SELECTING THERAPY CYCLE PARAMETERS BASED ON MONITORED BRAIN SIGNAL

• US 20110137371A1
• Filed: 07/26/2010
• Published: 06/09/2011
• Est. Priority Date: 12/03/2009
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Stypulkowski, Paul H., Giftakis, Jonathon E.
• Granted Patent: US 8,914,115 B2
• Time in Patent Office: Days
• US Class Current: 607/45
• CPC Class Codes: A61B 5/291 for electroencephalography [EEG]
• CPC Class Codes: A61B 5/293 Invasive
• CPC Class Codes: A61B 5/4094 Diagnosing or monitoring seizure diseases, e.g. epilepsy
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: G16H 40/63 for local operation

Abstract

Bioelectrical brain signals may be monitored at one more regions of the brain of a patient by a medical device. The monitored bioelectrical signals may be used to select one or more therapy cycle parameters, e.g., on cycle duration and/or off cycle duration, for therapy delivered to treat a patient disorder. In one example, the off cycle duration of a therapy may be selected based on the washout period determined from sensed brain signals of the patient following delivery of therapy during an on cycle. In another example, the on cycle duration and/or off cycle duration of a therapy may be selected to maintain the value of one or more characteristics of a brain signal (e.g., cortical activity) of patient within a threshold range of a target value defined for the characteristic that is associated with effective treatment of the patient disorder.

Claims

1. A method comprising:

monitoring a brain signal of a patient;

selecting at least one parameter of a therapy cycle based on the monitored brain signal of the patient, wherein the at least one parameter of the therapy cycle includes at least one of on cycle duration or off cycle duration; and

controlling delivery of the therapy to the patient according to the at least one selected parameter of the therapy cycle.

2. The method of claim 1, wherein monitoring the brain signal of the patient comprises monitoring the brain signal of the patient during an off cycle of the therapy, and

wherein selecting the at least one parameter of the therapy cycle based on the brain signal of the patient comprises:

comparing the monitored brain signal of the patient during the off cycle to a baseline brain signal; and

automatically adjusting at least one of the off cycle duration or the on cycle duration based on the comparison of the monitored brain signal of the patient to the baseline brain signal.

3. The method of claim 2, wherein comparing the monitored brain signal of the patient during the off cycle of the therapy to the baseline brain signal comprises determining whether a characteristic of the monitored brain signal is within a threshold range of the baseline brain signal.

4. The method of claim 1, further comprising:

controlling delivery of the therapy to the patient according to a first therapy program for a first on cycle duration, wherein monitoring the brain signal of the patient comprises monitoring the brain signal of the patient following the first on cycle duration; and

determining a washout period for the therapy based on the monitored brain signal of the patient following the first on cycle duration,

wherein selecting at least one parameter of the therapy cycle based on the monitored brain signal of the patient comprises selecting at least one parameter of the therapy cycle based on the washout period determined for the therapy.

5. The method of claim 1, further comprising:

controlling delivery of therapy according to a plurality of therapy programs, wherein monitoring the brain signal of the patient comprises monitoring the brain signal after delivery of therapy for each of the therapy programs; and

determining a washout period for each of the therapy programs based on the monitored brain signal,

wherein selecting at least one parameter of the therapy cycle based on the monitored brain signal of the patient comprises selecting the at least one parameter of the therapy cycle for each therapy program based on the washout period for the respective therapy program.

6. The method of claim 1, further comprising:

controlling delivery of therapy to the patient according to a first therapy program defining at least one therapy parameter value during at least one on cycle, wherein monitoring the brain signal of the patient comprises monitoring the brain signal of the patient following the delivery of therapy during the at least one on cycle; and

adjusting the at least one therapy parameter value defined by the therapy program based on the monitored brain signal.

7. The method of claim 1, wherein therapy is delivered to the patient at a first location within a brain of the patient that is different from a second location within the brain in which the brain signal is monitored.

8. The method of claim 1, wherein the monitored brain signal comprises at least one of an electroencephalogram (EEG) signal, an electrocorticogram (ECoG) signal, a local field potential (LFP) sensed from within one or more regions of a brain of the patient or an action potential signal from the brain of the patient.

