Selecting electrode combinations for stimulation therapy

• US 20080004674A1
• Filed: 06/07/2007
• Published: 01/03/2008
• Est. Priority Date: 06/30/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: King, Gary, Miyazawa, Gabriela, Greenberg, Jordan, Tidemand, Kevin, Goetz, Steven, Wesselink, Wilbert
• Granted Patent: US 8,666,506 B2
• Time in Patent Office: Days
• US Class Current: 607/46
• CPC Class Codes: A61N 1/0529 Electrodes for brain stimulation
• CPC Class Codes: A61N 1/0534 Electrodes for deep brain stimulation
• CPC Class Codes: A61N 1/0553 Paddle shaped electrodes, e.g. for laminotomy
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/63 for local operation

Abstract

Techniques for selecting electrode combinations for stimulation therapy are described. The techniques include selecting one or more electrode combinations based on information associating a plurality of electrode combinations with at least one value of a therapy metric. The therapy metric comprises a quantifiable result of delivery of stimulation, and may be generated computer modeling of delivery of stimulation via the electrode combinations. In one embodiment, a clinician may deliver stimulation via a baseline electrode combination, receive patient feedback to the baseline electrode combination, select a therapy metric based on the patient feedback, and select additional electrode combinations based on the selected therapy metric and the information associating the electrode combinations with therapy metric values. In another embodiment, the clinician may select a therapy metric prior to providing a test stimulation and select additional electrode combinations based on the selected therapy metric and the information associating electrode combinations with metric values.

Claims

1. A method comprising:

selecting a baseline electrode combination;

delivering stimulation therapy to a patient via the baseline electrode combination;

receiving patient feedback to the therapy delivery via the baseline electrode combination;

selecting a therapy metric based on the patient feedback, the therapy metric comprising a quantifiable result of delivery of stimulation; and

selecting an additional electrode combination based on information associating a plurality of electrode combinations with a respective value of the therapy metric, wherein the values of the therapy metric associated with the electrode combinations are generated by computer modeling of delivery of stimulation via the electrode combinations.

2. The method of claim 1, wherein the additional electrode combination optimizes the therapy metric relative to the plurality of electrode combinations.

3. The method of claim 1, wherein the therapy metric includes at least one of:

a dorsal column current;

usage range;

a ratio of dorsal column stimulation threshold voltage to dorsal root stimulation threshold voltage;

a recruitment area;

an area factor;

a maximum output voltage;

or a dorsal column stimulation threshold voltage.

4. The method of claim 1, wherein selecting the additional electrode combination based on the information that associates the plurality of electrode combinations with the respective value of the therapy metric comprises referencing a data structure presented on a display of a computing device, wherein the data structure presents the plurality of electrode combinations and associated therapy metric values.

5. The method of claim 1, wherein selecting the therapy metric based on the patient feedback comprises receiving user input selecting the therapy metric.

6. The method of claim 1, wherein selecting the additional electrode combination based on the information that associates the plurality of electrode combinations with the respective value of the therapy metric comprises inputting the therapy metric into a computing device, wherein the computing device comprises a processor that provides an output indicating at least one electrode combination from the plurality of electrode combinations based on the therapy metric value.

7. The method of claim 1, wherein the information associates a plurality of electrode combinations within a first electrode combination class and a second electrode combination class with the respective value of the therapy metric, wherein the first electrode combination class is characterized by electrodes within one or two electrode columns of an implantable array of electrodes that includes at least three electrode columns, and the second electrode combination class is characterized by electrodes within at least three electrode columns of the implantable array of electrodes.

8. The method of claim 1, wherein the information associates a plurality of electrode combinations within at least five groups of electrode combinations during a therapy evaluation period, wherein a first group is characterized by a rostral anode electrode pattern, a second group is characterized by a caudal anode electrode pattern, a third group is characterized by a first cathode disposed between two anodes, the first cathode and anodes being located in a same column of electrodes, a fourth group is characterized by a second cathode disposed between a first row of anodes and a second row of anodes, and a fifth group is characterized by a transverse electrode combination, wherein anodes of the transverse electrode combination are displaced substantially transversely relative to a third cathode of the transverse electrode combination, and a stimulation field resulting from delivery of stimulation via the transverse combination is oriented substantially transversely relative to a target tissue for the stimulation.

9. The method of claim 8, wherein the at least five groups of electrode combinations further comprises a sixth group characterized by an off-center cathode.

10. The method of claim 1, further comprising programming the additional electrode combination into the medical device to deliver chronic stimulation therapy to the patient.

11. The method of claim 1, further comprising optimizing the additional electrode combination.

12. The method of claim 1, further comprising determining a number of leads to implant in the patient based on the additional electrode combination.

13. The method of claim 1, wherein selecting an additional electrode combination based on information associating a plurality of electrode combinations with a respective value of the therapy metric comprises selecting a plurality of additional electrode combinations, the method further comprising:

delivering stimulation to the patient according to each of the plurality of additional electrode combinations; and

receiving patient feedback for each of the plurality of additional electrode combinations.

14. A method comprising:

selecting a therapy metric from a list of electrode combinations and associated values of at least one therapy metric, the therapy metric comprising a quantifiable result of delivery of stimulation; and

selecting an electrode combination based on the selected therapy metric and the list of electrode combinations and associated values of at least one therapy metric, wherein the values of the therapy metric associated with the electrode combinations are generated by computer modeling of delivery of stimulation via the electrode combinations.

