Identification of electrode combination for efficacious electrical stimulation therapy

• US 8,918,184 B1
• Filed: 03/12/2013
• Issued: 12/23/2014
• Est. Priority Date: 03/12/2013
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Torgerson, Nathan A., Davenport, Lynn A.
• Primary Examiner(s): VOORHEES, CATHERINE M
• Application Number:
  US13/796,529
• Time in Patent Office: 651 Days
• Field of Search: 607/59, 607 39- 42, 607 45- 46, 607/48, 607/51, 607 72- 74
• US Class Current: 607/59
• CPC Class Codes: A61N 1/36017 with leads or electrodes penetrating the skin
• CPC Class Codes: A61N 1/3605 Implantable neurostimulators for stimulating central or peripheral nerve system
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/37241 providing test stimulations
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/3727 characterised by the modulation technique

Abstract

One or more efficacious electrode combinations for delivering electrical stimulation therapy to a patient may be selected based on the delivery of electrical stimulation to the patient via a predefined set of test electrode combinations in a predetermined order. In some examples, the electrode combinations of the set are arranged in the predetermined order such that adjacent electrode combinations in the order include at least one shared anode electrode or cathode electrode. In addition, the electrode combinations in the predetermined order may define a predetermined sequence of electrode patterns, each electrode pattern defining a relative arrangement between one or more anodes and one or more cathodes of the respective electrode pattern. In some examples, the transition between electrode combinations in the predefined set is achieved by incrementally adjusting at least one of anodic amplitudes assigned to active anode electrodes or cathodic amplitudes assigned to active cathode electrodes.

Claims

1. A method comprising:

with one or more processors, selecting a predefined set of electrode combinations, wherein each electrode combination includes one or more anode electrodes, one or more cathode electrodes, or both one or more anode electrodes and one or more cathode electrodes, a relative arrangement of the one or more anodes and the one or more cathodes defining an electrode pattern of the electrode combination; and

with the one or more processors, automatically controlling a medical device to deliver, in a predetermined order, electrical stimulation to a patient via each electrode combination of the predefined set of electrode combinations, each pair of adjacent electrode combinations in the predetermined order including at least one same anode electrode or cathode electrode, wherein the electrode combinations in the predetermined order define a predetermined sequence of electrode patterns.

2. The method of claim 1, further comprising selecting an electrode combination from the predefined set of electrode combinations based on the delivery of the electrical stimulation by the medical device.

3. The method of claim 1, wherein at least one electrode pattern appears multiple times at different positions in the sequence.

4. The method of claim 1, wherein the predetermined sequence of electrode patterns includes a repeating sequence of the electrode patterns.

5. The method of claim 1, wherein each pattern includes anodes and cathodes uninterrupted by inactive electrodes.

6. The method of claim 1, wherein each pair of adjacent electrode combinations in the predetermined order include at least one same anode electrode and at least one same cathode electrode.

7. The method of claim 1, wherein the electrode combinations are defined by subsets of electrodes of an electrical stimulation lead, wherein controlling the medical device to deliver, in the predetermined order, electrical stimulation to the patient via each electrode combination of the predefined set of electrode combinations comprises controlling the medical device to deliver electrical stimulation to the patient via at least two electrode patterns at two different axial positions along the lead.

8. The method of claim 1, wherein the electrode combinations are defined by subsets of electrodes of an electrical stimulation lead, wherein the electrode combinations are arranged in the predetermined order such that electrode combinations are propagated down the lead.

9. The method of claim 1, further comprising:

receiving a first user input;

controlling the medical device to one of pause delivering electrical stimulation or continue delivering electrical stimulation according to a currently selected electrode combination of the predefined set of electrode combinations in response to receiving the first user input;

subsequently receiving a second user input; and

controlling the medical device to transition from the currently selected electrode combination to a next electrode combination in the predetermined order in response to receiving the second user input.

