Method and apparatus for controlling neurostimulation according to physical state

• US 8,433,419 B2
• Filed: 10/13/2011
• Issued: 04/30/2013
• Est. Priority Date: 10/13/2010
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Chavan, Abhi V., Maile, Keith R., Ternes, David J., Hincapie Ordonez, Juan Gabriel, Ruble, Stephen, Hamann, Jason J.
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US13/272,786
• Publication Number:
  US 20120095530A1
• Time in Patent Office: 565 Days
• Field of Search: 607/59
• US Class Current: 607/59
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/3614 based on impedance measurement

Abstract

A neurostimulation system senses a signal indicative of a patient'"'"'s physical state such as posture and/or activity level. In various embodiments, a stored value for each of stimulation parameters controlling delivery of neurostimulation is selected according to the patient'"'"'s physical state. In various embodiments, values of the stimulation parameters are approximately optimized for each of a number of different physical states, and are stored for later selection.

Claims

1. A system for delivering neurostimulation to a patient, the system comprising:

a sensor circuit configured to sense a signal indicative of a physical state of the patient and set a current value for a sensor parameter representing the physical state to one of predefined values of the sensor parameter using the sensed signal;

a stimulation output circuit configured to deliver the neuro stimulation; and

a stimulation control circuit configured to control the delivery of the neurostimulation using a plurality of stimulation parameters including one or more sensor-driven parameters, the stimulation control circuit including;

a storage circuit configured to store one or more values for each parameter of the plurality of stimulation parameters, the one or more values including sensor-dependent values for each sensor-driven parameter of the one or more sensor-driven parameters, the sensor-dependent values each corresponding to a value of the predefined values of the sensor parameter; and

a stimulation parameter adjustor configured to determine whether a first stored sensor-dependent value for each parameter of the one or more sensor-driven parameters is currently optimal and select the first stored sensor-dependent value for the each parameter in response to the determination that the first stored sensor-dependent value for the each parameter is currently optimal, the first stored sensor-dependent value corresponding to the current value of the sensor parameter.

2. The system of claim 1, wherein the sensor circuit configured to sense the signal indicative of the physical state of the patient comprises a sensor circuit configured to sense a posture, an activity level, or both the posture and the activity level of the patient.

3. The system of claim 2, wherein the predefined values of the sensor parameter are assigned to predefined levels corresponding to degrees of specificity in describing the physical state, and the stimulation parameter adjustor is configured to select a second sensor-dependent value for the each parameter of the one or more sensor-driven parameters in response to the determination that the first stored sensor-dependent value for the each parameter is not currently optimal, the second stored sensor-dependent value corresponding to a predefined value of the sensor parameter assigned to a level of the predefined levels that is higher than the level of the predefined levels to which the current value of the sensor parameter.

4. The system of claim 2, comprising an implantable device including at least the stimulation circuit, the stimulation controller, and portions of the sensor circuit and an external device configured to be communicatively coupled to the implantable device, the external device including a parameter input device configured to receive the sensor-dependent values of the sensor-driven parameters from a user.

5. The system of claim 2, wherein the stimulation parameter adjustor comprises a titration module configured to perform a titration of the neurostimulation for the current value of the sensor parameter in response to the determination that the first stored sensor-dependent value for the each parameter is not currently optimal.

6. The system of claim 5, wherein the stimulation parameter adjustor is configured to determine whether the first stored sensor-dependent value for the each parameter of the one or more sensor-driven parameters is currently optimal based on whether the titration of the neurostimulation for the current value of the sensor parameter was performed within a specified period of time.

7. The system of claim 5, comprising a monitoring circuit configured to monitor one or more physiological signals each being a function of the sensor parameter and indicative of one or more effects of the neurostimulation, and wherein the titration module is configured to perform the titration of the neurostimulation using the one or more physiological signals.

