Treatment of aphasia by electrical stimulation and/or drug infusion

• US 20070100389A1
• Filed: 11/01/2005
• Published: 05/03/2007
• Est. Priority Date: 11/01/2005
• Status: Active Grant

• Current Assignee: Boston Scientific Neuromodulation Corporation (Boston Scientific Corporation)
• Original Assignee: Advanced Bionics Corporation (Sonova Holding AG)
• Inventors: Carbunaru, Rafael, Jaax, Kristen, Whitehurst, Todd
• Granted Patent: US 7,684,867 B2
• Time in Patent Office: Days
• US Class Current: 607/42
• CPC Class Codes: A61M 2205/054 with electrotherapy
• CPC Class Codes: A61M 2205/3523 using telemetric means
• CPC Class Codes: A61M 2205/3546 Range
• CPC Class Codes: A61M 2205/3569 sublocal, e.g. between console and disposable
• CPC Class Codes: A61M 2205/8243 by induction
• CPC Class Codes: A61M 2210/0693 Brain, cerebrum
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: A61N 1/37205 Microstimulators, e.g. implantable through a cannula

Abstract

Systems and methods are provided for applying electrical stimulation and/or introducing one or more stimulating drugs to the brain to treat or prevent aphasia, including through use of at least one system control unit (SCU) for controlling electrical pulses delivered via electrodes implanted in the brain and/or for producing drug infusion pulses to targeted areas in the brain.

Claims

1. A method of treating a communication disorder in an aphasia patient, comprising:

providing at least one System Control Unit (SCU) controllably connected to one or more electrodes and/or infusion outlets;

implanting the one or more electrodes and/or infusion outlets in or adjacent to one or more language areas of the aphasia patient'"'"'s brain;

activating the SCU to control delivery of stimuli from the one or more electrodes and/or drug delivery catheters to treat or reduce an occurrence or severity of a symptom of aphasia.

2. The method of claim 1, wherein the language areas are selected from the:

insula, frontoparietal operculum, posterior temporal cortex, inferior parietal cortex, lateral temporal-occipital cortex, arcuate fasciculus, thalamus, superior temporal gyrus, extrasylvian posterior temporal cortex, posterior parietal cortex, Broca'"'"'s area, pre-Rolandic gyrus, Wemicke'"'"'s area, putamen, and combinations thereof.

3. The method of claim 1, wherein the SCU is connected to or comprises at least one pump that is operably connected to the catheter, and wherein the stimulus comprises stimulation via one or more drugs delivered from catheter through action of the pump.

4. The method of claim 1, wherein one or more of the SCU comprises at least one micro stimulator.

5. The method of claim 1, wherein the Broca'"'"'s area stimulus is applied to at least a posterior inferior frontal gyrus region of Broca'"'"'s area.

6. The method of claim 1, wherein the pre-Rolandic gyrus stimulus is applied to at least an inferior precentral region of the pre-Rolandic gyrus.

7. The method of claim 1, wherein the aphasia is Wernicke'"'"'s aphasia and the stimulus is applied to at least one of the:

posterior temporal cortex, posterior parietal cortex, inferior parietal cortex, and extrasylvian posterior temporal cortex.

8. The method of claim 1, wherein the posterior parietal cortex is a right posterior parietal cortex.

9. The method of claim 1, wherein the stimulus is applied to two or more of the areas to prevent accommodation.

10. The method of claim 1, wherein the stimulus is electrical stimulation and the response of the patient is tuned and controlled by customized programming.

11. The method of claim 3, wherein the drug increases excitement of at least one area of the brain that exhibits chronic decreased activity and wherein the drug is one or more of:

excitatory neurotransmitters, excitatory neurotransmitter agonists, inhibitory neurotransmitter antagonists, agents that increase the level of an excitatory neurotransmitter, and agents that decrease the level of an inhibitory neurotransmitter.

12. The method of claim 11, wherein the drug that increases excitement of at least one area of the brain that exhibits chronic decreased activity is selected from the group consisting of:

glutamate, dopamine, norepinephrine, epinephrine, acetylcholine, serotonin, glutamate receptor agonist, L-aspartic acid, N-methyl-D-aspartic acid (NMDA), bethanechol, norepinephrine, bicuculline, edrophonium, mestinon, and combinations thereof.

13. The method of claim 3, wherein the drug decreases excitement of at least one area of the brain that exhibits chronic increased activity and wherein the drug is one or more of:

inhibitory neurotransmitters, inhibitory neurotransmitter agonists, excitatory neurotransmitter antagonists, agents that increase the level of an inhibitory neurotransmitter, agents that decrease the level of an excitatory neurotransmitter, anesthetic agents, and/or analgesic medications.

