Method For Blocking Activation Of Tissue Or Conduction Of Action Potentials While Other Tissue Is Being Therapeutically Activated

• US 20080058888A1
• Filed: 10/31/2007
• Published: 03/06/2008
• Est. Priority Date: 05/17/2001
• Status: Active Grant

• Current Assignee: Gary King
• Original Assignee: Gary King
• Inventors: King, Gary
• Granted Patent: US 8,165,681 B2
• Time in Patent Office: Days
• US Class Current: 607/40
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/39624 Pain reduction therapy

Abstract

A desired effect is produced by therapeutically activating tissue at a first site within a patient'"'"'s body and a corresponding undesired side effect is reduced by blocking activation of tissue or conduction of action potentials at a second site within the patient'"'"'s body by applying high frequency stimulation and/or direct current pulses at or near the second site. Time-varying DC pulses may be used before or after a high frequency blocking signal. The high frequency stimulation may begin before and continue during the therapeutic activation. The high frequency stimulation may begin with a relatively low amplitude, and the amplitude may be gradually increased. The desired effect may be promotion of micturition or defecation and the undesired side effect may be sphincter contraction.

Claims

1. A method of blocking undesirable side effect activation of electrically excitable tissue, the method comprising the steps of:

therapeutically activating tissue at a first predetermined site within a patients body; and

blocking activation of tissue or conduction of action potentials at a second predetermined site within the patient'"'"'s body by applying high frequency stimulation or one or more direct current pulses or both high frequency stimulation and one or more direct current pulses at or near the second site.

2. The method of claim 1 wherein the undesired effect is muscle contraction.

3. The method of claim 2, wherein:

the desired effect is promotion of micturition; and

the undesired side effect is sphincter contraction.

4. The method of claim 1, wherein:

the first site is selected from the group consisting of the patients bladder dome, sacral roots, and pelvic plexus.

5. The method of claim 1, wherein:

the second site is selected from the group consisting of the patient'"'"'s;

sacral dorsal roots, spinal dorsal columns, conus medullaris, pudendal nerve, hypogastric plexi, and perineal nerve.

6. The method of claim 2, wherein:

the desired effect is promotion of defecation; and

the undesired side effect is selected from the group consisting of;

sphincter contraction, elevated pelvic floor, and sharp ano-rectal angle.

7. The method of claim 6, wherein:

the first site is selected from the group consisting of the patient'"'"'s;

hypogastric plexus, pelvic plexus, nerves to rectum, sacral roots, pelvic plexus, and rectal muscle.

8. The method of claim 7, wherein:

the second site is selected from the group consisting of the patient'"'"'s;

sacral dorsal roots, spinal dorsal columns, conus medullaris, pudendal nerve, and nerves to the patient'"'"'s pelvic floor muscles.

9. The method of claim 2, wherein:

the desired effect is peristalsis of the patient'"'"'s esophagus; and

the undesired side effect is contraction at the patient'"'"'s gastroesphageal sphincter.

10. The method of claim 9, wherein:

the first site is selected from the group consisting of the patient'"'"'s;

esophagus, nerves to the patient'"'"'s esophagus, pharynx, and nerves to the patient'"'"'s pharynx.

11. The method of claim 9, wherein:

the second site is selected from the group consisting of the patient'"'"'s;

hiatal esophagus area near the patient'"'"'s diaphragm and nerves to the patient'"'"'s esophagus.

12. The method of claim 2, wherein:

the desired effect is peristalsis of the patient'"'"'s ureter; and

the undesired side effect is closure of the patient'"'"'s anti-reflux valves near the patient'"'"'s bladder trigone.

13. The method of claim 12, wherein:

the first site is selected from the group consisting of the patient'"'"'s;

renal pelvis and a portion of the patient'"'"'s ureter.

14. The method of claim 12, wherein:

the second site is the base of the patient'"'"'s bladder near an entrance of the ureter hypogastric plexus, and pelvic plexus.

15. The method of claim 2, wherein:

the desired effect is peristalsis of the patient'"'"'s stomach; and

the undesired effect is closure of the patient'"'"'s pyloric sphincter.

16. The method of claim 15, wherein:

the first site is selected from the group consisting of the patient'"'"'s;

stomach wall muscles and the nerves leading to the patient'"'"'s stomach wall muscles.

17. The method of claim 15, wherein:

the second site is selected from the group consisting of the patient'"'"'s;

muscle fibers of the patient'"'"'s pyloric sphincter and nerves to the patient'"'"'s pyloric sphincter.

