TECHNIQUES FOR SELECTING SIGNAL DELIVERY SITES AND OTHER PARAMETERS FOR TREATING DEPRESSION AND OTHER NEUROLOGICAL DISORDERS, AND ASSOCIATED SYSTEMS AND METHODS

• US 20100036453A1
• Filed: 02/27/2009
• Published: 02/11/2010
• Est. Priority Date: 08/05/2008
• Status: Active Grant

• Current Assignee: Advanced Neuromodulation Systems Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Northstar Neuroscience, Inc.
• Inventors: Kopell, Brian, Hulvershorn, Justin, Gliner, Bradford E.
• Granted Patent: US 8,262,714 B2
• Time in Patent Office: Days
• US Class Current: 607/45
• CPC Class Codes: A61B 5/055 involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
• CPC Class Codes: A61B 5/4064 Evaluating the brain A61B5/031, A61B5/369, A61B5/14553 take precedence
• CPC Class Codes: A61B 6/501 for diagnosis of the head, e.g. neuroimaging or craniography
• CPC Class Codes: A61N 1/0531 Brain cortex electrodes
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: A61N 2/004 specially adapted for a specific therapy

Abstract

The present disclosure is directed generally to techniques for selecting signal delivery sites and other signal delivery parameters for treating depression and other neurological disorders, and associated systems and methods. A method in accordance with a particular embodiment includes obtaining first imaging information corresponding to a first region of a patient'"'"'s brain, the first imaging information being based at least in part on functional characteristics of the first region. The method further includes obtaining second imaging information corresponding to a second region of the patient'"'"'s brain, the second region being a subset of the first region, the second imaging information being based at least in part on functional or structural characteristics of the second region. A target neural population is then selected based at least in part on the second imaging information. The method still further includes applying an electromagnetic signal to the target neural population to improve a patient function.

Claims

1. A method for treating a patient, comprising:

obtaining first imaging information corresponding to a first region of a patient'"'"'s brain, the first imaging information being based at least in part on functional characteristics of the first region;

obtaining second imaging information corresponding to a second region of the patient'"'"'s brain, the second region being a subset of the first region, the second imaging information being based at least in part on functional or structural characteristics of the second region;

selecting a target neural population based at least in part on the second imaging information; and

applying an electromagnetic signal to the target neural population to improve a patient function.

2. The method of claim 1 wherein obtaining second imaging information includes obtaining second imaging information having a higher resolution than the first imaging information.

3. The method of claim 1 wherein obtaining second imaging information includes obtaining at least one of fractional anisotropy information and diffusion tensor imaging information.

4. The method of claim 1 wherein obtaining first imaging information includes obtaining first imaging information using fMRI techniques.

5. The method of claim 4 wherein obtaining first imaging information includes obtaining first information on a real-time or approximately real-time basis, and wherein obtaining the second information includes using spectroscopy techniques while the patient is present.

6. The method of claim 1 wherein obtaining second imaging information includes obtaining information including a thickness value of gray matter in the second region.

7. The method of claim 1 wherein obtaining first imaging information includes obtaining first imaging information of the patient'"'"'s dorsolateral prefrontal cortex.

8. The method of claim 1 wherein obtaining first imaging information includes obtaining first imaging information of the patient'"'"'s middle frontal gyrus.

9. The method of claim 1 wherein obtaining first imaging information includes obtaining first imaging information of the patient'"'"'s superior frontal gyrus.

10. The method of claim 1, further comprising identifying the patient as having depression, and wherein:

obtaining first imaging information includes obtaining functional magnetic resonance imaging information while engaging the patient in a task selected to trigger an emotional response in the patient, the first imaging information having a first resolution; and

wherein

obtaining second imaging information includes obtaining diffusion tensor imaging information having a second resolution greater than the first resolution, and wherein the method further comprises obtaining a fractional anisotropy level for the patient, and, based at least in part on the fractional anisotropy level, determining whether the patient is a suitable candidate for receiving an electromagnetic signal; and

wherein

applying an electromagnetic signal includes applying an electrical signal from an electrode positioned within the patient'"'"'s skull cavity and outside a cortical surface of the patient'"'"'s brain.

11. A method for treating a patient, comprising:

identifying a patient as having depression;

obtaining first imaging information corresponding to a first region of a patient'"'"'s brain, the first imaging information being obtained by functional magnetic resonance imaging techniques, the first region including the patient'"'"'s DLPFC;

obtaining second imaging information corresponding to a second region of the patient'"'"'s brain, the second region being a subset of the first region, the second imaging information being based at least in part on identifying neuronal fibers using diffusion tractography techniques;

selecting a signal delivery site based at least in part on the second imaging information;

implanting at least one electrode proximate to the signal delivery site, within the patient'"'"'s skull and outside a cortical surface of the patient'"'"'s brain; and

reducing or eliminating patient depression by preferentially directing electrical signals from the at least one electrode to the signal delivery site.