10. The method of claim 1, further comprising:

receiving user input selecting a starting electrode;

selecting a starting electrode combination from the predefined set of electrode combinations based on the starting electrode selected by the user; and

controlling the medical device to deliver electrical stimulation to the patient via the starting electrode combination and electrode combinations of the predefined set of electrode combinations following the starting electrode combination in the predetermined order.

11. The method of claim 1, further comprising:

receiving user input; and

modifying the predefined set of electrode combinations in response to receiving the user input.

12. The method of claim 11, wherein modifying the predefined set of electrode combinations includes removing at least one electrode combination from the predefined set of electrode combinations.

13. The method of claim 1, wherein the electrode patterns include a first simple bipole, a second simple bipole, a guarded cathode, and a guarded double cathode.

14. The method of claim 1, wherein controlling the medical device to deliver electrical stimulation to the patient via the predefined set of electrode combinations in the predetermined order comprises controlling the medical device to transition between a first electrode combination and a second electrode combination adjacent to the first electrode combination in the predetermined order by at least incrementally adjusting at least one of anodic amplitudes assigned to anodes of the first electrode combination or cathodic amplitudes assigned to cathodes of the first electrode combination.

15. The method of claim 1, wherein controlling the medical device to deliver, in the predetermined order, electrical stimulation to the patient via each electrode combination of the predefined set of electrode combinations comprises controlling the medical device to deliver electrical stimulation to the patient according to a predefined schedule of amplitude adjustments, the predefined schedule including a plurality of steps and, for each step, active electrodes for delivery of electrical stimulation therapy, and, for each of the active electrodes, an anodic amplitude setting or a cathodic amplitude setting.

16. The method of claim 15, wherein controlling the medical device according to the predefined schedule of amplitude adjustments comprises controlling the medical device to transition between subsequent steps of the predefined schedule by at least increasing or decreasing at least one of the anodic amplitude or the cathodic amplitude for at least one active electrode by an amplitude adjustment increment, wherein the amplitude adjustment increments are substantially the same between subsequent steps of the predefined schedule.

17. The method of claim 15, wherein controlling the medical device according to the predefined schedule of amplitude adjustments comprises controlling the medical device to transition between subsequent steps of the predefined schedule by at least increasing or decreasing at least one of the anodic amplitude or the cathodic amplitude for at least one active electrode by an amplitude adjustment increment, wherein the predefined schedule includes at least two different amplitude adjustment increments such that controlling the medical device to transition between subsequent steps of the predefined schedule comprises increasing or decreasing at least one of the anodic amplitude or the cathodic amplitude for at least one active electrode by one amplitude adjustment increment of the at least two different amplitude adjustment increments.

18. The method of claim 17, wherein the predefined schedule includes two different amplitude adjustment increments, wherein increasing or decreasing the at least one of the anodic amplitude or the cathodic amplitude for the at least one active electrode is by an amplitude adjustment increment of the two different amplitude adjustment increments that alternates between subsequent steps of the predefined schedule.

19. The method of claim 1, wherein controlling the medical device to deliver, in the predetermined order, electrical stimulation to the patient via each electrode combination of the predefined set of electrode combinations comprises controlling the medical device to deliver electrical stimulation to the patient via at least one electrode combination of the predefined set of electrode combinations with at least one of a plurality of different anodic amplitude settings or a plurality of different cathodic amplitude settings.

20. A system comprising:

a medical device

a plurality of electrodes; and

a processor configured to control the medical device to deliver, in a predetermined order, electrical stimulation to a patient via each electrode combination of a predefined set of electrode combinations, wherein the electrode combinations of the predefined set of electrode combinations are defined by subsets of electrodes of the plurality of electrodes, and wherein each electrode combination includes one or more anode electrodes, one or more cathode electrodes, or both one or more anode electrodes and one or more cathode electrodes, a relative arrangement of the one or more anodes and the one or more cathodes defining an electrode pattern of the electrode combination, each pair of adjacent electrode combinations in the predetermined order including at least one same anode electrode or cathode electrode, wherein the electrode combinations in the predetermined order define a predetermined sequence of electrode patterns.

