Systems and methods for treating disorders of the central nervous system by modulation of brain networks

• US 8,027,730 B2
• Filed: 10/09/2006
• Issued: 09/27/2011
• Est. Priority Date: 01/21/2005
• Status: Active Grant

• Current Assignee: Michael Sasha John
• Original Assignee: Michael Sasha John
• Inventors: John, Michael Sasha
• Primary Examiner(s): Layno; Carl H.
• Assistant Examiner(s): Bays; Pamela M
• Application Number:
  US11/309,835
• Publication Number:
  US 20070043401A1
• Time in Patent Office: 1,814 Days
• Field of Search: 607/2, 607/3, 607/45, 607/62, 607115-117, 607/139, 600/544, 600/545
• US Class Current: 607/45
• CPC Class Codes: A61N 1/0529 Electrodes for brain stimulation
• CPC Class Codes: A61N 1/0531 Brain cortex electrodes
• CPC Class Codes: A61N 1/0534 Electrodes for deep brain stimulation
• CPC Class Codes: A61N 1/36017 with leads or electrodes penetrating the skin
• CPC Class Codes: A61N 1/36025 for treating a mental or cerebral condition
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

The present invention involves methods and systems for treatment of brain disorders using neuromodulation of brain networks. Treatment of one or more brain networks associated with a brain disorder is realized with a consideration of network dynamics and coupling effects such as indirect stimulation of non-target regions. A brain modulation system (BMS) increases, decreases, or otherwise modulates network regional activity in a differential manner. Therapy may aim to maintain electrical or chemical (relative) characteristics within a specified range. Therapy is initiated/adjusted using network functional imaging data including the use of brain network modeling. Linking rules may guide in the setting and subsequent adjusting of the therapy related to regions of brain network. Novel techniques are described for deterring the emergence of neural adaptation and of unintentional/indirect modulation arising from connectivity between network structures.

Claims

1. A method of treating a brain disorder of a patient comprising:

implanting at least a first and a second electrode in a first and a second region of a brain network associated with the brain disorder of the patient;

implanting an implantable neurostimulation device, having a processor, a sensing subsystem, and a stimulation subsystem, the device configured to operate upon said first and said second electrode to provide at least one of sensing and stimulation;

operating the processor of the implantable neurostimulation device, to implement a therapy program which is configured for providing therapy of the brain network by

operating to control the sensing subsystem to operate upon the at least one of the first and second electrodes in order to sense data,

operating to evaluate at least one measured feature, that is measured from the sensed data of at least two regions of the brain network, in relation to treatment criteria that define at least one network event, in order to detect the at least one type of network event, and

operating to control the stimulation subsystem to adjust stimulation as a function of the detected network event.

2. The method of treating a brain disorder of claim 1 wherein adjusting stimulation as a function of the detected network event comprises adjusting stimulation as a function of a measured feature of the sensed data related to the network event.

3. The method of treating a brain disorder of claim 1 wherein adjusting stimulation includes adjusting stimulation for at least two regions of the brain network.

4. The method of treating a brain disorder of claim 1 wherein providing therapy of the brain network includes providing therapy to at least two regions of the brain network.

5. The method of claim 1 in which the detection of at least one type of network event comprises evaluating a difference between a measured feature of the sensed data from the at least two regions.

6. The method of claim 1 in which adjusting stimulation includes at least one of responsively providing stimulation by adjusting stimulation to be “

on”

for a selected duration in response to the detection of the network event; and

adjusting stimulation according to a characteristic of the network event.

7. The method of claim 1 in which the stimulating in response to the detection of the network event, comprises providing a specified spatial pattern of stimulation, the pattern including at least one region of the network.

8. The method of claim 1 in which the stimulating in response to detection of the network event, comprises selecting and providing a temporal-spatial pattern of stimulation for at least two regions of the network.

9. The method of claim 1 in which the network event is defined at least as a temporal pattern of activity in the sensed data.

10. The method of claim 9 in which the temporal pattern of activity is defined by evaluating the data from a first sensor relative to a second sensor, for at least one time interval.

11. The method of claim 1 in which the network event is defined at least as a spatial pattern of activity.

12. The method of claim 1 in which the network event is defined as a spatial-temporal pattern of activity across at least two different regions of the network.

13. The method of claim 1 in which the network event is defined as at least one measured feature having at least a specified magnitude for each of the first and a second electrode.

14. The method of claim 1 in which _the network event is defined_as at least one measured feature having at least a specified magnitude from data sensed from a first electrode relative to the data sensed from a second electrode.

15. The method of claim 1 in which the at least two brain regions are selected at least in part because these share at least one fiber pathway.

16. The method of claim 15 in which the fiber pathway is selected to be at least one of:

efferent; and

, afferent with respect to at least one brain region of the network.

