SELECTIVE NERVE STIMULATION USING PRESYNAPTIC TERMINAL DEPLETION BLOCK

• US 20150202446A1
• Filed: 01/14/2015
• Published: 07/23/2015
• Est. Priority Date: 01/17/2014
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Franke, Manfred, Ternes, David J., Hincapie Ordonez, Juan Gabriel, Ruble, Stephen B., Hamann, Jason J.
• Granted Patent: US 10,413,731 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00595 Cauterization
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/0558 Anchoring or fixation means therefor
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/36067 Movement disorders, e.g. tremor or Parkinson disease stimulating motor muscle A61N1/36003
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/3611 Respiration control stimulating respiratory organs A61N1/3601
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/36128 Control systems
• CPC Class Codes: A61N 1/36132 using patient feedback
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/36171 Frequency
• CPC Class Codes: A61N 1/37205 Microstimulators, e.g. implantable through a cannula
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3787 from an external energy source

Abstract

An example of a system may include a stimulator and at least one controller. The stimulator may be configured to deliver nerve stimulation to capture a first set of axons in a nerve and to deliver depletion block stimulation to capture a second set of axons in the nerve, where the second set is a subset of the first. The depletion block stimulation may include a series of pulses at a depletion pulse frequency within a range between about 100 Hz to about 1 kHz, and the nerve stimulation may include a series of pulses at a stimulation pulse frequency within a range of about 0.25 Hz to about 50 Hz. At least a portion of the nerve stimulation and at least a portion of the depletion block stimulation may be delivered to be effective in providing a nerve block while delivering nerve stimulation.

Claims

1. A system, comprising:

a stimulator configured to deliver nerve stimulation to capture a first set of axons in a nerve and to deliver depletion block stimulation to capture a second set of axons in the nerve, the second set of axons being a subset of the first set of axons, the depletion block stimulation including a series of pulses at a depletion pulse frequency within a range between about 100 Hz to about 1 kHz, the nerve stimulation including a series of pulses at a stimulation pulse frequency within a range of 0.25 Hz to 50 Hz; and

at least one controller configured to communicate with the stimulator and control the depletion block stimulation and the nerve stimulation, at least a portion of the nerve stimulation and at least a portion of the depletion block stimulation being delivered to be effective in providing a nerve block while delivering nerve stimulation.

2. The system of claim 1, wherein the stimulator is configured to deliver neural stimulation to the nerve using a first electrode and a second electrode, and to deliver depletion block stimulation to the nerve using the first electrode and the second electrode.

3. The system of claim 1, wherein the stimulator is configured to deliver neural stimulation to the nerve using a first electrode and a second electrode, and to deliver depletion block stimulation to the nerve using a third electrode and a fourth electrode.

4. The system of claim 1, wherein the stimulator is configured to deliver neural stimulation to the nerve using a first electrode and a second electrode, and to deliver depletion block stimulation to the nerve using the second electrode and a third electrode.

5. The system of claim 1, wherein the subset of the first set, which forms the second set, has a lower stimulation threshold than a remainder of the first set.

6. The system of claim 1, wherein the controller is configured to:

control the depletion block stimulation and the nerve stimulation to provide intermittent neural stimulation with alternating stimulation ON periods and stimulation OFF periods;

deliver the nerve stimulation to capture the first set of axons in the nerve during stimulation ON periods and not during stimulation OFF periods; and

deliver depletion block stimulation to capture the second set of axons in the nerve during the stimulation ON periods and not during the stimulation OFF periods.

7. The system of claim 1, wherein the controller is configured to initiate delivery of the depletion block stimulation before initiating delivery of the nerve stimulation.

8. The system of claim 7, wherein the stimulation ON periods are for a time period within a range between a ¼

of a second and 150 seconds, and the stimulation OFF periods are for a time period between 1 second and 150 seconds.

9. The system of claim 6, further comprising a physiologic sensor configured to sense a physiologic parameter, the controller operably connected to the sensor to detect a physiologic event from the sensed physiologic parameter, the controller further configured to trigger timing for the intermittent stimulation based on the detected physiologic event.

10. The system of claim 6, wherein the neural stimulator is configured to deliver stimulation to a cervical region of a vagus nerve, the second set of axons includes A-type motor fibers.

11. The system of claim 10, wherein at least some of the axons in the first set of axons are B-type fibers, and the second set excludes at least some the B-type fibers in the first set.

12. The system of claim 1, wherein the controller is configured to implement a programmed titration routine, and in implementing the programmed titration routine the controller is configured to interrupt delivery of the stimulation to the nerve, adjust at least one of the nerve stimulation or the depletion stimulation during the interruption, and reinstate delivery of the stimulation to the nerve.

13. The system of claim 12, wherein in adjusting the at least one of the nerve stimulation or the depletion stimulation the controller is configured to adjust at least one of an amplitude of the nerve stimulation or an amplitude of the depletion stimulation.

14. The system of claim 12, wherein in adjusting the at least one of the nerve stimulation or the depletion stimulation the controller is configured to adjust at least one of a pulse width for the series of pulses in the nerve stimulation or a pulse width for the series of pulses in the depletion stimulation.

15. A method, comprising:

delivering stimulation to a nerve having a plurality of axons, wherein delivering stimulation includes;

delivering nerve stimulation configured to capture a first set of axons in the nerve, wherein delivering nerve stimulation includes delivering a series of electrical pulses at a stimulation pulse frequency where the stimulation pulse frequency is between the range of about 0.25 Hz and about 50 Hz, wherein the delivered nerve stimulation is capable of inducing action potentials in the first set of axons; and

delivering a presynaptic depletion block stimulation configured to capture a second set of axons in the nerve, the second set being a subset of the first set, wherein delivering the presynaptic depletion block stimulation includes delivering a series of electrical pulses at a depletion pulse frequency, the depletion pulse frequency being within a range between about 100 Hz to about 1 kHz,

wherein at least a portion of the nerve stimulation and at least a portion of the depletion block stimulation are delivered to be effective in providing a nerve block while delivering nerve stimulation.

16. The method of claim 15, wherein the subset of the first set, which forms the second set, has a lower stimulation threshold than a remainder of the first set.

17. The method of claim 15, wherein delivering nerve stimulation includes delivering stimulation at an amplitude higher than the depletion stimulation.

18. The method of claim 15, wherein delivering stimulation to the nerve includes delivering intermittent neural stimulation with alternating stimulation ON periods and stimulation OFF periods, wherein:

delivering nerve stimulation configured to capture the first set of axons in the nerve includes delivering the series of electrical pulses at the stimulation pulse frequency during stimulation ON periods and not during stimulation OFF periods; and

delivering the presynaptic depletion block stimulation includes delivering the series of electrical pulses at the depletion pulse frequency during the stimulation ON periods and not during the stimulation OFF periods.

19. The method of claim 15, wherein delivering the presynaptic depletion block and delivering the nerve stimulation includes initiating delivery of the presynaptic depletion block before initiating delivery of the nerve stimulation.

20. The method of claim 15, wherein delivering stimulation to the nerve includes delivering stimulation to a cervical region of a vagus nerve, the second set of axons includes A-type motor fibers.