SYSTEMS AND METHODS FOR SELECTING NEURAL MODULATION CONTACTS FROM AMONG MULTIPLE CONTACTS

• US 20120253422A1
• Filed: 03/30/2011
• Published: 10/04/2012
• Est. Priority Date: 03/30/2011
• Status: Abandoned Application

• Current Assignee: Nevro Corporation
• Original Assignee: Nevro Corporation
• Inventors: Thacker, James R., Parker, Jon
• Application Number:
  US13/076,197
• Publication Number:
  US 20120253422A1
• Time in Patent Office: Days
• US Class Current: 607/46
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36132 using patient feedback
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

The present technology is directed generally to systems and methods for selecting neural modulation contacts from among multiple contacts. A system in accordance with a particular embodiment includes a patient implantable signal delivery system having (n) contacts positioned to deliver therapy signals to a patient, where (n) is greater than three, and an external signal generator coupled to the signal delivery device and having a computer-readable medium containing instructions that, when executed, perform the operations of (a) identifying a contact pair, (b) delivering neural modulation signals to the contact pair, (c) changing one or more of the contacts of the contact pair, and (d) repeating operations (b)-(c) for each of at most (n−1) unique contact pairs.

Claims

1. A method for treating a patient, comprising:

implanting a signal delivery device proximate to a patient'"'"'s spinal cord, the signal delivery device having eight contacts positioned to deliver neural modulation signals to the patient;

during a trial period;

(a) selecting a first contact;

(b) selecting a second contact immediately neighboring the first contact;

(c) delivering neural modulation signals to the patient via the first and second contacts;

(c) evaluating a performance characteristic of the neural modulation signals;

(d) repeating operations (a)-(c) with (i) a different first contact, (ii) a different second contact, or (iii) both a different first contact and a different second contact, until neural modulation signals have been applied to all pairs of neighboring contacts;

(e) without delivering neural modulation signals via any other combinations of contacts, selecting a pair of contacts for extended therapy; and

applying the neural modulation signals to the patient'"'"'s spinal cord via the selected pair of contacts at a frequency of from about 3 kHz to about 50 kHz.

2. The method of claim 1 wherein selecting the first contact includes selecting a distal-most contact of the signal delivery device.

3. The method of claim 1 wherein the neighboring contacts are spaced apart from each other by at least one vertebral body.

4. The method of claim 1 wherein selecting the first contact includes selecting the first contact based at least on part on a vertebral level of the first contact.

5. The method of claim 1 wherein evaluating a performance characteristic includes evaluating an effectiveness with which the neural modulation signals reduce chronic pain in the patient.

6. The method of claim 1 wherein repeating operations (a)-(c) includes repeating operations (a)-(c) with (i) a different first contact, (ii) a different second contact or (iii) both a different first contact and a different second contact, selected in descending order of an expected value of the associated performance characteristic.

7. A method for treating a patient, comprising:

implanting a signal delivery device proximate to a patient'"'"'s spinal cord, the signal delivery device having (n) contacts positioned to deliver neural modulation signals to the patient, where (n) is greater than three;

during a trial period;

(a) for each of at most (n−

1) unique contact pairs, delivering first neural modulation signals to the patient and evaluating a performance characteristic of the neural modulation signals; and

(b) selecting a pair of contacts for further neural modulation, based at least in part on evaluating the performance characteristic of the first neural modulation signals; and

applying the first neural modulation signals or second neural modulation signals to the patient'"'"'s spinal cord via the selected pair of contacts for an additional period of time.

8. The method of claim 7 wherein each of the unique contact pairs includes a first contact and an immediately neighboring second contact.

9. The method of claim 7 wherein at least one of the unique contact pairs includes a first contact and a non-neighboring second contact.

10. The method of claim 7 wherein evaluating includes evaluating for a period of at least one day before delivering the neural modulation signals to a different contact pair.

11. The method of claim 7 wherein (n) is equal to eight.

12. The method of claim 7 wherein immediately neighboring contacts of the signal delivery device are spaced apart by about one vertebral body.

13. The method of claim 7 wherein applying the first or second neural modulation signals includes applying neural modulation signals to address chronic pain in the patient.

14. The method of claim 7 wherein selecting a pair of contacts includes selecting a pair of contacts from a predetermined set of (n−

1) contact pairs.

15. The method of claim 14 wherein the patient is one of multiple patients on whom the operations of implanting, delivering, selecting and applying are performed, and wherein selecting includes selecting from the same predetermined set of (n−

1) contact pairs for each of the multiple patients.

