of the implantable device.

8. The method for using an implantable device to treat a neurological disorder of claim 7, wherein the system state comprises a time of day.

9. The method for using an implantable device to treat a neurological disorder of claim 7, wherein the system state comprises an elapsed time since a system event.

10. The method for using an implantable device to treat a neurological disorder of claim 9, wherein the system event comprises a detection, a therapy delivery, a mode change, or a scheduled event.

11. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the detecting step is performed by a triggering detection channel included in a plurality of detection channels of the implantable device, and wherein the parameter is obtained from an indication of which of the plurality of detection channels is the triggering detection channel.

12. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the parameter comprises an electrographic measurement.

13. The method for using an implantable device to treat a neurological disorder of claim 12, wherein the electrographic measurement comprises a characteristic of the neurological event.

14. The method for using an implantable device to treat a neurological disorder of claim 13, wherein the detecting step is performed by a triggering detection channel of the implantable device, and wherein the electrographic measurement is obtained from a data storage areas associated with the triggering detection channel.

15. The method for using an implantable device to treat a neurological disorder of claim 13, wherein the detecting step is performed by a triggering detection channel included in a plurality of detection channels of the implantable device, and wherein the electrographic measurement is obtained from a data storage area associated with a detection channel other than the triggering detection channel.

16. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the parameter is obtained from a physiological sensor in communication with the implantable device.

17. The method for using an implantable device to treat a neurological disorder of claim 1, further comprising the step of transforming the parameter.

18. The method for using an implantable device to treat a neurological disorder of claim 17, wherein the transformed parameter is within a specified range.

19. The method for using an implantable device to treat a neurological disorder of claim 17, wherein the transformed parameter is mapped to a specified distribution.

20. The method for using an implantable device to treat a neurological disorder of claim 1, further comprising the step of modifying the therapy based at least in part of the parameter.

21. The method for using an implantable device to treat a neurological disorder of claim 1, further comprising the step of repeating the analyzing, selecting, and applying steps.

22. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the therapy comprises an application of electrical brain stimulation.

23. The method for using an implantable device to treat a neurological disorder of claim 22, wherein the electrical brain stimulation comprises responsive stimulation.

24. The method for using an implantable device to treat a neurological disorder of claim 22, wherein the electrical brain stimulation comprises programmed stimulation.

25. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the therapy comprises an application of a therapeutic agent.

26. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the therapy comprises an application of sensory stimulation.

27. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the therapy comprises a patient warning.

28. The method for using an implantable device to treat a neurological disorder of claim 22, wherein the therapy is applied to a focus of epileptiform activity.

29. The method for using an implantable device to treat a neurological disorder of claim 22, wherein the therapy is applied to a predetermined site in the brain of the patient.

30. The method for using an implantable device to treat a neurological disorder of claim 29, wherein the predetermined site is located in a target structure selected from a group comprising the caudate nucleus, the subthalamic nucleus, the anterior thalamus, the ventralateral thalamus, the globus pallidus internus, the globus pallidus externus, the substantia nigra, and the neostriatum.

31. The method for using an implantable device to treat a neurological disorder of claim 29, wherein the predetermined structure comprises a functional neural pathway.

32. A method for treating a neurological disorder in a patient, the method comprising the steps of:

implanting a device in the body of the patient;

implanting a plurality of electrodes in the body of the patient, wherein each of the plurality of electrodes is coupled to the device;

detecting a neurological event with the device;

analyzing a parameter measured by the implantable device, wherein the parameter is representative of a characteristic of the neurological event;

selecting a therapy based at least in part on the parameter; and

applying the therapy with the device.

33. The method for treating a neurological disorder of claim 32, further comprising the step of implanting a sensor in the body of the patient, and wherein the parameter is obtained from the sensor.

34. The method for treating a neurological disorder of claim 33, wherein the sensor comprises an EEG sensor, an EMG sensor, an accelerometer, a motion sensor, an orientation sensor, a blood pressure sensor, a blood flow sensor, a blood oxygenation sensor, a drug concentration sensor, a neurotransmitter concentration sensor, or a sleep sensor.

35. A method for using an implantable device to treat a neurological disorder, the method comprising the steps of:

detecting a neurological event with a triggering detection channel of the implantable device;

analyzing a parameter observed by the implantable device, wherein the parameter comprises an electrographic measurement representative of a characteristic of the event and obtained from a data storage area associated with the triggering detection channel;

selecting a therapy based at least in part on the parameter; and

delivering the therapy.

36. A method for using an implantable device to treat a neurological disorder, the method comprising the steps of:

detecting a neurological event with a triggering detection channel included in a plurality of detection channels of the implantable device;

analyzing a parameter observed by the implantable device, wherein the parameter is representative of a characteristic of the event and obtained from an indication of which of the plurality of detection channels is the triggering detection channel;

selecting a therapy based at least in part on the parameter; and

delivering the therapy.

37. An implantable neurostimulator for the treatment of a neurological disorder, comprising:

a detection subsystem adapted to detect a neurological event and to observe an event characteristic related to the neurological event; and

a therapy subsystem adapted to deliver a therapy to the patient, wherein the therapy is selected at least in part based on the event characteristic.

38. The implantable neurostimulator of claim 37, wherein the neurological event comprises a seizure.

39. The implantable neurostimulator of claim 37, wherein the neurological event comprises a seizure onset.

40. The implantable neurostimulator of claim 37, wherein the event characteristic comprises an event type.

41. The implantable neurostimulator of claim 37, wherein the event characteristic comprises an event location.

42. The implantable neurostimulator of claim 37, wherein the event characteristic is obtained from a device state of the implantable neurostimulator.

43. The implantable neurostimulator of claim 37, wherein the detection subsystem includes a plurality of detection channels.

44. The implantable neurostimulator of claim 43, wherein the event characteristic comprises a triggering detection channel identified upon an event detection as one of the plurality of detection channels.

45. The implantable neurostimulator of claim 37, wherein the event characteristic is obtained from a data storage area associated with the detection subsystem.

46. The implantable neurostimulator of claim 37, further comprising a sensor in communication with the detection subsystem, and wherein the event characteristic is obtained from the sensor.

47. The implantable neurostimulator of claim 37, wherein the event characteristic is obtained from a measurement of a physiological condition.