METHODS FOR TREATING NEUROLOGICAL DISORDERS, INCLUDING NEUROPSYCHIATRIC AND NEUROPSYCHOLOGICAL DISORDERS, AND ASSOCIATED SYSTEMS

• US 20080103548A1
• Filed: 08/02/2007
• Published: 05/01/2008
• Est. Priority Date: 08/02/2006
• Status: Abandoned Application

• Current Assignee: Advanced Neuromodulation Systems Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Northstar Neuroscience, Inc.
• Inventors: Sheffield, W., Sloan, Leif, Fowler, Brad, Gliner, Bradford
• Application Number:
  US11/833,217
• Publication Number:
  US 20080103548A1
• Time in Patent Office: Days
• US Class Current: 607/45
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease

Abstract

Methods for treating neurological disorders, including neuropsychiatric and neuropsychological disorders, and associated systems are disclosed. One such method includes identifying one or more neural populations, including a cortical target neural population, associated with a neurological condition. The method can further include comparing a patient-specific measure of a characteristic parameter for a selected one of the neural populations with a target measure for the same parameter. If the patient-specific measure differs from the target measure by at least a target amount, the method can include selecting an electrical signal polarity, frequency, or both polarity and frequency based at least in part on the difference between the patient-specific measure and the target measure. The method can further include applying electrical signals to the target neural population at the selected signal polarity, frequency, or both polarity and frequency to reduce the difference between the patient-specific measure and the target measure.

Claims

1. A method for treating a patient having a neurological condition, comprising:

identifying one or more neural populations associated with the condition, including a cortical target neural population;

comparing a patient-specific measure of a characteristic parameter for a selected one of the neural populations with a target measure for the parameter; and

if the patient-specific measure differs from the target measure by at least a target amount;

selecting an electrical signal polarity, frequency, or both polarity and frequency based at least in part on the difference between the patient-specific measure and the target measure; and

applying electrical signals to the target neural population at the selected signal polarity, frequency, or both polarity and frequency to reduce the difference between the patient-specific measure and the target measure.

2. The method of claim 1 wherein the target measure corresponds to a measure of the parameter associated with a normal individual.

3. The method of claim 1, wherein identifying one or more neural populations includes identifying a non-cortical neural population associated with the dysfunction.

4. The method of claim 3, further comprising determining the cortical target neural population at least in part on the basis of neural associations between the non-cortical neural population and the cortical target neural population.

5. The method of claim 3 wherein identifying a non-cortical neural population includes identifying a non-cortical neural population that is inhibited by output of the cortical target neural population.

6. The method of claim 3 wherein identifying a non-cortical neural population includes identifying a non-cortical neural population that is excited by output of the cortical target neural population.

7. The method of claim 3 wherein identifying a non-cortical neural population includes identifying a non-cortical neural population that inhibits output of the cortical target neural population.

8. The method of claim 3 wherein identifying a non-cortical neural population includes identifying a non-cortical neural population that excites output of the cortical target neural population.

9. The method of claim 3 wherein identifying a non-cortical neural population includes identifying one or more of the following:

the cingulate cortex, the amygdala, and the limbic cortex.

10. The method of claim 3 wherein identifying a non-cortical neural population includes identifying one or more of the following:

the medial dorsal thalamus and the ventral striatum.

11. The method of claim 1 wherein the target neural population includes at least one of the following:

the prefrontal cortex, the mediolateral frontal cortex, the orbitolateral frontal cortex and the dorsolateral prefrontal cortex.

12. The method of claim 1 wherein comparing a patient-specific measure of a characteristic parameter for a selected one of the neural populations includes comparing a neural activity level of the cortical target neural population with a target neural activity level.

13. The method of claim 1 wherein comparing a patient-specific measure of a characteristic parameter for a selected one of the neural populations includes comparing a neural activity level of a non-cortical neural population with a target neural activity level.

14. The method of claim 1 wherein comparing a patient-specific measure of a characteristic parameter includes comparing a neural output level of the cortical target neural population with a target neural output level.

15. The method of claim 14 wherein the neural output level is below the target neural output level, and wherein selecting an electrical signal polarity includes selecting an anodal polarity.

16. The method of claim 14 wherein the neural output level is above the target neural output level, and wherein selecting an electrical signal polarity includes selecting a cathodal polarity.