16. A method for treating a patient, comprising:

implanting a signal delivery device proximate to a patient'"'"'s spinal cord, the signal delivery device having (n) contacts positioned to deliver neural modulation signals to the patient, where (n) is greater than three;

during a trial period;

(a) for each of at most (n−

1) unique contact pairs, delivering neural modulation signals to the patient and evaluating a performance characteristic of the neural modulation signals;

(b) based at least in part on evaluating the performance characteristic of the neural modulation signals delivered via the at most (n−

1) unique contact pairs, and before delivering neural modulation signals to any other contact pairs, determining that none of the at most (n−

1) unique contact pairs provides neural modulation with the performance characteristic meeting a performance criterion;

(c) for each of at least one additional contact pair beyond (n−

1), delivering neural modulation signals to the patient and evaluating the performance characteristic of the neural modulation signals; and

(d) selecting a pair of contacts to deliver the neural modulation signals for an extended period of time, based at least in part on evaluating the performance characteristic of the neural modulation signals delivered via the at least one additional contact pair; and

applying the neural modulation signals to the patient'"'"'s spinal cord via the selected pair of contacts for an extended period of time.

17. The method of claim 16 wherein applying neural modulation signals for an extended period of time includes addressing the patient'"'"'s chronic pain.

18. The method of claim 16 wherein the performance criterion includes an effectiveness with which the neural modulation signals reduce chronic pain.

19. The method of claim 16 wherein selecting a pair of contacts includes selecting a pair of contacts from a predetermined set of (n−

1) contact pairs.

20. The method of claim 19 wherein the patient is one of multiple patients on whom the operations of implanting, delivering, selecting and applying are performed, and wherein selecting includes selecting from the same predetermined set of (n−

1) contact pairs for each of the multiple patients, regardless of patient condition.

21. A system for treating a patient, comprising:

a patient implantable signal delivery device having (n) contacts positioned to deliver therapy signals to a patient, where (n) is greater than three; and

an external signal generator coupled to the signal delivery device and having a computer-readable medium containing instructions that, when executed, perform the following operations;

(a) identify a contact pair;

(b) deliver neural modulation signals to the contact pair;

(c) change one or both of the contacts of the contact pair; and

(d) repeat operations (b)-(c) for each of at most (n−

1) unique contact pairs.

22. The system of claim 21, further comprising a percutaneous signal delivery cable connected between the signal delivery device and the signal generator.

23. The system of claim 21, further comprising an implanted pulse generator programmed with instructions to apply neural modulation signals to the patient'"'"'s spinal cord via a target pair of contacts for an extended period of time to address chronic pain in the patient.

24. The system of claim 21 wherein identifying a contact pair includes selecting a contact pair from a predetermined set of unique contact pairs.

25. The system of claim 21 wherein identifying a contact pair includes receiving a user input corresponding to at least one contact of the pair.

26. The system of claim 21 wherein identifying a contact pair includes identifying immediately neighboring contacts.

27. The system of claim 26 wherein changing one or both contacts includes changing from one immediately neighboring contact to another immediately neighboring contact.

28. The system of claim 21 wherein the computer-readable medium contains further instructions that, when executed perform the following operations:

for each of the contact pairs, receive an indication of a performance characteristic of the corresponding neural modulation signals; and

select a pair of contacts for extended neural modulation, based at least in part on the performance characteristic of the neural modulation signals corresponding to each of the contact pairs.

29. A system for treating a patient, comprising:

a computer-readable medium containing instructions that, when executed, perform the following operations;

(a) select a contact pair belonging to a set of (n) contacts carried by a patient-implantable signal delivery device, where n is greater than three;

(b) deliver neural modulation signals to the contact pair;

(c) change the contact pair; and

(d) repeat operations (b)-(c) for each of at most (n−

1) unique contact pairs.

30. The system of claim 29 wherein the computer-readable medium contains instructions that, when executed, perform the following additional operations:

receive an indication of a deficient contact; and

automatically substitute another contact for the deficient contact.

31. The system of claim 29 wherein changing the contact pair includes automatically changing the contact pair.

32. The system of claim 29 wherein the computer-readable medium contains instructions that, when executed, perform the following additional operations:

for each of the contact pairs, automatically receive an indication of a performance characteristic of the corresponding neural modulation signals; and

select a pair of contacts for extended patient therapy, based at least in part on the performance characteristic indications.

33. A system for treating a patient, comprising:

a computer-readable medium containing instructions that, when executed, perform the following operations;

(a) select a contact pair belonging to a set of (n) contacts carried by a patient-implantable signal delivery device, where n is greater than three;

(b) deliver neural modulation signals to the contact pair;

(c) change the contact pair;

(d) repeat operations (b)-(c) for each of at most (n−

1) unique contact pairs;

(e) receive an indication corresponding to none of the at most (n−

1) unique contact pairs providing neural modulation with the performance characteristic meeting a performance criterion; and

(f) for each of at least one additional contact pair beyond (n−

1), deliver neural modulation signals to the patient.

34. The system of claim 33 wherein n is at least eight.

35. The system of claim 33 wherein the computer-readable medium contains instructions, that, when executed, deliver neural modulation signals to at least one of the at least one additional contact pair for an extended period of time.

36. The system of claim 33 wherein the computer-readable medium contains instructions, that, when executed, automatically select each of the at least one additional contact pairs beyond (n−

1).