NERVE STIMULATION TECHNIQUES

• US 20140046407A1
• Filed: 10/21/2013
• Published: 02/13/2014
• Est. Priority Date: 08/31/2001
• Status: Abandoned Application

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: BioControl Medical (B.C.M) Ltd.
• Inventors: BEN-EZRA, Omry, BEN-DAVID, Tamir, COHEN, Ehud, AYAL, Shai
• Application Number:
  US14/059,104
• Publication Number:
  US 20140046407A1
• Time in Patent Office: Days
• US Class Current: 607/62
• CPC Class Codes: A61B 5/1118 Determining activity level
• CPC Class Codes: A61B 5/14503 invasive, e.g. introduced into the body by a catheter or needle or using implanted sensors A61B5/1459, A61B5/1464, A61B5/1473, A61B5/1482, A61B5/14865 take precedence
• CPC Class Codes: A61B 5/14546 for measuring analytes not otherwise provided for, e.g. ions, cytochromes
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61N 1/0556 Cuff electrodes
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/3615 Intensity
• CPC Class Codes: A61N 1/36178 Burst or pulse train parameters
• CPC Class Codes: A61N 1/36189 using modulation techniques

Abstract

An electrode device is configured to be coupled to a parasympathetic site of a subject. A control unit is configured to drive the electrode device to apply a current in bursts of one or more pulses, during “on” periods that alternate with low stimulation periods, wherein at least one of the low stimulation periods immediately following the at least one of the “on” periods has a low stimulation duration equal to at least 50% of the “on” duration; set the current applied on average during the low stimulation periods to be less than 20% of the current applied on average during the “on” periods; and ramp a number of pulses per burst during a commencement of the at least one of the “on” periods and/or a conclusion of the at least one of the “on” periods.

Claims

1-168. -168. (canceled)

169. Apparatus comprising:

an electrode device, configured to be coupled to a site of a subject selected from the group consisting of;

a vagus nerve, an epicardial fat pad, a pulmonary vein, a carotid artery, a carotid sinus, a coronary sinus, a vena cava vein, a right ventricle, a right atrium, and a jugular vein; and

a control unit, configured to;

drive the electrode device to apply to the site a current in bursts of one or more pulses, during “

on”

periods that alternate with low stimulation periods, wherein at least one of the “

on”

periods has an “

on”

duration of at least three seconds, and includes at least three bursts, and wherein at least one of the low stimulation periods immediately following the at least one of the “

on”

periods has a low stimulation duration equal to at least 50% of the “

on”

duration,

set the current applied on average during the low stimulation periods to be less than 20% of the current applied on average during the “

on”

periods, and

during at least one transitional period of the at least one of the “

on”

periods, ramp a number of pulses per burst, the at least one transitional period selected from the group consisting of;

a commencement of the at least one of the “

on”

periods, and a conclusion of the at least one of the “

on”

periods.

172. The apparatus according to claim 169, further comprising a sensor configured to sense a level of copeptin in blood of the subject, wherein the control unit is configured to set a ratio of (a) an average “

on”

duration of the “

on”

periods to (b) an average duration of the low stimulation periods, responsively to the sensed level of copeptin, such that the ratio is positively correlated with the copeptin level.

182. The apparatus according to claim 169, wherein the at least one transitional period includes the commencement of the at least one of the “

on”

periods, and wherein the control unit is configured to ramp up the number of pulses per burst during the commencement.

183. The apparatus according to claim 182, wherein the control unit is configured to set the number of pulses of an initial burst of the at least one of the “

on”

periods and a second burst immediately subsequent to the initial burst to be equal to 1 and 2, respectively.

184. The apparatus according to claim 183, wherein the control unit is configured to set the number of pulses of a third burst of the at least one of the “

on”

periods immediately subsequent to the second burst to be equal to 3.

185. The apparatus according to claim 169, wherein the at least one transitional period includes the conclusion of the at least one of the “

on”

periods, and wherein the control unit is configured to ramp down the number of pulses per burst during the conclusion.