17. The method of claim 14 wherein the neural output level is above the target output level, and wherein selecting an electrical signal frequency includes selecting a frequency in the range of from about 0.5 Hz to about 40 Hz.

18. The method of claim 14 wherein the neural output level is below the target output level, and wherein selecting an electrical signal frequency includes selecting a frequency above about 40 Hz.

19. The method of claim 1 wherein comparing a patient-specific measure of a performance parameter includes comparing a neural input level of the selected neural population with a target neural input level.

20. The method of claim 1 wherein comparing a patient-specific measure of a performance parameter includes comparing a neural responsiveness level of the selected neural population with a target neural responsiveness level.

21. The method of claim 20 wherein the neural responsiveness level is above the target neural responsiveness level, and wherein selecting an electrical stimulation polarity includes selecting a cathodal polarity.

22. The method of claim 1 wherein applying electrical signals includes applying anodal signals to hyperpolarize dendrites of the cortical target neural population.

23. The method of claim 22 wherein the electrical signals are first electrical signals, and wherein the method further comprises applying cathodal second electrical signals in addition to the anodal first electrical signals.

24. The method of claim 23 wherein the first electrical signals and the second electrical signals are applied via the same electrical contact implanted beneath the patient'"'"'s skull.

25. The method of claim 23 wherein the first electrical signal is applied via a first electrical contact implanted beneath the patient'"'"'s skull, and the second electrical signals are applied via a second electrical contact implanted beneath the patient'"'"'s skull.

26. The method of claim 23 wherein the first and second electrical signals are applied sequentially.

27. The method of claim 23, further comprising engaging the patient in an adjunctive therapy as part of a treatment regimen that also includes applying the second electrical signals.

28. The method of claim 1, further comprising engaging the patient in an adjunctive therapy as part of a treatment regimen that also includes applying the electrical signals.

29. The method of claim 28 wherein the adjunctive therapy includes psychotherapy.

30. The method of claim 28 wherein the adjunctive therapy includes training the patient to handle stimuli that result in dysfunctional responses.

31. The method of claim 28 wherein the adjunctive therapy includes training directed at improving the patient'"'"'s cognitive processing ability.

32. The method of claim 28 wherein the adjunctive therapy includes administering drugs to the patient.

33. The method of claim 1 wherein applying electrical signals includes applying cathodal signals to depolarize dendrites of the cortical target neural population.

34. The method of claim 1 wherein applying electrical signals includes applying electrical signals from an electrode implanted within the patient'"'"'s skull.

35. The method of claim 1 wherein applying electrical signals includes applying electrical signals at a frequency of from about 0.5 Hz to about 125 Hz.

36. The method of claim 1, further comprising varying a frequency with which the electrical signals are applied.

37. The method of claim 1, further comprising selecting a frequency with which the electrical signals are applied, based at least in part on the selected electrical signal polarity.

38. The method of claim 1 wherein applying electrical signals includes applying electrical signals at a current of from about 0.5 mA to about 15 mA.

39. The method of claim 1 wherein applying electrical signals includes applying electrical signals at a voltage of from about 0.25 volts to about 10 volts.

40. The method of claim 1 wherein applying electrical signals includes applying electrical signals having a first phase pulse width of from about 10 μ

sec to about 500 μ

sec.

41. The method of claim 1 wherein applying electrical signals includes applying electrical signals having a biphasic and/or charge-balanced pulse shape.

42. The method of claim 1 wherein the condition includes a reduced responsiveness to a drug, and wherein applying electrical signals increases the patient'"'"'s responsiveness to the drug.

43. The method of claim 1 wherein identifying one or more neural populations associated with the condition includes identifying neural populations associated with a depressive disorder.

44. The method of claim 1 wherein identifying one or more neural populations associated with the condition includes identifying neural populations associated with a post traumatic stress disorder.

45. The method of claim 44 wherein the post traumatic stress disorder is triggered by a sensory input, and wherein the identifying one or more neural populations includes identifying a corresponding sensory center of the patient'"'"'s brain, and wherein applying electrical signals includes applying inhibitory signals to the sensory center.

46. The method of claim 1 wherein the condition includes bipolar disorder, and wherein the target neural population is a first target neural population, and wherein the method further comprises:

applying the signals to the first target neural population to address the patient'"'"'s manic behavior; and

applying electromagnetic signals to a second target neural population different than the first to address the patient'"'"'s depressive behavior.