14. The method of claim 13, wherein drug that decreases excitement of at least one area of the brain that exhibits chronic increased activity is selected from the group consisting of:

gamma-aminobutyric acid, dopamine, glycine, midazolam, clonidine, muscimol, prazosin, metoprolol, atropine, benztropine, acetylcholinesterase and Group II metabotropic glutamate receptor agonists.

15. The method of claim 1, further comprising sensing at least one condition indicating a need for stimulus to one or more language areas of the brain.

16. The method of claim 15, wherein the sensed condition is at least one of regional cerebral blood flow (rCBF), impedance, electrical activity of the brain, nerve activity, muscle activity, neurotransmitter level, neurotransmitter breakdown product level and vocal cord vibration.

17. The method of claim 15, wherein the sensed condition is detected by positioning a sensor adjacent to one or more of the language areas.

18. The method of claim 1, wherein one or more of the SCU control one or more stimulation parameters selected from the group consisting of:

on/off patterns;

pulsewidth;

pulse amplitude;

repetition rate or pulses per second (pps); and

electrode configurations.

19. The method of claim 18, wherein the electrode configurations are selected from the group consisting of:

monopolar, bipolor or tripolar, and combinations thereof.

20. An aphasia treatment system comprising:

at least one system control unit (SCU) having a replenishable power source;

at least one electrode in electrical communication with the SCU and adapted for implantation in one or more language areas of the brain, and

an external battery charger.

21. The system of claim 20, wherein at least one of the SCU provides a multiplicity of stimulation channels, wherein each stimulation channel is independently programmable with different stimulation parameters.

22. The system of claim 21, wherein the different stimulation parameters are selected from one or more of:

pulsewidth, stimulation amplitude, repetition rate or pulses per second (pps), and an electrode configuration that may be either monopolar or bipolar.

23. The system of claim 20, wherein the SCU comprises processing circuitry including:

a control logic circuit, a timer logic circuit, a microcontroller circuit, and a memory circuit coupled to the microcontroller circuit; and

wherein the control logic, timer logic and microcontroller circuits are responsive to programming signals stored in the memory circuit to generate stimulation pulses having a specified amplitude, pulsewidth and repetition rate (pps).

24. The system of claim 20, further comprising one or more sensors in electrical communication with the SCU, wherein the sensors are capable of sensing at least one condition indicating a need for stimulus to the one or more language areas of the brain.

25. The system of claim 24, wherein the one or more sensors detect conditions selected from the group consisting of:

regional cerebral blood flow (rCBF), impedance, electrical activity of the brain, nerve activity, muscle activity, neurotransmitter level, neurotransmitter breakdown product level and vocal cord vibration.

26. The system of claim 20, wherein the area is selected from one ore more of the group consisting of:

insula, frontoparietal operculum, posterior temporal cortex, inferior parietal cortex, lateral temporal-occipital cortex, arcuate fasciculus, thalamus, superior temporal gyrus, extrasylvian posterior temporal cortex, posterior parietal cortex, Broca'"'"'s area, pre-Rolandic gyrus, Wernicke'"'"'s area and putamen.

27. A method for treating aphasia in a patient so affected comprising:

implanting one or more stimulus delivery electrode(s) in at least one of the skull and the brain of the aphasia patient and in electrical connection with at least one language area of the brain;

implanting a rechargeable System Control Unit (SCU) that is connected electrically to and controls delivery of electrical stimuli from the one or more delivery electrode(s);

delivering electrical stimuli from the SCU via the electrode(s) to the at least one language area treat or reduce an occurrence or severity of a symptom of aphasia.

28. The method of claim 27, wherein the language area is one ore more of the group consisting of the:

insula, frontoparietal operculum, posterior temporal cortex, inferior parietal cortex, lateral temporal-occipital cortex, arcuate fasciculus, thalamus, superior temporal gyrus, extrasylvian posterior temporal cortex, posterior parietal cortex, Broca'"'"'s area, Wernicke'"'"'s area, pre-Rolandic gyrus, and putamen.

29. The method of claim 27, wherein the SCU comprises electrical circuitry that receives power and/or receives or transmits data by inductive or radio-frequency (RF) coupling to a transmitting coil placed outside the body.

30. The method of claim 27, further comprising implanting at least one sensor for detecting electrical activity in electrical connection with at least one language area of the brain.

31. The method of claim 27, wherein the aphasia is conduction aphasia and the stimulus delivery electrodes are disposed in an array that provides for electrical stimulus to Broca'"'"'s area and Wernicke'"'"'s area.

32. The method of claim 28, wherein a plurality of electrodes are implanted to prevent accommodation and encourage adaptation.