17. The method of claim 1 in which the therapy program includes controlling the stimulation subsystem to operate upon at least said first and said second electrode to provide stimulation with at least one specified lag, in relation to the detection of the network event.

18. The method of claim 17 in which the specified lag is defined differently for said first and said second electrode.

19. The method of claim 17 in which the specified lag is defined for a first electrode relative to a second electrode in order to produce a spatial-temporal pattern of stimulation.

20. The method of claim 1_in which the detected network event is defined by applying linking rules to the sensed data related to at least two brain regions.

21. The method of claim 20 in which the linking rules are applied to measurements associated with at least one of:

time;

space;

magnitude;

duration of activity;

frequency;

neurotransmitter level;

chemical level;

blood-flow;

inhibition;

activation; and

, volume of activation.

22. The method of claim 3 in which adjusting stimulation includes adjusting a characteristic of stimulation for the at least two regions of the brain network according to linking rules.

23. The method of claim 22 in which the adjusting a characteristic of stimulation according to linking rules uses linking rules that are derived by:

sensing a first sample of baseline activity data for a set of sensors;

stimulating at least one area of the network;

sensing a second sample of sensed data reflective of stimulation related activity;

comparing said first sample of baseline activity data to the second sample of stimulation related activity in order to calculate stimulation effect results; and

, defining linking rules according to the stimulation effect results.

24. The method of claim 23 wherein defining linking rules according to the stimulation effect results comprises defining linking rules to compensate for at least one of the stimulation effect results.

25. The method of treating a brain disorder of claim 1 wherein providing therapy includes stimulating at least two regions of a brain network, and wherein at least a second region is stimulated using a stimulation protocol which has been shown in that patient to compensate for indirect modulation of said second region induced by stimulation of a first region.

26. The method of treating a brain disorder of claim 1 wherein providing therapy includes stimulating at least a first and second region of the brain network such that a characteristic of the first region remains within a specified range relative to the second region.

27. The method of treating a brain disorder of claim 1 wherein providing therapy includes stimulating at least one region of a brain network to modulate the covariance of a first region with at least a second region.

28. The method of treating a brain disorder of claim 1 wherein providing therapy includes stimulating with a stimulation protocol having parameters which were selected based upon a model of network interactions.

29. The method of treating a brain disorder of claim 3 wherein providing therapy includes making adjustments in the treatment protocol and wherein the steps for making the adjustment to the treatment protocol comprise:

stimulating said first brain area according to a first aspect of the treatment protocol;

stimulating said second area according to a second aspect of the treatment protocol;

iteratively modifying said second aspect of the protocol a number of times until a desired therapeutic benefit is obtained; and

, including the use of said first and said second aspect of the treatment protocol in the provision of subsequent treatment therapy.

30. The method of claim 29 further comprising the steps of:

altering the first aspect of the treatment protocol used for stimulating said first brain area if the second aspect of the treatment protocol that is used for stimulating said second area has been iteratively modified the number of times and a desired therapeutic benefit has not been obtained; and

, repeating the steps of the method of claim 29.

31. The method of treating a brain disorder of claim 1 wherein providing therapy includes making adjustments in the treatment protocol and wherein the steps for making the adjustment to the treatment protocol comprise:

sensing sensed data;

processing sensed data to obtain result data;

evaluating the result data to define a current network state;

selecting treatment criteria associated with the current network state;

evaluating treatment by comparing sensed data to treatment criteria; and

, if the treatment criteria fail to be met, providing at least one of;

stimulating; and

, modifying the neurostimulation protocol.

32. The method of treating a brain disorder of claim 1 wherein providing therapy includes stimulating a first region with two different stimulation protocols, wherein the first protocol is designed to modulate both the first region and primarily a second region rather than a third region;

and the second protocol is designed to modulate both the first region and primarily a third region rather than a second region.

33. The method of claim 32 wherein the two different stimulation protocols occur at least one of:

concurrently;

sequentially; and

in a partially overlapping manner.

34. The method of treating a brain disorder of claim 1 wherein providing therapy includes stimulating a brain network with a stimulation protocol which has been selected at least in part based upon classification of a patient, and where the classification comprises a comparison of the patient with past patients.

35. The method of claim 34 wherein said comparison of the patient with past patients comprises a comparison including at least one of:

a response to a drug;

the results of a network model;

the results of a network model for which a specific stimulation protocol was successful;

the results of neuroimaging data;

the results of neuroimaging data collected during an emotionally salient task;

a cluster of behavioral symptoms; and

, one or more psychiatric test battery results.

36. The method of claim 1 wherein adjusting stimulation as a function of the detected network event includes processing sensed data by an algorithm of the therapy program to provide stimulation responsively according to at least one of:

as dictated by a control law;

a comparison with statistical thresholds;

a comparison with statistical thresholds computed from normative data; and

, according to the state of a relevant network.