21. The system of claim 20, wherein the processor is configured to select an electrode combination from the predefined set of electrode combinations based on the delivery of the electrical stimulation by the medical device.

22. The system of claim 20, wherein at least one electrode pattern appears multiple times at different positions in the sequence.

23. The system of claim 20, wherein each pair of adjacent electrode combinations in the predetermined order include at least one same anode electrode and at least one same cathode electrode.

24. The system of claim 20, further comprising a memory that stores the predefined set of electrode combinations in the predetermined order.

25. The system of claim 20, wherein the medical device comprises the processor.

26. The system of claim 20, further comprising a medical device programmer that comprises the processor.

27. The system of claim 20, wherein the predetermined sequence of electrode patterns includes a repeating sequence of electrode patterns.

28. The system of claim 20, wherein each pattern includes anodes and cathodes uninterrupted by inactive electrodes.

29. The system of claim 20, further comprising an electrical stimulation lead comprising the plurality of electrodes, the electrode combinations being defined by subsets of electrodes of the plurality of electrodes, wherein the processor is configured to control the medical device to deliver, in the predetermined order, electrical stimulation to the patient via each electrode combination of the predefined set of electrode combinations by at least controlling the medical device to deliver electrical stimulation to the patient via at least two electrode patterns at two different axial positions along the lead.

30. The system of claim 20, further comprising an electrical stimulation lead comprising the plurality of electrodes, the electrode combinations being defined by subsets of electrodes of the plurality of electrodes, wherein the electrode combinations are arranged in the predetermined order such that electrode combinations are transitioned down the lead.

31. The system of claim 20, further comprising a user interface, wherein the processor is configured to receive a first user input via the user interface, control the medical device to one of pause electrical stimulation or continue delivering electrical stimulation according to a currently selected electrode combination of the predefined set of electrode combinations in response to receiving the first user input, subsequently receive a second user input, and control the medical device to transition from the currently selected electrode combination to a next electrode combination in the predetermined order in response to receiving the second user input.

32. The system of claim 20, further comprising a user interface, wherein the processor is configured to receive user input selecting a starting electrode via the user interface, select a starting electrode combination from the predefined set of electrode combinations based on the starting electrode selected by the user, and control the medical device to deliver, in the predetermined order, electrical stimulation to the patient via the starting electrode combination and each electrode combination of the predefined set of electrode combinations following the starting electrode combination in the predetermined order.

33. The system of claim 20, further comprising a user interface, wherein the processor is configured to receive user input via the user interface and modify the predefined set of electrode combinations in response to receiving the user input.

34. The system of claim 33, wherein the processor is configured to modify the predefined set of electrode combinations by at least removing at least one electrode combination from the predefined set of electrode combinations.

35. The system of claim 20, wherein the electrode patterns include a first simple bipole, a second simple bipole, a guarded cathode, and a guarded double cathode.

36. The system of claim 20, wherein the processor is configured to control the medical device to deliver, in the predetermined order, electrical stimulation to the patient via each electrode combination of the predefined set of electrode combinations by at least controlling the medical device to transition between a first electrode combination and a second electrode combination adjacent to the first electrode combination in the order by incrementally adjusting at least one of anodic amplitudes assigned to anodes of the first electrode combination or cathodic amplitudes assigned to cathodes of the first electrode combination.

37. The system of claim 20, wherein the processor is configured to control the medical device to deliver, in the predetermined order, electrical stimulation to the patient via each electrode combination of the predefined set of electrode combinations in the predetermined order by at least controlling the medical device to deliver electrical stimulation to the patient according to a predefined schedule of amplitude adjustments, the predefined schedule including a plurality of steps and, for each step, active electrodes for delivery of electrical stimulation therapy, and, for each of the active electrodes, an anodic amplitude setting or a cathodic amplitude setting.