12. The method of claim 11 wherein obtaining second imaging information includes obtaining a number of neuronal tracts.

13. The method of claim 11 wherein obtaining second imaging information includes obtaining a density of neuronal tracts.

14. The method of claim 11 wherein selecting a signal delivery site includes selecting a signal delivery site based at least in part on a characteristic of neuronal fibers projecting from the signal delivery site to Brodmann area 10.

15. The method of claim 11 wherein selecting a signal delivery site includes selecting a signal delivery site based at least in part on a characteristic of neuronal fibers projecting from the signal delivery site to Brodmann area 25.

16. The method of claim 11 wherein obtaining first imaging information includes obtaining first imaging information while the patient performs a working memory task.

17. The method of claim 11 wherein obtaining first imaging information includes obtaining first imaging information while the patient is exposed to an emotional trigger stimulus.

18. The method of claim 11, further comprising obtaining a fractional anisotropy level for the patient, and, based at least in part on the fractional anisotropy level, determining whether the patient is a suitable candidate for receiving an electromagnetic signal.

19. The method of claim 18 wherein determining includes determining that the fractional anisotropy level is below an average value for a generalized patient population, and above a threshold value.

20. A method for treating a patient, comprising:

identifying a patient as having depression;

identifying a baseline level of excitability for a first area of the patient'"'"'s brain, the first area not including the patient'"'"'s DLPFC;

for at least one second area of the patient'"'"'s brain at the patient'"'"'s DLPFC;

applying stimulation to the patient'"'"'s DLPFC; and

after applying stimulation to the patient'"'"'s DLPFC, identifying a change in the patient'"'"'s excitability level at the first area; and

based at least in part on identified changes in the patient'"'"'s excitability level at the first area, performing at least one of the following;

identifying the patient as a candidate for cortical signal delivery;

selecting a target neural population to receive cortical signals; and

/or

updating cortical signal delivery parameters.

21. The method of claim 20, further comprising:

implanting at least one electrode proximate to the target site, within a cranial cavity of the patient'"'"'s skull and outside a cortical surface of the patient'"'"'s brain; and

reducing or eliminating patient depression by preferentially directing electrical signals from the at least one electrode to the target site.

22. The method of claim 20, further comprising selecting the first area to include the patient'"'"'s motor cortex.

23. The method of claim 20, further comprising selecting the first area to include the patient'"'"'s sensory cortex.

24. The method of claim 20, wherein applying stimulation to the patient'"'"'s DLPFC includes applying stimulation using rTMS techniques, and wherein identifying a change in the patient'"'"'s excitability level includes using a paired-pulse technique.

25. The method of claim 20, further comprising:

implanting at least one signal delivery electrode at the patient'"'"'s DLPFC;

implanting at least one sensor at a location selected to identify a patient response produced by the first area of the patient'"'"'s brain; and

automatically updating signal delivery parameters provided by the at least one electrode based at least in part on information received from the at least one sensor.

26. A method for treating a patient, comprising:

identifying a patient as having depression;

identifying a baseline level of the patient'"'"'s motor cortex excitability;

for multiple areas of the patient'"'"'s DLPFC;

applying stimulation to the patient'"'"'s DLPFC using rTMS techniques;

after applying stimulation to the patient'"'"'s DLPFC, identifying a change in the patient'"'"'s motor cortex excitability using paired-pulse TMS stimulation;

based at least in part on identified changes in the patient'"'"'s motor cortex excitability for the multiple areas of the patient'"'"'s DLPFC, selecting a signal delivery site;

implanting at least one electrode proximate to the signal delivery site, within a cranial cavity of the patient'"'"'s skull and outside a cortical surface of the patient'"'"'s brain; and

reducing or eliminating patient depression by preferentially directing electrical signals from the at least one electrode to the signal delivery site.

27. The method of claim 26 wherein selecting a signal delivery site includes selecting the signal delivery site to be at an area of the DLPFC that has a greater effect on motor cortex excitability than other areas of the DLPFC.

28. The method of claim 26, wherein applying stimulation to the patient'"'"'s DLPFC includes applying stimulation for a period of about 20 minutes.

29. The method of claim 26, further comprising repeating the process of identifying a change in the patient'"'"'s motor cortex excitability and the process of selecting a signal delivery site during the course of the patient'"'"'s therapy to account for patient adaptation to the electrical signals.