37. The method of claim 1 wherein providing therapy of a brain network further comprises operating an algorithm which realizes a strategy of sensing and stimulation that decreases the risk of reduced treatment benefit due to adaptation by the network, wherein if evaluation of sensed data indicates that the current stimulation protocol does not meet a treatment criterion then at least one stimulated region of the network is exchanged for stimulating in an alternative region of the network according to a therapy program protocol operated by the therapy program, said alternative region having been previously shown to provide therapeutic benefit.

38. The method of claim 1 wherein at least the first and second brain regions of the brain network are each selected to uniquely be at least one of the following:

network nuclei;

a neural tissue volume associated with a particular function;

neural tissue having a distinct cell type, activation pattern or activity level;

neural tissue volumes which have been identified using functional imaging;

tissues volumes which have been defined as nodes in a network;

a tissue volume which have been identified by lesion studies as being related to network associated with a particular deficit;

an afferent tract; and

, an efferent tract.

39. The method of claim 2 wherein sensing data includes further configuring the electrodes with sensors to obtain sensing at least one of the following types of data:

electrical;

optical;

motion;

muscle activity; and

, chemical.

40. The method of claim 1 wherein providing therapy includes further configuring the device for providing at least one of the following types of stimulation:

electrical;

optical;

chemical; and

, vibratory.

41. The method of claim 1 in which the brain network event which is detected is at least one of:

an event in the contralateral hemisphere to the hemisphere being stimulated; and

, an event in the ipsilateral hemisphere to the hemisphere being stimulated.

42. The method of claim 1_in which the brain network event is defined for a brain network associated primarily with at least one of the following:

a psychiatric disorder;

a sensory disorder;

a movement disorder;

a pain disorder;

an attention disorder;

a mood disorder;

an age-related disorder;

a cardiac disorder;

a sympathetic disorder;

an eating disorder;

a sleep disorder; and

, an epileptic disorder.

43. The method of claim 1 in which the brain network is selected to include structures primarily located within at least one of the following:

the frontal cortex;

the limbic system;

the HPA axis;

a fronto-parietal circuit;

a thalamocortical circuit;

a cortical circuit;

a subcritical circuit;

the subgenucliate area;

the subcallosol area; and

, the cingulate.

44. The method of claim 2 wherein adjusting stimulation in response to detection of the event comprises evaluating the sensed data and stimulating if the evaluation indicates a result that is different than a desired result.

45. The method of treating a brain disorder of claim 1 wherein the therapy further includes using the sensed data to provide stimulation according to at least one control law.

46. The method of treating a brain disorder of claim 1 wherein a network event is defined as an unwanted network state related to a symptom of the disorder for which treatment is being given, and stimulation is provided using a selected therapy protocol which has been previously shown to deter the network from remaining in the unwanted state.

47. An implantable neurostimulation device comprising:

a sensing subsystem including a first and a second electrode configured for sensing data from a first and a second region of a brain network, said brain network being identified as related to a disorder of the central nervous system;

a stimulation subsystem configured for stimulating at least a first region of the brain network,

a processor subsystem configured to operate a therapy program the therapy program configured for providing therapy of the brain network by evaluating sensed data to detect network events and adjusting stimulation as a function of the detected network events

wherein network events are detected by an evaluation protocol which evaluates the sensed data in relation to defined treatment criteria that define at least one network event.

48. The implantable neurostimulation device of claim 47, wherein said therapy program is configured for concurrently providing therapy of at least the first and a second region of a brain network.

49. The therapy program of claim 48 wherein the therapy program is implemented by an algorithm in which a characteristic of therapy related to a first brain region is adjusted based upon therapy related to a second brain region.

50. The therapy program of claim 48 wherein the therapy relies upon a stimulation protocol which is implemented by an algorithm that includes adjusting stimulation provided to a first brain region relative to the therapy provided to a second brain region for at least one of the following characteristics of a stimulation signal:

amplitude;

frequency;

duration;

pulse characteristics; and

, lag between intervals during which stimulation is applied.

51. The implantable neurostimulation device of claim 47, wherein said evaluation protocol is configured for evaluating sensed data related to at least two regions of the brain network.

52. The implantable neurostimulation device of claim 47, wherein said therapy program is implemented by algorithms and circuitry under control of the processor subsystem.

53. The evaluation protocol of claim 51 wherein the evaluation of sensed data includes evaluation of relative levels of activity which have been defined for a network event.

54. The implanted neurostimulation device of claim 51 wherein the evaluation protocol that is configured for evaluating sensed data related to at least two regions of a brain network, is further configured for detecting a network event using the difference between features measured in the sensed data for each of the at least two regions of the brain network.

