Differential neurostimulation therapy driven by physiological therapy

• US 7,966,073 B2
• Filed: 05/16/2006
• Issued: 06/21/2011
• Est. Priority Date: 04/05/2000
• Status: Expired due to Term

• Current Assignee: Neuropace Inc.
• Original Assignee: Neuropace Inc.
• Inventors: Tcheng, Thomas K., Pless, Benjamin D.
• Primary Examiner(s): Getzow; Scott M
• Application Number:
  US11/436,191
• Publication Number:
  US 20060212093A1
• Time in Patent Office: 1,862 Days
• Field of Search: 600544-546, 607/45
• US Class Current: 607/45
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/0022 Monitoring a patient using a global network, e.g. telephone networks, internet
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/026 Measuring blood flow A61B3/1233, A61B3/1241 take precedence
• CPC Class Codes: A61B 5/076 Permanent implantations telemetry using implanted circuitry A61B5/0031; implanted stimulators for therapy A61N1/3605, A61N1/362, A61N1/372
• CPC Class Codes: A61B 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61B 5/14546 for measuring analytes not otherwise provided for, e.g. ions, cytochromes
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/369 Electroencephalography [EEG] devices for psychotechnics A61B5/16
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4812 Detecting sleep stages or cycles
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/743 Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61N 1/0529 Electrodes for brain stimulation
• CPC Class Codes: A61N 1/0531 Brain cortex electrodes
• CPC Class Codes: A61N 1/0539 Anchoring of brain electrode systems, e.g. within burr hole
• CPC Class Codes: A61N 1/36064 Epilepsy
• CPC Class Codes: A61N 1/36067 : Movement disorders, e.g. tremor or Parkinson disease stimulating motor muscle A61N1/36003
• CPC Class Codes: A61N 1/36078 : Inducing or controlling sleep or relaxation non-implantable stimulator A61M21/00
• CPC Class Codes: A61N 1/36135 : using physiological parameters
• CPC Class Codes: A61N 1/36139 : with automatic adjustment

Abstract

An implantable neurostimulator system adapted to provide therapy for various neurological disorders is capable of varying therapy delivery strategies based on the context, physiological or otherwise, into which the therapy is to be delivered. Responsive and scheduled therapies can be varied depending on various sensor measurements, calculations, inferences, and device states (including elapsed times and times of day) to deliver an appropriate course of therapy under the circumstances.

Claims

1. A method for using an implantable device to treat a neurological disorder in a human patient, comprising:

detecting a neurological event by configuring a plurality of channels in the device to detect a neurological event in a continuously monitored electrographic signal based upon a plurality of detection parameters;

adapting a form of stimulation to treat the neurological event by configuring at least one channel in the device to extract at least one adaptive stimulation parameter from at least one measurement, wherein the at least one adaptive stimulation parameter determines a type of therapy to be delivered to the patient, a plurality of stimulation parameters with which the therapy will be characterizable, and a timing according to which the therapy will be delivered;

selecting the type of therapy from a plurality of possible therapies based at least in part on the at least one adaptive stimulation parameter;

selecting the stimulation parameters based at least in part on the at least one adaptive stimulation parameter;

determining the timing of the therapy delivery based on the at least one adaptive stimulation parameter; and

delivering the selected therapy type according to the stimulation parameters and synchronized with the detected event in accordance with the timing.

2. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the at least one adaptive stimulation parameter comprises a half wave measurement, a line length measurement, or an area measurement of a waveform defined by a plurality of measurements.

3. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the at least one measurement is representative of a system state of the implantable device.

4. The method for using an implantable device to treat a neurological disorder of claim 3, wherein the system state comprises a time of day.

5. The method for using an implantable device to treat a neurological disorder of claim 3, wherein the system state comprises an elapsed time since a system event.

6. The method for using an implantable device to treat a neurological disorder of claim 5, wherein the system event comprises a detected neurological event, an instance of therapy delivery, a mode change, or a scheduled event.

7. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the detection channel in the plurality of detection channels on which the neurological event is detected is a triggering detection channel, and wherein the at least one adaptive stimulation parameter is extracted from a measurement corresponding to an indication of which of the plurality of detection channels is the triggering detection channel.

8. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the at least one adaptive stimulation parameter is extracted from an electrographic measurement.

9. The method for using an implantable device to treat a neurological disorder of claim 8, wherein the electrographic measurement comprises a characteristic of the neurological event.

10. The method for using an implantable device to treat a neurological disorder of claim 9, wherein the detection channel in the plurality of detection channels on which the neurological event is detected is detecting step is performed by a triggering detection channel, and wherein the electrographic measurement is obtained from a data storage area associated with the triggering detection channel.

11. The method for using an implantable device to treat a neurological disorder of claim 9, wherein the detection channel in the plurality of detection channels on which the neurological event is detected is a triggering detection channel, and wherein the electrographic measurement is obtained from a data storage area associated with a detection channel other than the triggering detection channel.

12. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the at least one adaptive stimulation parameter is obtained from a physiological sensor in communication with the implantable device.

13. The method for using an implantable device to treat a neurological disorder of claim 1, further comprising the step of transforming the parameter into a numeric quantity and selecting the type of therapy based on the numeric quantity.

