PROBABILISTIC NEUROLOGICAL DISORDER TREATMENT

• US 20070213785A1
• Filed: 04/28/2006
• Published: 09/13/2007
• Est. Priority Date: 03/10/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Osorio, Ivan, Frei, Mark
• Granted Patent: US 8,209,018 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 5/369 Electroencephalography [EEG] devices for psychotechnics A61B5/16
• CPC Class Codes: A61B 5/4094 Diagnosing or monitoring seizure diseases, e.g. epilepsy
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: A61N 1/361 Phantom sensations, e.g. tinnitus
• CPC Class Codes: G16H 20/70 relating to mental therapies, e.g. psychological therapy or autogenous training
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

Disclosed are probabilistic approaches to patient evaluation, warning and treatment of a neurological disorder. Disclosed techniques estimate probability distribution functions or cumulative distribution functions, determined by relying on representative historical profiles, comprising information in short and/or long timescales obtained at times that may be intermittent or temporally discontinuous from each other or from other events of interest. The patient may thereby be treated based on the determined probability information.

Claims

1. A probabilistic method of treating a patient with a neurological disorder of potential episodes, where the probability that the patient will have an episode is estimated on the basis of time-based information, comprising:

treating the patient in relation to the estimated probability, where treating the patient comprises the group of evaluating the patient, diagnosing the disorder of the patient, comparing therapies for the patient, alerting the patient, alerting a caregiver, dosing the patient, stimulating the patient and similarly treating the patient.

2. A probabilistic treatment method as in claim 1, further comprising:

determining the probability that the patient will have the episode on the basis of the time-based information; and

thereafter treating the patient as described.

3. A probabilistic treatment method as in claim 1, for a patient with multiple potential episodes, further comprising:

determining probabilities that the patient will have episodes over time based on the time-based information; and

electrically stimulating the patient in a series of stimulation events at least one parameter of which is established in accordance with the time-based information.

4. A probabilistic treatment method as in claim 3, for a patient with multiple potential seizures, further comprising:

determining probabilities that the patient will have seizures over time based on the time-based information; and

electrically stimulating the patient in a series of stimulation events at least one parameter of which is established in accordance with the time-based information.

5. A probabilistic treatment method as in claim 4, for a patient who enjoys a protective carry-over effect against seizures arising from the stimulation events, further comprising:

stimulating the patient in the series of stimulation events at least one parameter of which is established in accordance with the protective carry-over effect.

6. A probabilistic treatment method as in claim 5, further comprising:

determining the probabilities that the patient will have seizures over time in relation to information based on the times of stimulation events, to thereby determine the degree of carry-over effect enjoyed by the patient; and

timing the stimulation events based on the degree of carry-over effect.

7. A probabilistic method of treating a patient with a neurological disorder of potential episodes, based on the empirical probability density of episodes relative to time with respect to a fiducial sequence, comprising:

treating the patient in relation to the empirical probability density of episodes relative to time with respect to a fiducial sequence, where treating the patient comprises the group of evaluating the patient, diagnosing the disorder of the patient, comparing therapies for the patient, alerting the patient, alerting a caregiver, dosing the patient, stimulating the patient and similarly treating the patient.

8. A probabilistic method as in claim 7, further comprising:

determining the empirical probability density of episodes relative to time with respect to a fiducial sequence.

9. A probability-based apparatus for treating a patient with a neurological disorder of potential episodes, comprising:

means for delivering treatment to the patient; and

apparatus for generating in the delivery means, treatment for the patient in relation to the empirical probability density of episodes relative to time with respect to a fiducial sequence, where treating the patient comprises the group of evaluating the patient, diagnosing the patient, comparing therapies for the patient, alerting the patient, alerting a caregiver, dosing the patient, stimulating the patient and similarly treating the patient;

whereby the patient is treated in relation to the empirical probability density of episodes relative to time with respect to a fiducial sequence.

10. Apparatus as in claim 9 further comprising:

means for generating in the delivery means, treatment for a breakthrough episode.

11. Apparatus as in claim 9 further comprising:

sensing means for sensing neurological activity in the patient; and

apparatus for generating in the delivery means, treatment for the patient in relation to the neurological activity sensed by the sensing means.

12. Apparatus as in claim 9, in which the fiducial sequence is selected from among the group comprising times of onset of stimulation delivery, times of onset of trains of electrical stimulation, times of ends of stimulation delivery, times of changing of stimulation intensity, and time of day.

14. A method of treating subjects with inoperable bi-temporal lobe epilepsy, using high frequency stimulation of certain thalamic nuclei.

15. The method of claim 14, wherein the thalamic nuclei are selected from the group comprising the N Reticulatus polaris and N Lateroplaris.

16. A probabilistic method for warning or control of neurological events comprising:

estimating a probability of an occurrence of a neurological event based on changes in at least one signal combined with at least one criterion, wherein the at least one criterion is selected from the group consisting of a state of the subject, a metabolic state of an organ, a time of day, a time elapsed from at least one prior seizure, a characteristic of at least one prior seizure, type of at least one prior treatment, a time elapsed from at least one prior treatment, and exposure to a seizure precipitant or trigger; and

treating or warning the patient in relation to the estimated probability.

17. The probabilistic method of claim 16, wherein the signal is selected from the group consisting of an electrical signal, a thermal signal, a chemical signal, and a cognitive signal.

18. The probabilistic method of claim 16, wherein treating or warning the patient is performed taking into account an environmental context selected from the group consisting of a risk of physical injury, a risk of functional impairment, a social consequence, an economic consequence, a medical consequence, and a safety consequence.

19. The probabilistic method of claim 16, wherein estimating the probability of an event is continuously performed using in-hospital equipment.

20. The probabilistic method of claim 16, wherein estimating the probability of an event is continuously performed on an outpatient basis.