47. The method of claim 46, further comprising changing the population to which the signals are directed in automatic response to a patient-initiated request.

48. The method of claim 46, further comprising:

automatically detecting a change in a state of the patient between a depressive state and a manic state; and

in response to automatically detecting the change in state, automatically changing the population to which the signals are directed.

49. The method of claim 46 wherein the disorder includes bipolar disorder, and wherein the signals are applied in accordance with a first set of signal parameters, and wherein the method further comprises:

applying the signals in accordance with the first set of signal parameters when the patient experiences one of a depressive episode and a manic episode; and

in response to a patient-initiated request, presenting to the patient an indication that the electromagnetic signals are applied in accordance with a second set of signal parameters different than the first when the patient experiences the other of a manic episode and a depressive episode, without actually changing the signal parameters.

50. The method of claim 49 wherein the apparent change in signal parameters includes an apparent change in the target neural population to which the signals are directed.

51. The method of claim 1 wherein applying signals includes applying signals on a generally continuous basis for a period of days, weeks or months.

52. The method of claim 1 wherein applying signals includes applying signals at signal levels that are below the threshold level for neural cells at the target neural population.

53. The method of claim 1 wherein the condition includes a depressive disorder, and wherein applying signals includes applying inhibitory signals to a region of the patient'"'"'s brain that is at least partially responsible for the patient'"'"'s emotive responses.

54. The method of claim 1 wherein the condition includes a depressive disorder, and wherein applying signals includes applying excitatory signals to a region of the patient'"'"'s brain at least partially responsible for any of (a) the patient'"'"'s memory, (b) the patient'"'"'s learning, and (c) the patient'"'"'s neurological reward processes.

55. The method of claim 54 wherein applying excitatory signals includes applying excitatory signals to the patient'"'"'s orbitofrontal cortex to address dysfunction of the patient'"'"'s neurological reward processes.

56. The method of claim 1 wherein the condition includes a depressive disorder, and wherein applying signals includes applying first, low frequency signals to the patient'"'"'s right hemisphere to inhibit neural signals at the right hemisphere, and wherein the method further comprises applying second, higher frequency signals to the patient'"'"'s left hemisphere to disinhibit neural signals at the patient'"'"'s left hemisphere.

57. The method of claim 1 wherein the condition includes a post traumatic stress disorder, and wherein applying signals includes (a) applying inhibitory signals to a region of the patient'"'"'s brain that is at least partially responsible for the patient'"'"'s emotive response, (b) applying inhibitory signals to a region of the patient'"'"'s brain that is at least partially responsible for the patient'"'"'s memory, or both (a) and (b).

58. A method for treating a depressed patient, comprising:

detecting a patient-specific characteristic parameter for a selected neural population, the selected neural population including Brodman area 9 or Brodman area 25;

comparing the detected measure of the characteristic parameter with a target measure for the parameter; and

if the detected measure differs from the target measure by at least a target amount;

selecting an electrical signal polarity, frequency, or both polarity and frequency based at least in part on the characteristic parameter; and

applying electrical signals to the patient'"'"'s cortex at Brodman area 9 at the selected signal polarity, frequency, or both polarity and frequency to reduce the difference between the detected measure and the target measure and reduce the depression.

59. The method of claim 58 wherein the characteristic parameter includes an output level of the selected neural population, and wherein the detected level is less than the target level, and wherein the signal polarity is selected to be anodal.

60. The method of claim 58 wherein the characteristic parameter includes a responsiveness level of the neural population, and wherein the detected level is greater than the target level, and wherein the signal polarity is selected to be cathodal.

61. A method for treating a patient having a neurological condition, comprising:

identifying one or more neural populations associated with the condition, including a cortical target neural population;

comparing a patient-specific measure of a characteristic parameter for a selected one of the neural populations with a target measure for the parameter; and

if the patient-specific measure differs from the target measure by at least a target amount;

selecting an electrical signal polarity, frequency, or both polarity and frequency based at least in part on the nature of the condition; and

applying electrical signals to the target neural population at the selected signal polarity, frequency, or both polarity and frequency to reduce the difference between the patient-specific measure and the target measure.

62. The method of claim 61 wherein selecting an electrical signal polarity includes selecting the polarity to be cathodal based on a condition that includes major depressive disorder.