186. The apparatus according to claim 185, wherein the control unit is configured to set the number of pulses of last and penultimate bursts of the at least one of the “

on”

periods to be equal to 1 and 2, respectively.

187. The apparatus according to claim 186, wherein the control unit is configured to set the number of pulses of an antepenultimate burst of the at least one of the “

on”

periods to be equal to 3.

188. The apparatus according to claim 169, wherein the control unit is configured to set the current applied on average during the low stimulation periods to be less than 20% of the current applied on average during the “

on”

periods.

189. The apparatus according to claim 188, wherein the control unit is configured to set the current applied on average during the low stimulation periods to be less than 5% of the current applied on average during the “

on”

periods.

190. The apparatus according to claim 189, wherein the control unit is configured to withhold applying the current during the low stimulation periods.

170-171. -171. (canceled)

173-181. -181. (canceled)

191-268. -268. (canceled)

269. A method comprising:

applying, to a site of a subject, a current in bursts of one or more pulses, during “

on”

periods that alternate with low stimulation periods, at least one of the “

on”

periods having an “

on”

duration of at least three seconds, and including at least three bursts, and at least one of the low stimulation periods immediately following the at least one of the “

on”

periods having a low stimulation duration equal to at least 50% of the “

on”

duration, the site selected from the group consisting of;

a vagus nerve, an epicardial fat pad, a pulmonary vein, a carotid artery, a carotid sinus, a coronary sinus, a vena cava vein, a right ventricle, a right atrium, and a jugular vein;

setting the current applied on average during the low stimulation periods to be less than 20% of the current applied on average during the “

on”

periods; and

during at least one transitional period of the at least one of the “

on”

periods, ramping a number of pulses per burst, the at least one transitional period selected from the group consisting of;

a commencement of the at least one of the “

on”

periods, and a conclusion of the at least one of the “

on”

periods.

272. The method according to claim 269, further comprising sensing a level of copeptin in blood of the subject, wherein applying the current comprises setting a ratio of (a) an average “

on”

duration of the “

on”

periods to (b) an average duration of the low stimulation periods, responsively to the sensed level of copeptin, such that the ratio is positively correlated with the copeptin level.

282. The method according to claim 269, wherein the at least one transitional period includes the commencement of the at least one of the “

on”

periods, and wherein ramping comprises ramping up the number of pulses per burst during the commencement.

283. The method according to claim 282, wherein ramping comprises setting the number of pulses of an initial burst of the at least one of the “

on”

periods and a second burst immediately subsequent to the initial burst to be equal to 1 and 2, respectively.

284. The method according to claim 283, wherein ramping comprises setting the number of pulses of a third burst of the at least one of the “

on”

periods immediately subsequent to the second burst to be equal to 3.

285. The method according to claim 269, wherein the at least one transitional period includes the conclusion of the at least one of the “

on”

periods, and wherein ramping comprises ramping down the number of pulses per burst during the conclusion.

286. The method according to claim 285, wherein ramping comprises setting the number of pulses of last and penultimate bursts of the at least one of the “

on”

periods to be equal to 1 and 2, respectively.

287. The method according to claim 286, wherein ramping comprises setting the number of pulses of an antepenultimate burst of the at least one of the “

on”

periods to be equal to 3.

288. The method according to claim 269, wherein setting the current applied on average during the low stimulation periods comprises setting the current applied on average during the low stimulation periods to be less than 20% of the current applied on average during the “

on”

periods.

289. The method according to claim 288, wherein setting the current applied on average during the low stimulation periods comprises setting the current applied on average during the low stimulation periods to be less than 5% of the current applied on average during the “

on”

periods.

290. The method according to claim 289, wherein setting the current applied on average during the low stimulation periods comprises withholding applying the current during the low stimulation periods.

270-271. -271. (canceled)

273-281. -281. (canceled)

291-460. -460. (canceled)