15. The method of claim 14, selecting an electrode combination based on the selected therapy metric and the list of electrode combinations and associated values of at least one therapy metric comprises selecting the electrode combination to optimize the selected therapy metric for a patient.

16. The method of claim 14, further comprising:

delivering stimulation to a patient according to the selected electrode combination;

receiving patient feedback relating to the stimulation delivered via the selected electrode combination; and

selecting an additional electrode combination from the list of electrode combinations based on the patient feedback and the associated values of at least one therapy metric.

17. A computing device comprising:

a memory comprising a plurality of electrode combinations and at least one associated therapy metric value, the therapy metric comprising a quantifiable result of delivery of stimulation, wherein the therapy metric values are generated with experimental computer modeling of delivery of stimulation via the electrode combinations;

a user interface comprising a display and configured to receive input from a user indicating a selected therapy metric; and

a processor that selects an additional electrode combination from among the plurality of electrode combinations stored within the memory based on the selected therapy metric, and presents the additional electrode combination to the user via the display.

18. The computing device of claim 17, wherein the therapy metric includes at least one of:

a dorsal column current;

usage range;

a ratio of dorsal column stimulation threshold voltage to dorsal root stimulation threshold voltage;

a recruitment area;

an area factor;

a maximum output voltage;

or a dorsal column stimulation threshold voltage.

19. The computing device of claim 17, wherein the processor presents a data structure via the display, wherein the data structure includes the plurality of electrode combinations and associated therapy metric values.

20. The computing device of claim 17, wherein the plurality of electrode combinations comprises electrode combinations within a first electrode combination class and a second electrode combination class, wherein the first electrode combination class is characterized by electrodes within one or two electrode columns of an implantable array of electrodes that includes at least three electrode columns, and the second electrode combination class is characterized by electrodes within at least three electrode columns of the implantable array of electrodes.

21. The computing device of claim 17, wherein the plurality of electrode combinations comprises at least one electrode combination from at least five groups of electrode combinations, the at least five groups comprising:

a first group characterized by a rostral anode electrode pattern;

a second group characterized by a caudal anode electrode pattern;

a third group characterized by a first cathode disposed between two anodes, the first cathode and anodes being located in a same column of electrodes;

a fourth group characterized by a second cathode disposed between a first row of anodes and a second row of anodes; and

a fifth group characterized by a transverse electrode combination, wherein anodes of the transverse electrode combination are displaced substantially transversely relative to a third cathode of the transverse electrode combination, and a stimulation field resulting from delivery of stimulation via the transverse combination is oriented substantially transversely relative to a target tissue for the stimulation.

22. The computing device of claim 21, wherein the at least five groups further comprises a sixth group comprising an off-center cathode.

23. The computing device of claim 17, wherein the processor presents an interactive graphical display via the display, the graphical display comprising a first section for receiving user input relating to a type of therapy metric and a second section for outputting at least one of a group of electrode combinations based on the selected type of therapy metric or an electrode combination based on the selected type of therapy metric.

24. The computing device of claim 23, wherein the additional electrode combination optimizes the selected therapy metric within the plurality of electrode combinations.

25. The computing device of claim 17, wherein the processor selects a plurality of additional electrode combinations from among the plurality of electrode combinations and controls the medical device to deliver stimulation to the patient according to each of the plurality of additional electrode combinations and receives patient feedback for each of the plurality of additional electrode combinations.

26. The computing device of claim 17, wherein the processor is configured to control a medical device to deliver electrical stimulation therapy to a patient via a baseline electrode combination and receive user input including patient feedback relating to the baseline electrode combination via the user interface.

27. The computing device of claim 26, wherein processor is configured to receive input from the user selecting the baseline electrode combination via the user interface.

28. The computing device of claim 26, wherein the memory stores the baseline electrode combination.

29. The computing device of claim 26, wherein the processor selects the additional electrode combination based on the selected therapy metric and the patient feedback.

30. A computing device comprising:

a memory comprising a plurality of electrode combinations and at least one associated therapy metric value, the therapy metric comprising a quantifiable result of delivery of stimulation, wherein the therapy metric values are generated with experimental computer modeling of delivery of stimulation via the electrode combinations;

a user interface; and

a processor configured to control a medical device to deliver electrical stimulation therapy to a patient via a baseline electrode combination, receive user input including patient feedback relating to the baseline electrode combination via the user interface, and select an additional electrode combination from within the plurality of electrode combinations based on the patient feedback and the associated therapy metric values.

31. The computing device of claim 30, wherein processor is configured to receive input from the user selecting the baseline electrode combination via the user interface.

32. The computing device of claim 30, wherein memory stores the baseline electrode combination.

33. A computer-readable medium comprising instructions that cause a processor to:

control an electrical stimulator to deliver stimulation therapy to a patient via a baseline electrode combination;

receive patient feedback to the therapy delivery via the baseline electrode combination;

select a therapy metric based on the patient feedback, the therapy metric comprising a quantifiable result of delivery of stimulation; and

select an additional electrode combination based on information associating a plurality of electrode combinations with a respective value of the therapy metric, wherein the values of the therapy metric associated with the electrode combinations are generated by computer modeling of delivery of stimulation via the electrode combinations.

34. The computer-readable medium of claim 33, wherein the instructions cause the processor to select the therapy metric based on the patient feedback by receiving user input selecting the therapy metric.