Method for increasing the therapeutic ratio/usage range in a neurostimulator
First Claim
1. A method for maximizing the therapeutic ratio (TR) of a neurostimulator system, wherein the therapeutic ratio is defined as the ratio of a maximum comfortable stimulation level (numerator) to a just-perceivable stimulation level (denominator), comprising:
- determining the pulse amplitudes of the just-perceptible stimulation level for a patient for at least two fixed pulse durations;
determining the pulse amplitudes of the maximum comfortable stimulation level for the patient for the at least two fixed pulse durations;
determining a fixed duration therapeutic ratio for each of the at least two fixed pulse durations;
determining the pulse durations of the just-perceptible stimulation level for the patient for at least two fixed pulse amplitudes;
determining the pulse durations of the maximum comfortable stimulation level for the patient for the at least two fixed pulse amplitudes;
determining a fixed amplitude therapeutic ratio for each the at least two fixed pulse amplitudes; and
selecting a stimulation level control strategy that maximizes the therapeutic ratio.
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Abstract
A system and method for patient control of the stimulation parameters of a Spinal Cord Stimulation (SCS) system, or other neurostimulation system, provides an increased Therapeutic Ratio (TR). Measurements of the just-perceptible stimulation level and the maximum-comfortable stimulation level are made for at least two values of pulse duration and two values of pulse amplitude. A Therapeutic Ratio is determined for stimulation level control strategies based on fixed pulse duration and variable pulse amplitude, and alternatively for fixed pulse amplitude and variable pulse duration. The control strategy providing the greatest therapeutic ratio is then selected for use by the patient. In an alternative embodiment, the pulse durations at the just-perceptible and maximum-comfortable stimulation levels are measured, and the pulse amplitudes at the just-perceptible and maximum-comfortable stimulation levels are determined using a curve-fitting process. Similarly, the pulse amplitudes may first be measured and the pulse widths determined using a curve-fitting process.
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Citations
16 Claims
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1. A method for maximizing the therapeutic ratio (TR) of a neurostimulator system, wherein the therapeutic ratio is defined as the ratio of a maximum comfortable stimulation level (numerator) to a just-perceivable stimulation level (denominator), comprising:
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determining the pulse amplitudes of the just-perceptible stimulation level for a patient for at least two fixed pulse durations; determining the pulse amplitudes of the maximum comfortable stimulation level for the patient for the at least two fixed pulse durations;
determining a fixed duration therapeutic ratio for each of the at least two fixed pulse durations;determining the pulse durations of the just-perceptible stimulation level for the patient for at least two fixed pulse amplitudes; determining the pulse durations of the maximum comfortable stimulation level for the patient for the at least two fixed pulse amplitudes;
determining a fixed amplitude therapeutic ratio for each the at least two fixed pulse amplitudes; andselecting a stimulation level control strategy that maximizes the therapeutic ratio. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. An implantable neural stimulation system comprising:
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an electrode array; an Implantable Pulse Generator (IPG); an electrical connection between the IPG and the electrode array; and means for controlling the IPG based on a stimulation strategy that produces a large Therapeutic Ratio (TR) wherein the therapeutic ratio is defined as the ratio of a maximum comfortable stimulation level to a just-perceivable stimulation level. - View Dependent Claims (14)
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15. A method for maximizing the therapeutic ratio (TR) of a neurostimulator system, comprising:
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(a) selecting one of at least two fixed pulse durations; (b) performing the following steps; (1) providing neurostimulation to a patient at the selected fixed pulse duration and with a varying pulse amplitude, (2) computing a lower amplitude-duration (AD) product as the product of the selected fixed stimulation duration and the stimulation amplitude at the just-perceptible stimulation level, and (3) computing an upper AD product as the product of the selected fixed stimulation duration and the stimulation amplitude at the maximum comfortable stimulation level; (c) selecting a new one of the at least two fixed pulse durations and repeating steps (b)(1) through (b)(3) for the newly selected fixed pulse duration; (d) selecting the one of the at least two fixed pulse durations which resulted in the smallest lower AD product and the pulse amplitude that resulted in the smallest lower AD product as the minimum stimulation level; (e) selecting the one of the at least two fixed pulse durations which resulted in the greatest upper AD product and the pulse amplitude that resulted in the greatest upper AD product as the maximum stimulation level; and (f) creating a stimulation level control strategy that runs from the minimum stimulation level to the maximum stimulation level. - View Dependent Claims (16)
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Specification