18. The method of claim 2, wherein:

the desired effect is peristalsis of the patient'"'"'s intestine; and

the undesired effect is closure of the patient'"'"'s ileocecal valve to the patient'"'"'s colon.

19. The method of claim 18, wherein:

the first site is selected from the group consisting of the patient'"'"'s;

intestinal wall smooth muscle, hypogastric plexus, and nerves to the patient'"'"'s hypogastric plexus.

20. The method of claim 18, wherein:

the second site is selected from the group consisting of the patient'"'"'s;

ileocecal valve, mesenteric ganglia, dorsal root, spinal dorsal columns, and splanchnic nerves.

21. The method of claim 2, wherein:

the desired effect is extension of the patient'"'"'s leg;

the first site is the patient'"'"'s femoral nerve to the patient'"'"'s quadriceps femoris;

the undesired side effect is co-contraction of the antagonist muscles; and

the second site is the patient'"'"'s tibial nerve to the patient'"'"'s gastrocnemius muscle.

22. The method of claim 2, wherein:

the desired effect is movement of one of the patient'"'"'s joints in a predetermined direction;

the first site is the patient'"'"'s peripheral nerve;

the undesired side effect is co-contraction of antagonist muscles; and

the second site is the patient'"'"'s nerve branch to an antagonist muscle.

23. The method of claim 2, wherein the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses begin before and continue during the therapeutic activation.

24. The method of claim 2, wherein the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses begin with a relatively low amplitude and the amplitude is gradually increased.

25. The method of claim 2, wherein the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses are terminated by gradually reducing the amplitude of the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses.

26. The method of claim 2, further comprising the steps of:

sensing a state of the tissue at the second site or at a site that is remote from both the first site and the second site; and

in response to the sensing step, adjusting at least one parameter of the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses, the parameter being selected from the group consisting of;

pulse amplitude, pulse width, pulse frequency, pulse duty cycle, pulse polarity, and pulse waveform.

27. The method of claim 2, further comprising:

sensing a state of the tissue at the second site or at a site remote from both the first site and the second site; and

in response to an indication from the sensor that tissue at the second site is activated, applying the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses to the second site.

28. A method of blocking undesirable side effect activation of electrically excitable tissue, wherein such undesirable side effect activation includes muscle contraction, the method comprising the steps of:

therapeutically activating tissue at a first predetermined site within a patient'"'"'s body by applying low frequency stimulation at or near the first predetermined site; and

blocking activation of tissue or conduction of action potentials at a second predetermined site within the patient'"'"'s body by applying high frequency stimulation or one or more direct current pulses or both high frequency stimulation and one or more direct current pulses at or near the second site such that the high frequency stimulation and/or the direct current pulses prevent the low frequency stimulation applied at the first site from activating the electrically excitable tissue, or causing conduction of action potentials, at the second site.

29. The method of claim 28, wherein:

the desired effect is promotion of micturition and the first site is selected from the group consisting of the patient'"'"'s bladder dome, sacral roots, and pelvic plexus; and

the undesired side effect is sphincter contraction and the second site is selected from the group consisting of the patient'"'"'s;

sacral dorsal roots, spinal dorsal columns, conus medullaris, pudendal nerve, hypogastric plexi, and perineal nerve.

30. The method of claim 28, wherein:

the desired effect is promotion of defecation and the first site is selected from the group consisting of the patient'"'"'s;

hypogastric plexus, pelvic plexus, nerves to rectum, sacral roots, pelvic plexus, and rectal muscle; and

the undesired side effect is selected from the group consisting of;

sphincter contraction, elevated pelvic floor, and sharp ano-rectal angle and the second site is selected from the group consisting of the patient'"'"'s;

sacral dorsal roots, spinal dorsal columns, conus medullaris, pudendal nerve, and nerves to the patient'"'"'s pelvic floor muscles.

31. The method of claim 28, wherein:

the desired effect is peristalsis of the patient'"'"'s esophagus and the first site is selected from the group consisting of the patient'"'"'s;

esophagus, nerves to the patient'"'"'s esophagus, pharynx, and nerves to the patient'"'"'s pharynx; and

the undesired side effect is contraction at the patient'"'"'s gastroesphageal sphincter and the second site is selected from the group consisting of the patient'"'"'s;

hiatal esophagus area near the patient'"'"'s diaphragm and nerves to the patient'"'"'s esophagus.

