Differential neurostimulation therapy driven by physiological therapy

• US 8,423,145 B2
• Filed: 06/14/2012
• Issued: 04/16/2013
• Est. Priority Date: 04/05/2000
• Status: Expired due to Fees

• Current Assignee: Neuropace Inc.
• Original Assignee: Neuropace Inc.
• Inventors: Pless, Benjamin D., Tcheng, Thomas K.
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US13/523,855
• Publication Number:
  US 20120253417A1
• Time in Patent Office: 306 Days
• Field of Search: 607/45, 607/62
• 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 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, by at least one of a plurality of detection channels, a neurological event of interest in a monitored electrographic signal of a patient, the plurality of detection channels including at least one triggering detection channel that is configured to derive signal timing for delivering a selected therapy when a parameter is detected, the parameter being associated with the triggering detection channel and corresponding to an electrographic measurement, a characteristic of the neurological event of interest being represented by the electrographic measurement;

analyzing the parameter measured by the implantable device;

selecting a therapy from a plurality of therapies based at least in part on the parameter;

determining a timing of the therapy based at least in part on the parameter; and

applying the selected therapy to the patient in synchronization with the neurological event of interest based at least in part on the parameter.

2. The method for treating a neurological disorder of claim 1, further comprising the step of implanting a sensor in the body of the patient, when wherein the parameter is obtained from the sensor.

3. The method for treating a neurological disorder of claim 2, wherein the sensor comprises one of:

an EEG sensor;

an EMG sensor;

an accelerometer;

a motion sensor;

an orientation sensor;

a blood pressure sensor;

a blood flow sensor;

a blood oxygenation sensor;

a drug concentration sensor;

a neurotransmitter concentration sensor; and

a sleep sensor.

4. The method for treating a neurological disorder in a patient of claim 1, further comprising:

transforming the parameter into a numeric quantity; and

selecting the type of therapy based on the numeric quantity.

5. The method for treating a neurological disorder in a patient of claim 4, further comprising:

selecting the type of therapy based on a comparison of the numeric quantity to a predetermined range of values.

6. The method for treating a neurological disorder in a patient of claim 4, wherein the transformed parameter is mapped to a specified distribution.

7. The method for treating a neurological disorder in a patient of claim 1, further comprising:

modifying the therapy based at least in part on the parameter.

8. The method for treating a neurological disorder in a patient of claim 1, further comprising:

repeating the analyzing, selecting, determining, and applying steps.

9. The method for treating a neurological disorder in a patient of claim 1, wherein the type of therapy selected from a plurality of possible therapies comprises an application of electrical brain stimulation.

10. The method for treating a neurological disorder in a patient of claim 9, wherein the electrical brain stimulation comprises responsive stimulation.

11. The method for treating a neurological disorder in a patient of claim 9, wherein the electrical brain stimulation comprises programmed stimulation.

12. The method for treating a neurological disorder in a patient of claim 1, wherein the therapy comprises an application of a therapeutic agent.

13. The method for treating a neurological disorder in a patient of claim 1, wherein the therapy comprises an application of sensory stimulation.

14. The method for treating a neurological disorder in a patient of claim 1, wherein the therapy comprises a patient warning.

15. The method for treating a neurological disorder in a patient of claim 1, wherein the therapy is applied to a focus of epileptic form activity.

16. The method for treating a neurological disorder in a patient of claim 1, wherein the therapy is applied to a predetermined site in the brain of the patient.

17. The method for treating a neurological disorder in a patient of claim 16, 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.

18. The method for treating a neurological disorder in a patient of claim 16, wherein the predetermined site comprises a functional neural pathway.

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

detecting, by at least one of a plurality of detection channels, a neurological event of interest in a monitored electrographic signal of a patient, the plurality of detection channels including at least one triggering detection channel that is configured to derive signal timing for delivering a selected therapy when a parameter is detected, the parameter being associated with the triggering detection channel and corresponding to an electrographic measurement, a characteristic of the neurological event of interest being represented by the electrographic measurement;

analyzing the parameter measured by the implantable device;

selecting a therapy from a plurality of therapies based at least in part on the parameter;

determining a timing of the therapy based at least in part on the parameter; and

applying the selected therapy to the patient in synchronization with the neurological event of interest based at least in part on the parameter.

20. The method for using an implantable device to treat a neurological disorder of claim 19, further comprising:

storing the parameter that comprises the electrographic measurement.