9. The method of claim 1, wherein the therapy is delivered to at least one of an anterior thalamic nucleus, internal capsule, cingulate, formix, mammillary bodies, mammillothalamic tract, subgenual component of the cingulate cortex, cortex, vagal nerve, or hippocampus of the patient.

10. The method of claim 1, wherein monitoring the brain signal of the patient comprises monitoring the brain signal within one of an anterior thalamic nucleus or hippocampus of a brain of the patient and controlling delivery of the therapy to the patient comprises controlling therapy delivery to the other of the anterior thalamic nucleus or hippocampus of the brain of the patient.

11. The method of claim 1, wherein monitoring the brain signal of the patient comprises monitoring the brain signal within one of an anterior thalamic nucleus or hippocampus of a brain of the patient and controlling delivery of the therapy to the patient comprises controlling therapy delivery to the same of the anterior thalamic nucleus or hippocampus of the brain of the patient.

12. The method of claim 1, wherein selecting the at least one parameter of the therapy cycle comprises:

selecting a first on cycle;

delivering therapy to the patient according to the first on cycle;

selecting a first off cycle based on the delivery of therapy according to the first on cycle;

selecting a second on cycle;

delivering therapy to the patient according to the second on cycle;

selecting a second off cycle based on the delivery of therapy according to the second on cycle; and

selecting a first combination comprising the first on cycle and the first off cycle or a second combination comprising the second on cycle and the second off cycle.

13. The method of claim 1, wherein selecting the at least one parameter of the therapy cycle comprises:

selecting a plurality of on cycles;

delivering therapy to the patient according to each on cycle of the plurality of on cycles;

selecting respective off cycles for each on cycle of the plurality of on cycles based on the delivery of therapy according to each on cycle of the plurality of on cycles; and

selecting at least one of the on cycles of the plurality of on cycles and the respective off cycle as the at least one parameter of the therapy cycle.

14. The method of claim 1, wherein selecting the at least one parameter of the therapy cycle comprises:

selecting an on cycle;

delivering therapy to the patient according to the on cycle and each of a plurality of off cycles; and

selecting the on cycle and at least one off cycle of the plurality of off cycles as the at least one parameter of the therapy cycle based on the delivery of therapy to the patient according to the on cycle and each of a plurality of off cycles.

15. The method of claim 1, further comprising periodically adjusting the at least one selected parameter of the therapy cycle based at least in part on the brain signal monitored following the selection of the at least one parameter.

16. A system comprising:

a sensing module configured to monitor a brain signal of a patient;

a therapy module configured to deliver therapy to the patient; and

a processor configured to select at least one parameter of a therapy cycle based on the monitored brain signal of the patient and control the therapy module to deliver the therapy to the patient according to the at least one selected parameter of the therapy cycle,

wherein the at least one parameter of the therapy cycle includes at least one of an on cycle duration or an off cycle duration.

17. The system of claim 16, wherein the sensing module monitors the brain signal of the patient during an off cycle of the therapy,

wherein the processor selects the at least one parameter of the therapy cycle based on the brain signal of the patient by at least:

comparing the monitored brain signal of the patient during the off cycle to a baseline brain signal; and

automatically adjusting at least one of the off cycle duration or the on cycle duration based on the comparison of the monitored brain signal of the patient to the baseline brain signal.

18. The system of claim 17, wherein the sensing monitors brain signal of the patient during the off cycle of the therapy to a baseline brain signal by at least determining whether a characteristic of the monitored brain signal is within a threshold range of the baseline brain signal.

19. The system of claim 16, wherein the processor is configured to control delivery of the therapy to the patient according to a first therapy program for a first on cycle duration, wherein the sensing module monitors the brain signal of the patient by monitoring the brain signal of the patient following the first on cycle duration, and the processor is configured to determine a washout period for the therapy based on the monitored brain signal of the patient following the first on cycle duration, and

wherein the processor selects at least one parameter of the therapy cycle based on the monitored brain signal of the patient by at least selecting at least one parameter of the therapy cycle based on the washout period determined for the therapy.

20. The system of claim 16, wherein the processor is configured to control delivery of therapy according to a plurality of therapy programs, wherein the sensing module monitors the brain signal of the patient by at least monitoring the brain signal after delivery of therapy for each of the therapy programs, and the processor determines a washout period for each of the therapy programs based on the monitored brain signals, and

wherein the processor is configured to select at least one parameter of the therapy cycle based on the monitored brain signal of the patient by at least selecting the at least one parameter of the therapy cycle for each therapy program based on the brain signal monitored for respective therapy programs.