32. The method of claim 28, wherein:

the desired effect is peristalsis of the patient'"'"'s ureter and the first site is selected from the group consisting of the patient'"'"'s;

renal pelvis and a portion of the patient'"'"'s ureter; and

the undesired side effect is closure of the patient'"'"'s anti-reflux valves near the patient'"'"'s bladder trigone and the second site is the base of the patient'"'"'s bladder near an entrance of the ureter, hypogastric plexus, and pelvic plexus.

33. The method of claim 28, wherein:

the desired effect is peristalsis of the patient'"'"'s stomach and the first site is selected from the group consisting of the patient'"'"'s;

stomach wall muscles and the nerves leading to the patient'"'"'s stomach wall muscles; and

the undesired effect is closure of the patient'"'"'s pyloric sphincter and the second site is selected from the group consisting of the patient'"'"'s;

muscle fibers of the patient'"'"'s pyloric sphincter and nerves to the patient'"'"'s pyloric sphincter.

34. The method of claim 28, wherein:

the desired effect is peristalsis of the patient'"'"'s intestine and the first site is selected from the group consisting of the patient'"'"'s;

intestinal wall smooth muscle, hypogastric plexus, and nerves to the patient'"'"'s hypogastric plexus; and

the undesired effect is closure of the patient'"'"'s ileocecal valve to the patient'"'"'s colon and the second site is selected from the group consisting of the patient'"'"'s;

ileocecal valve, mesenteric ganglia, dorsal root, spinal dorsal columns, and splanchnic nerves.

35. The method of claim 28, wherein:

the desired effect is extension of the patient'"'"'s leg;

the first site is the patient'"'"'s femoral nerve to the patient'"'"'s quadriceps femoris;

the undesired side effect is co-contraction of the antagonist muscles; and

the second site is the patient'"'"'s tibial nerve to the patient'"'"'s gastrocnemius muscle.

36. The method of claim 28, wherein:

the desired effect is movement of one of the patient'"'"'s joints in a predetermined direction;

the first site is the patient'"'"'s peripheral nerve;

the undesired side effect is co-contraction of antagonist muscles; and

the second site is the patient'"'"'s nerve branch to an antagonist muscle.

37. The method of claim 28, wherein the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses begin before and continue during the therapeutic activation.

38. The method of claim 28, wherein the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses begin with a relatively low amplitude and the amplitude is gradually increased.

39. The method of claim 28, wherein the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses are terminated by gradually reducing the amplitude of the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses.

40. The method of claim 28, further comprising the steps of:

sensing a state of the tissue at the second site or at a site that is remote from both the first site and the second site; and

in response to the sensing step, adjusting at least one parameter of the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses, the parameter being selected from the group consisting of;

pulse amplitude, pulse width, pulse frequency, pulse duty cycle, pulse polarity, and pulse waveform.

41. The method of claim 40, further comprising:

sensing a state of the tissue at the second site or at a site remote from both the first site and the second site; and

in response to an indication from the sensor that tissue at the second site is activated, applying the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses to the second site.

42. A method of blocking undesirable side effect activation of electrically excitable tissue, wherein such undesirable side effect activation includes muscle contraction, the method comprising the steps of:

implanting a tissue stimulating system in a patient'"'"'s body with a first electrode at or near a first predetermined site within the patient'"'"'s body and a second electrode at or near a second predetermined site within the patient'"'"'s body;

therapeutically activating tissue at the first predetermined site within a patient'"'"'s body by applying low frequency stimulation at or near the first predetermined site with the first electrode; and

blocking activation of tissue or conduction of action potentials at a second predetermined site within the patient'"'"'s body by applying high frequency stimulation or one or more direct current pulses or both high frequency stimulation and one or more direct current pulses at or near the second site with the second electrode such that the high frequency stimulation and/or the direct current pulses prevent the low frequency stimulation applied at the first site from activating the electrically excitable tissue, or causing conduction of action potentials, at the second site.

43. The method of claim 42, wherein the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses begin before and continue during the therapeutic activation.

44. The method of claim 42, wherein the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses begin with a relatively low amplitude and the amplitude is gradually increased.

45. The method of claim 42, wherein the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses are terminated by gradually reducing the amplitude of the high frequency stimulation or the direct current pulses or both the high frequency stimulation and the direct current pulses.