38. The system of claim 37, wherein the processor is configured to control the medical device according to the predefined schedule of amplitude adjustments by at least controlling the medical device to transition between subsequent steps of the predefined schedule by at least increasing or decreasing at least one of the anodic amplitude or the cathodic amplitude for at least one active electrode by an amplitude adjustment increment, wherein the amplitude adjustment increments are substantially the same between subsequent steps of the predefined schedule.

39. The system of claim 37, wherein the processor is configured to control the medical device according to the predefined schedule of amplitude adjustments by at least controlling the medical device to transition between subsequent steps of the predefined schedule by at least increasing or decreasing at least one of the anodic amplitude or the cathodic amplitude for at least one active electrode by an amplitude adjustment increment, wherein the predefined schedule includes at least two different amplitude adjustment increments such that the processor is configured to control the medical device to transition between subsequent steps of the predefined schedule by at least increasing or decreasing at least one of the anodic amplitude or the cathodic amplitude for at least one active electrode by one amplitude adjustment increment of the at least two different amplitude adjustment increments.

40. The system of claim 39, wherein the predefined schedule includes two different amplitude adjustment increments, wherein increasing or decreasing the at least one of the anodic amplitude or the cathodic amplitude for the at least one active electrode is by an amplitude adjustment increment of the two different amplitude adjustment increments that alternates between subsequent steps of the predefined schedule.

41. The system of claim 20, wherein the processor is configured to control the medical device to deliver, in the predetermined order, electrical stimulation to the patient via each electrode combination of the predefined set of electrode combinations by at least controlling the medical device to deliver electrical stimulation to the patient with at least one electrode combination of the predefined set of electrode combinations and at least one of a plurality of different anodic amplitude settings or a plurality of different cathodic amplitude settings.

42. A system comprising:

means for delivering electrical stimulation to a patient; and

means for controlling the means for delivering electrical stimulation to deliver, in a predetermined order, electrical stimulation to the patient via each electrode combination of a predefined set of electrode combinations, wherein each electrode combination includes one or more anode electrodes, one or more cathode electrodes, or both one or more anode electrodes and one or more cathode electrodes, a relative arrangement of the one or more anodes and the one or more cathodes defining an electrode pattern of the electrode combination, each pair of adjacent electrode combinations in the predetermined order including at least one same anode electrode or cathode electrode, wherein the electrode combinations in the predetermined order define a predetermined sequence of electrode patterns.

43. The system of claim 42, wherein the electrode patterns include a first simple bipole, a second simple bipole, a guarded cathode, and a guarded double cathode.

44. The system of claim 42, wherein the means for controlling is configured to control the means for delivering electrical stimulation to transition between electrode combinations of the predefined set of electrode combinations based on a predefined schedule of amplitude adjustments, the predefined schedule including a plurality of steps and, for each step, active electrodes for delivery of electrical stimulation therapy, and, for each of the active electrodes, an anodic amplitude setting or a cathodic amplitude setting.

45. A non-transitory computer-readable storage medium comprising instructions that, when executed by a processor, cause the processor to:

control a medical device to deliver, in a predetermined order, electrical stimulation to a patient via each electrode combination of a predefined set of electrode combinations, wherein each electrode combination includes one or more anode electrodes, one or more cathode electrodes, or both one or more anode electrodes and one or more cathode electrodes, a relative arrangement of the one or more anodes and the one or more cathodes defining an electrode pattern of the electrode combination, each pair of adjacent electrode combinations in the predetermined order including at least one same anode electrode or cathode electrode, wherein the electrode combinations in the predetermined order define a predetermined sequence of electrode patterns; and

select an electrode combination from the predefined set of electrode combinations based on the delivery of the electrical stimulation by the medical device.

46. The non-transitory computer-readable storage medium of claim 45, wherein the instructions, when executed by the processor, cause the processor to control the medical device to transition between electrode combinations of the predefined set of electrode combinations based on a predefined schedule of amplitude adjustments, the predefined schedule including a plurality of steps and, for each step, active electrodes for delivery of electrical stimulation therapy, and, for each of the active electrodes, an anodic amplitude setting or a cathodic amplitude setting.