55. The network event of claim 47 wherein the network event is defined as activity measured between at least two regions of the brain network, having a magnitude that is within a specified range for each of said regions.

56. The network event of claim 47 wherein the network event is defined as activity having a delay within a specified range as measured between at least two regions of the brain network.

57. The network event of claim 47 wherein the network event is defined as activity having a specified direction as measured between at least two regions of the brain network.

58. The network event of claim 47 wherein the network event is defined as activity having a specified amount of coupling within a specified range as measured between at least two regions of the brain network.

59. The network event of claim 47 wherein the network event is defined as activity having a specified correlation within a specified range as measured between at least two regions of the brain network.

60. The evaluation protocol of claim 51 wherein the said evaluating sensed data from a first brain area is evaluated differently if stimulation has occurred in a second brain area.

61. The network event of claim 47 wherein the network event is defined as activity characterized by a specified temporal-spatial distribution as measured across at least two regions of the brain network and at least two intervals in time.

62. The network event of claim 47 wherein the network event is defined as activity with magnitudes within selected ranges for selected sensor combinations, and wherein said ranges may be unique for each sensor.

63. The implantable neurostimulation device of claim 47, in which said modulation of a first brain region of the brain network has been shown to cause modulation of the second brain region, and wherein the therapy program is further configured for treating a brain network by adjusting the treatment to compensate for the modulation of the second brain region.

64. The implantable neurostimulation device of claim 47, wherein the therapy program is further configured for treating a brain network in which the activity of each of said first and second brain regions has been shown to be coupled, by adjusting the treatment to compensate for this coupling.

65. The evaluation protocol of claim 51 which is configured for evaluating sensed data, wherein said evaluating sensed data occurs for at least one of:

an interval;

a set of intervals;

at least one interval defined in relation to a period of stimulation.

66. The implantable neurostimulation device of claim 47 wherein the at least one of the first electrode and second electrode are configured with at least one sensor component that is configured to sense data which is at least one of:

electrical data;

chemical data;

optical data;

a characteristic related to perfusion;

a characteristic related to activation; and

, a characteristic related to coupling between at least two brain regions.

67. The implantable neurostimulation device of claim 47, wherein the stimulation subsystem has a stimulation protocol which is configured to stimulate at least two regions of a brain network in response to the detection of a network event.

68. The implantable neurostimulation device of claim 47, wherein the stimulation protocol is defined to provide stimulation according to characteristics of the network event, said characteristics including at least one of:

the size of the event;

the relative size of the event for at least two regions of the network;

the relative delay of the event between at least two regions of the network;

the spatial distribution of the event across at least two regions of the network;

the pattern of transmission of activity between at least two regions of the network;

temporal-spatial distribution of activity as measured across at least two regions of the brain network; and

, activity sensed for at least a first region of the network that is related to stimulation provided at a second region of the network.

69. The implantable neurostimulation device of claim 47, wherein the processor subsystem is configured to processensed data to provide result data, said processor further configured to control the stimulation provided by the stimulation subsystem according to a stimulation protocol, and wherein the stimulation protocol is implemented by an algorithm so that providing therapy includes providing stimulation according to at least one control law that operates upon the result data.

70. The control law of claim 69, wherein the control law is configured to provide therapy to the first brain region and the second brain region, and wherein the therapy provided to the second brain region is adjusted based upon therapy provided to the first brain region.

71. The control law of claim 69, wherein the control law is configured to provide therapy to at least a first brain region and apply stimulation to a second brain region, according to linking rules.

72. The implantable neurostimulation device of claim 47 further wherein providing therapy to the first region of the brain network is adjusted based upon therapy provided to a second brain region, said therapy to at least one region of the brain network being accomplished by a control law that operates upon the sensed data.

73. The implantable neurostimulation device of claim 47 which also includes a patient programmer which permits at least one of the following:

adjustment of therapy by the patient that is restricted according to linking rules;

selection of a subset of the regions of a brain network to receive therapy;

selection of at least one linking rule to be used during therapy;

adjustment of at least one linking rule within limits set by a physician; and

, performance of a calibration routine to derive a liking rule which is to be used during subsequent therapy.

74. An implantable neurostimulation system including:

a sensing subsystem including a first sensor configured for sensing data from at least one of a first and a second region of a brain network

a stimulation subsystem configured for stimulating at least a first region of a brain network,

a processor subsystem configured to operate a therapy program the therapy program configured for providing therapy of the brain network, the therapy program comprising;

a sensing protocol configured to operate the sensing subsystem and obtain sensed data;

an evaluation protocol configured to detect a network event by evaluating the sensed data in relation to a defined treatment criterion that defines a network event; and

,

a stimulation protocol configured for adjusting stimulation provided by the stimulation subsystem as a function of the detected network event;

wherein the network event is defined using data associated with at least two brain regions of the brain network.