21. The system of claim 16, wherein the processor controls delivery of therapy to the patient according to a first therapy program defining at least one therapy parameter value during at least one on cycle wherein the sensing module monitors the brain signal of the patient comprises monitoring the brain signal of the patient following the delivery of therapy during the at least one on cycle and the processor adjusts the at least one therapy parameter value defined by the therapy program based on the monitored brain signal.

22. The system of claim 16, wherein the therapy module delivers the therapy to the patient at a first location within a brain of the patient that is different from a second location within the brain in which the brain signal is monitored by the sensing module.

23. The system of claim 16, wherein the monitored brain signal comprises at least one of an electroencephalogram (EEG) signal, an electrocorticogram (ECoG) signal, a local field potential (LFP) sensed from within one or more regions of a brain of the patient or an action potential signal from the brain of the patient.

24. The system of claim 16, wherein the therapy module delivers the therapy to at least one of an anterior thalamic nucleus, internal capsule, cingulate, formix, the mammillary bodies, the mammillothalamic tract, subgenual component of the cingulate cortex, cortex, vagal nerve, or hippocampus of the patient.

25. The system of claim 16, wherein the sensing module monitors the brain signal of the patient by at least monitoring the brain signal within one of an anterior thalamic nucleus or hippocampus of a brain of the patient, and the processor controls delivery of the therapy to the patient by controlling therapy delivery to the other of the anterior thalamic nucleus or hippocampus of the brain of the patient.

26. The system of claim 16, wherein the sensing module monitors the brain signal of the patient by at least monitoring the brain signal within one of an anterior thalamic nucleus or hippocampus of a brain of the patient, and the processor controls delivery of the therapy to the patient by controlling therapy delivery to the same of the anterior thalamic nucleus or hippocampus of the brain of the patient.

27. The system of claim 16, wherein the processor selects the at least one parameter of the therapy cycle by:

selecting a first on cycle;

controlling delivering of therapy to the patient according to the first on cycle;

selecting a first off cycle based on the delivery of therapy according to the first on cycle;

selecting a second on cycle;

controlling delivering of therapy to the patient according to the second on cycle;

selecting a second off cycle based on the delivery of therapy according to the second on cycle; and

selecting a first combination comprising the first on cycle and the first off cycle or a second combination comprising the second on cycle and the second off cycle.

28. The system of claim 16, wherein the processor selects the at least one parameter of the therapy cycle by:

selecting a plurality of on cycles;

controlling delivery of therapy to the patient according to each on cycle of the plurality of on cycles;

selecting respective off cycles for each on cycle of the plurality of on cycles based on the delivery of therapy according to each on cycle of the plurality of on cycles; and

selecting at least one of the on cycles of the plurality of on cycles and the respective off cycle as the at least one parameter of the therapy cycle.

29. The system of claim 16, wherein the processor selects the at least one parameter of the therapy cycle by:

selecting an on cycle;

controlling delivery of therapy to the patient according to the on cycle and each of a plurality of off cycles; and

selecting the on cycle and at least one off cycle of the plurality of off cycles as the at least one parameter of the therapy cycle based on the delivery of therapy to the patient according to the on cycle and each of a plurality of off cycles.

30. The system of claim 16, wherein the processor is configured to periodically adjust the at least one selected parameter of the therapy cycle based at least in part on the brain signal monitored following the selection of the at least one parameter.

31. A system comprising:

means for monitoring a brain signal of a patient;

means for selecting at least one parameter of a therapy cycle on the monitored brain signal of the patient; and

means for controlling delivery of the therapy to the patient according to the at least one selected parameter of the therapy cycle,

wherein the at least one parameter of the therapy cycle includes at least one of an on cycle duration or an off cycle duration.

32. A computer-readable storage medium comprising instructions that cause a programmable processor to:

monitor a brain signal of a patient;

select at least one parameter of a therapy cycle on the monitored brain signal of the patient; and

control delivery of the therapy to the patient according to the at least one selected parameter of the therapy cycle,

wherein the at least one parameter of the therapy cycle includes at least one of an on cycle duration or an off cycle duration.