SYSTEMS AND METHODS FOR SELECTIVELY STIMULATING NERVE ROOTS

• US 20090270935A1
• Filed: 04/28/2009
• Published: 10/29/2009
• Est. Priority Date: 04/29/2008
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Shuros, Allan C., Ruble, Stephen, Hamann, Jason J., Zhao, Weiying
• Granted Patent: US 8,386,045 B2
• Time in Patent Office: Days
• US Class Current: 607/14
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/0553 Paddle shaped electrodes, e.g. for laminotomy
• CPC Class Codes: A61N 1/0556 Cuff electrodes
• CPC Class Codes: A61N 1/36057 adapted for stimulating afferent nerves
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/37241 providing test stimulations

Abstract

Various system embodiments comprise an implantable lead, an implantable housing, a neural stimulation circuit in the housing, and a controller in the housing and connected to the neural stimulation circuit. The lead has a proximal end and a distal end. The distal end is adapted to deliver neural stimulation pulses to the ventral nerve root and the dorsal nerve root. The proximal end of the lead is adapted to connect to the housing. The neural stimulation circuit is adapted to generate neural stimulation pulses to stimulate the ventral nerve root or the dorsal nerve root using the implantable lead. The controller is adapted to control the neural stimulation circuit to deliver a neural stimulation treatment.

Claims

1. An implantable system, comprising:

an implantable lead with a proximal end and a distal end, wherein the distal end is adapted to deliver neural stimulation pulses to a ventral nerve root and a dorsal nerve root;

an implantable housing, wherein the proximal end of the lead is adapted to connect to the housing;

a neural stimulation circuit in the housing, wherein the neural stimulation circuit is adapted to generate neural stimulation pulses to stimulate the ventral nerve root or the dorsal nerve root using the implantable lead; and

a controller in the housing and connected to the neural stimulation circuit, wherein the controller is adapted to control the neural stimulation circuit to deliver a neural stimulation treatment.

2. The system of claim 1, further comprising at least one switch, wherein:

the distal end of the lead includes a plurality of electrodes, and the lead includes a plurality of conductors extending from the proximal end to the distal end and adapted to be used to deliver neural stimulation pulses using selectable combinations of the plurality of electrodes;

the at least one switch is adapted to select the conductors on which the neural stimulation pulses are delivered; and

the controller is adapted to send a signal to the at least one switch to select the combinations of the plurality of electrodes.

3. The system of claim 1, further comprising a feedback circuit adapted to send a feedback signal representative of an efficacy of the neural stimulation pulses to the controller, wherein the controller is adapted to intermittently test the efficacy of the neural stimulation pulses.

4. The system of claim 3, wherein the controller is adapted to adjust at least one of a stimulation vector or a stimulation intensity based on the feedback signal.

5. The system of claim 1, further comprising a feedback circuit adapted to send a feedback signal representative of whether the neural stimulation pulses capture one of the nerve roots or elicit an undesired response, wherein the controller is adapted to adjust stimulation based on the feedback signal.

6. The system of claim 1, further comprising an event circuit adapted to send a feedback signal representative of whether a predetermined event has occurred, wherein the controller is adapted to adjust stimulation based on the feedback signal.

7. The system of claim 6, wherein the event is an arrhythmic event, an ischemic event or experienced pain.

8. The system of claim 1, further comprising a communication module adapted to communicate with another implantable medical device.

9. The system of claim 1, further comprising a communication module adapted to communicate with a portable external device.

10. The system of claim 1, wherein the controller is adapted to control the neural stimulation circuit to deliver the neural stimulation treatment according to a programmed schedule.

11. A system, comprising:

means for stimulating nerve roots including means for stimulating a ventral nerve root and means for stimulating a dorsal nerve root; and

means for independently controlling stimulation of the ventral nerve root and stimulation of the dorsal nerve root.

12. The system of claim 11, wherein the means for stimulating nerve roots includes means for inhibiting neural activity in the nerve roots, and means for increasing neural activity in the nerve roots.

13. A method, comprising:

using a neural stimulation lead fed vertically through a dorsal epidural space of a human and at least partially wrapped around a spinal cord, delivering electrical stimulation pulses to at least one of;

a ventral nerve root to stimulate or inhibit efferent sympathetic activity from the ventral nerve root;

or

a dorsal nerve root to stimulate afferent sympathetic activity from the ventral nerve root.

14. The method of claim 13, wherein delivering electrical stimulation pulses includes delivering electrical stimulation pulses to both the ventral nerve root and to the dorsal nerve root.

15. The method of claim 14, wherein delivering electrical stimulation includes delivering electrical stimulation pulses using at least a first conductor to stimulate the ventral nerve root, and delivering electrical stimulation pulses using at least a second conductor distinct from the first conductor to stimulate the dorsal nerve root.

16. The method of claim 15, further comprising alternating delivery of electrical stimulation to the ventral nerve root and delivery of electrical stimulation to the dorsal nerve root.

17. The method of claim 15, further comprising:

intermittently delivering electrical stimulation pulses to the ventral nerve root;

sensing an event; and

in response to the sensed event,

delivering electrical stimulation pulses to the dorsal nerve root to stimulate afferent sympathetic activity, or

delivering electrical stimulation pulses to the ventral nerve root to inhibit efferent sympathetic activity

18. The method of claim 17, wherein the sensed event is a tachyarrhythmia.

19. The method of claim 13, wherein delivering electrical stimulation pulses includes delivering neural stimulation based on a manual, patient-initiated input.

20. The method of claim 13, further comprising changing a frequency of the electrical stimulation to a first frequency range to inhibit sympathetic activity and to a second frequency range distinct from the first frequency range to stimulate sympathetic activity.

21. The method of claim 13, wherein the neural stimulation lead is at least partially wrapped around a spinal cord proximate to a vertebrae corresponding to at least one of T1, T2, T3, T4 or T5.

22. The method of claim 13, further comprising sensing at least one parameter to verify capture of a desired neural target.

23. The method of claim 22, wherein, if the capture of the desired neural target is not verified, automatically repositioning the neural stimulation field.

24. The method of claim 23, wherein automatically repositioning the neural stimulation field includes automatically changing stimulation vectors.

25. The method of claim 23, wherein automatically repositioning the neural stimulation field includes automatically changing stimulation intensity.