63. The method of claim 61 wherein selecting an electrical signal polarity includes selecting the polarity to be cathodal based on a condition that includes post-traumatic stress disorder.

64. The method of claim 61 wherein selecting an electric signal polarity includes selecting the polarity to be anodal based on a condition that includes depression.

65. A method for treating a patient having a neurological condition, comprising:

identifying one or more neural populations associated with the condition, including a cortical target neural population;

comparing a patient-specific measure of a characteristic parameter for a selected one of the neural populations with a target measure for the parameter; and

if the patient-specific measure differs from the target measure by at least a target amount;

selecting an electrical signal polarity, frequency, or both polarity and frequency based at least in part on (a) the difference between the patient-specific measure and the target measure, (b) the nature of the condition, or (c) both (a) and (b); and

applying electrical signals to the target neural population at the selected signal polarity, frequency, or both polarity and frequency to reduce the difference between the patient-specific measure and the target measure.

66. The method of claim 65 wherein comparing a patient-specific measure of a characteristic parameter for a selected one of the neural populations includes comparing a neural activity level of the cortical target neural population with a target neural activity level.

67. The method of claim 65 wherein comparing a patient-specific measure of a characteristic parameter for a selected one of the neural populations includes comparing a neural activity level of a non-cortical neural population with a target neural activity level.

68. The method of claim 65 wherein comparing a patient-specific measure of a characteristic parameter includes comparing a neural output level of the cortical target neural population with a target neural output level.

69. The method of claim 65, further comprising selecting a frequency with which the electrical signals are applied, based at least in part on the selected electrical signal polarity.

70. The method of claim 65 wherein identifying a cortical target neural population includes identifying a neural population at the DLPFC, wherein comparing a patient-specific measure includes comparing a hypoactive neural output level to a target level, and wherein selecting an electrical signal polarity includes selecting an anodal polarity.

71. A computer-implemented method for treating a patient having a neurological condition, comprising:

receiving an identity of the condition;

receiving an identity of one or more neural populations associated with the condition, including a cortical target neural population;

receiving a patient-specific measure of a characteristic parameter for a selected one of the neural populations;

comparing the patient-specific measure of the characteristic parameter with a target measure for the parameter; and

if the patient-specific measure differs from the target measure by at least a target amount, selecting a signal polarity, frequency, or both polarity and frequency for electrical signals to be applied to the target neural population, based at least in part on the difference between the patient-specific measure and the target measure.

72. The computer-implemented method of claim 71 wherein comparing a patient-specific measure of a characteristic parameter includes comparing a neural output level of the cortical target neural population with a target neural output level.

73. The computer-implemented method of claim 71 wherein the neural output level is below the target neural output level, and wherein selecting an electrical stimulation polarity includes selecting an anodal polarity.

74. The computer-implemented method of claim 71 wherein the neural output level is above the target neural output level, and wherein selecting an electrical stimulation polarity includes selecting a cathodal polarity.

75. An apparatus for effectuating a neural function of a patient comprising:

a response trigger positionable to deliver a stimulus to a patient;

a response detector operatively coupleable to the patient to receive a response indicative of a neuropsychiatric dysfunction from the patient resulting from operation of the response trigger;

a processor coupled to the response detector to receive information corresponding to the patient'"'"'s response, the processor being programmed with instructions to provide signal delivery parameters including signal polarity, frequency, or both, for electromagnetic signals applied to the patient, based at least in part on the information received from the response detector, to alter the patient'"'"'s neural functioning; and

a signal delivery device coupled to the patient to provide electromagnetic signals in accordance with the signal delivery parameters.

76. The system of claim 75 wherein the processor is coupled to the response trigger.

77. The system of claim 75 wherein the processor is programmed with instructions to select a signal delivery polarity based at least in part on the information received from the response detector.

78. The system of claim 75 wherein the processor is programmed with instructions to determine a difference between a target measure for a characteristic of the patient'"'"'s response, and an actual measure for the characteristic of the patient'"'"'s response received from the response detector, and select the signal delivery polarity based at least in part on the difference.

79. The system of claim 75 wherein the processor is programmed with instructions to determine a difference between a target measure for a characteristic of the patient'"'"'s response, and an actual measure for the characteristic of the patient'"'"'s response received from the response detector, and select the signal delivery frequency based at least in part on the difference.