8. The system of claim 7, wherein the monitoring circuit comprises:

an intended effect monitor configured to produce one or more intended effect parameters each indicative of a degree of an intended effect caused by the neurostimulation using the one or more physiological signals; and

a side effect monitor configured to produce one or more side effect parameters each indicative of a degree of a side effect caused by the neurostimulation using the one or more physiological signals,

and wherein the titration module is configured to approximately optimize the value for the each parameter of the one or more sensor-driven parameters for the current value of the sensor parameter using one or more parameters selected from the one or more side effect parameters and the one or more intended effect parameters.

9. The system of claim 8, wherein the titration module is configured to approximately optimize the value for the each parameter of the one or more sensor-driven parameters for the current value of the sensor parameter until the values for the one or more sensor-driven parameters are currently optimal for all the predefined values of the sensor parameter.

10. The system of claim 5, wherein the titration module is configured to abort the titration of the neurostimulation for the current value of the sensor parameter in response to a change in the current value of the sensor parameter during the titration of the neurostimulation.

11. A method for controlling neurostimulation, the method comprising:

delivering neurostimulation to a patient;

controlling the delivery of the neurostimulation using a plurality of stimulation parameters including one or more sensor-driven parameters;

sensing a signal indicative of a physical state of the patient;

setting a current value of a sensor parameter to a value selected from a plurality of predefined values using the sensed signal;

identifying a first stored sensor-dependent value for each parameter of the one or more sensor-driven parameters for the current value of the sensor parameter;

determining whether the identified first stored sensor-dependent value is currently optimal; and

applying the identified first stored sensor-dependent value in the controlling of the delivery of the neurostimulation in response to a determination that the identified stored sensor-dependent value is currently optimal.

12. The method of claim 11, wherein sensing the signal indicative of the physical state of the patient comprises sensing one or more signals indicative of a posture, an activity level, or both the posture and the activity level of the patient.

13. The method of claim 12, wherein the predefined values of the sensor parameter are assigned to predefined levels corresponding to degrees of specificity in describing the physical state, and comprising applying a second stored sensor-dependent value for the each parameter of the one or more sensor-driven parameters in response to the determination that the identified first stored sensor-dependent value for the each parameter is not currently optimal, the second stored sensor-dependent value corresponding to a predefined value of the sensor parameter assigned to a level of the predefined levels that is higher than the level of the predefined levels to which the current value of the sensor parameter.

14. The method of claim 12, comprising receiving one or more currently optimal values of the sensor-dependent values of the one or more sensor-driven parameters from a user.

15. The method of claim 12, comprising performing a titration of the neurostimulation for the current value of the sensor parameter in response to the determination that the identified first stored sensor-dependent value for the each parameter is not currently optimal.

16. The method of claim 15, comprising initiating the titration of the neurostimulation for the current value of the sensor parameter in response to the determination that the identified first stored sensor-dependent value for the each parameter is not currently optimal and the current value of the sensor parameter has remained unchanged for a specified time interval.

17. The method of claim 16, comprising aborting the titration of the neurostimulation for the current value of the sensor parameter in response to a change in the current value of the sensor parameter during the titration of the neurostimulation.

18. The method of claim 15, wherein performing the titration of the neurostimulation comprises:

monitoring one or more physiological signals each being a function of the sensor parameter;

producing one or more side effect parameters each indicative of a degree of a side effect of the neurostimulation using the one or more physiological signals; and

approximately optimizing the identified first stored sensor-dependent value using at least the one or more side effect parameters.

19. The method of claim 15, wherein performing the titration of the neurostimulation comprises:

monitoring one or more physiological signals each being a function of the sensor parameter;

producing one or more intended effect parameters each indicative of a degree of an intended effect of the neurostimulation using the one or more physiological signals; and

approximately optimizing the identified first stored sensor-dependent value using at least the one or more intended effect parameters.

20. The method of claim 15, wherein performing the titration of the neurostimulation comprises:

monitoring one or more physiological signals each being a function of the sensor parameter;

producing one or more side effect parameters each indicative of a degree of a side effect of the neurostimulation using the one or more physiological signals; and

producing one or more intended effect parameters each indicative of a degree of an intended effect of the neurostimulation using the one or more physiological signals; and

approximately optimizing the identified first stored sensor-dependent value using the one or more side effect parameters and the one or more intended effect parameters.