14. The method for using an implantable device to treat a neurological disorder of claim 13, further comprising selecting the type of therapy based on a comparison of the numeric quantity to a predetermined range of values.

15. The method for using an implantable device to treat a neurological disorder of claim 13, wherein the transformed parameter is mapped to a specified distribution.

16. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the type of therapy selected from the plurality of possible therapies comprises an application of electrical brain stimulation.

17. The method for using an implantable device to treat a neurological disorder of claim 16, wherein the electrical brain stimulation comprises responsive stimulation and is delivered in response to detection of the neurological event.

18. The method for using an implantable device to treat a neurological disorder of claim 16, wherein the electrical brain stimulation comprises programmed stimulation.

19. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the type of therapy selected from the plurality of possible therapies comprises an application of a therapeutic agent.

20. The method for using an implantable device to treat a neurological disorder of claim 1, wherein the type of therapy selected from the plurality of possible therapies comprises an application of sensory stimulation.

21. The method for using an implantable device to treat a neurological disorder of claim 16, wherein the therapy is applied to a focus of epileptiform activity.

22. The method for using an implantable device to treat a neurological disorder of claim 16, wherein the therapy is applied to a predetermined site in the brain of the patient.

23. The method for using an implantable device to treat a neurological disorder of claim 22, wherein the predetermined site is located in a target structure selected from a group comprising the caudate nucleus, the subthalamic nucleus, the anterior thalamus, the ventralateral thalamus, the globus pallidus internus, the globus pallidus externus, the substantia nigra, and the neostriatum.

24. The method for using an implantable device to treat a neurological disorder of claim 22, wherein the predetermined site is located in a target structure selected from a group comprising the caudate nucleus, the subthalamic nucleus, the anterior thalamus, the ventralateral thalamus, the globus pallidus internus, the globus pallidus externus, the substantia nigra, and the neostriatum.

25. A method for treating a neurological disorder in a patient, the method comprising the steps of:

implanting a device in the body of the patient;

implanting a plurality of electrodes in the body of the patient, wherein each of the plurality of electrodes is coupled to the device;

detecting a neurological event with the device;

adapting a form of stimulation to treat the neurological event by;

configuring the device to extract at least one adaptive stimulation parameter from a least one measurement acquired from the device,

selecting a type of therapy based at least in part on the at least one adaptive stimulation parameter; and

applying the therapy with the device in response to detection of the neurological event.

26. A method for using an implantable device to treat a neurological disorder, the method comprising the steps of:

detecting a neurological event with a triggering detection channel of the implantable device;

analyzing a parameter observed by the implantable device, wherein the parameter comprises an electrographic measurement representative of a characteristic of the event and obtained from a data storage area associated with the triggering detection channel;

selecting a therapy based at least in part on the parameter; and

delivering the therapy.

27. A method for using an implantable device to treat a neurological disorder, the method comprising the steps of:

detecting a neurological event with a triggering detection channel included in a plurality of detection channels of the implantable device;

analyzing a parameter observed by the implantable device, wherein the parameter is representative of a characteristic of the event and obtained from an indication of which of the plurality of detection channels is the triggering detection channel;

selecting a therapy based at least in part on the parameter; and

delivering the therapy.

28. An implantable neurostimulator for the treatment of a neurological disorder, comprising:

a detection subsystem having a plurality of channels configured to detect a neurological event in a continuously monitored electrographic signal based on a plurality of detection parameters;

an adaptive stimulation subsystem having at least one channel configured to extract at least one adaptive stimulation parameter from at least one measurement, wherein the at least one stimulation parameter determines a type of therapy to be delivered to the patient, a plurality of stimulation parameters with which the therapy will be characterizable, and a timing according to which the therapy will be delivered; and

a therapy subsystem configured to, based at least in part on the at least one adaptive stimulation parameter, select the type of therapy from a plurality of possible therapies, select the stimulation parameters according to which the stimulation will be delivered, synchronize the timing of the delivery of the therapy to the timing of a detected neurological event, and deliver the therapy to the patient.

29. The implantable neurostimulator of claim 28, wherein the neurological event comprises a seizure.

30. The implantable neurostimulator of claim 28, wherein the neurological event comprises a seizure onset.

31. The implantable neurostimulator of claim 28, wherein the at least one measurement from which the at least one adaptive stimulation parameter is extracted corresponds to an event type.

32. The implantable neurostimulator of claim 28, wherein the at least one measurement from which the at least one adaptive stimulation parameter is extracted corresponds to an event location.

33. The implantable neurostimulator of claim 28, wherein the at least one measurement from which the at least one adaptive stimulation parameter is extracted corresponds to a device state of the implantable neurostimulator.

34. The implantable neurostimulator of claim 28, wherein the at least one measurement from which the at least one adaptive stimulation parameter is extracted corresponds to a measurement retrieved from a data storage area associated with the detection subsystem.

35. The implantable neurostimulator of claim 28, further comprising a sensor in communication with the detection subsystem, the sensor configured to obtain an active electrophysiological measurement, and the adaptive stimulation subsystem is further configured to extract the at least one adaptive stimulation parameter from at least one measurement from the sensor.