Method and apparatus for controlling neurostimulation according to physical state

• US 8,983,617 B2
• Filed: 04/08/2013
• Issued: 03/17/2015
• 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:
  US13/858,405
• Publication Number:
  US 20130226264A1
• Time in Patent Office: 708 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 determine a current value of a sensor parameter representing a physical state of the patient;

a stimulation output circuit configured to deliver the neurostimulation; and

a stimulation control circuit configured to store a plurality of values of a sensor-driven parameter, identify a value of the sensor-driven parameter for the current value of the sensor parameter from the stored plurality of values of the sensor-driven parameter, determine whether the identified value of the sensor-driven parameter is currently optimal, control the delivery of the neurostimulation using the identified value of the sensor-driven parameter in response to the identified value of the sensor-driven parameter being determined to be currently optimal, and perform a titration of the neurostimulation for the current value of the sensor parameter in response to the identified value of the sensor-driven parameter being determined to be currently not optimal.

2. The system of claim 1, wherein the sensor circuit comprises:

a posture sensor configured to sense a posture signal indicative of a posture of the patient; and

a sensor processing circuit configured to determine the current value of the sensor parameter using the sensed posture signal.

3. The system of claim 1, wherein the sensor circuit comprises:

an activity sensor configured to sense an activity signal indicative of an activity level of the patient; and

a sensor processing circuit configured to determine the current value of the sensor parameter using the sensed activity signal.

4. The system of claim 1, comprising a parameter input device configured to receive the plurality of values of the sensor-driven parameter front a user.

5. The system of claim 1, wherein the stimulation control circuit is configured to determine whether the identified value of the sensor-driven parameter is currently optimal based on whether the neurostimulation was the titrated for the current value of the sensor parameter within a specified period of time.

6. The system of claim 1, comprising a monitoring circuit configured to monitor one or more physiological signals indicative of one or more effects of the neurostimulation, and wherein the stimulation control circuit is configured to perform the titration of the neurostimulation using the one or more physiological signals.

7. The system of claim 6, 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 the stimulation control circuit is configured to approximately optimize the value of the sensor-driven parameter for the current value of the sensor parameter using the one or more intended effect parameters.

8. The system of claim 6, wherein the monitoring circuit comprises 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 the stimulation control circuit is configured to approximately optimize the value of the sensor-driven parameter for the current value of the sensor parameter using the one or more side effect parameters.

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

a sensor circuit configured to determine a current value of a sensor parameter representing a physical state of the patient;

a stimulation output circuit configured to deliver the neurostimulation; and

a stimulation control circuit configured to store a plurality of values of a sensor-driven parameter, identify a value of the sensor-driven parameter for the current value of the sensor parameter from the stored plurality of values of the sensor-driven parameter, determine whether the identified value of the sensor-driven parameter is currently optimal, control the delivery of the neurostimulation using the identified value of the sensor-driven parameter in response to the identified value of the sensor-driven parameter being determined to be currently optimal, and approximately optimize the plurality of values of the sensor-driven parameter by performing a titration of the neurostimulation for a corresponding plurality of values of the sensor parameter.

10. The system of claim 9, wherein the sensor circuit comprises:

a posture sensor configured to sense a posture signal indicative of a posture of the patient; and

a sensor processing circuit configured to determine the current value of the sensor parameter using the sensed posture signal.

11. The system of claim 9, wherein the sensor circuit comprises:

an activity sensor configured to sense an activity signal indicative of an activity level of the patient; and

a sensor processing circuit configured to determine the current value of the sensor parameter using the sensed activity signal.

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

storing a plurality of values of a sensor-driven parameter;

delivering neurostimulation to a patient;

determining a current value of a sensor parameter indicative of a physical state of the patient;

identifying a value of the sensor-driven parameter for the current value of the sensor parameter from the stored plurality of values of the sensor-driven parameter;

determining whether the identified value of the sensor parameter is currently optimal;

controlling the delivery of the neurostimulation using the identified value of the sensor-driven parameter in response to the identified value of the sensor-driven parameter being determined to be currently optimal; and

titrating the neurostimulation for the current value of the sensor parameter in response to the identified value of the sensor-driven parameter being determined to be currently not optimal.

13. The method of claim 12, wherein titrating the neurostimulation comprises:

monitoring a degree of a side effect of the neurostimulation; and

approximately optimizing the identified value of the sensor-driven parameter based on the degree of the side effect of the neurostimulation.

14. The method of claim 13, wherein titrating the neurostimulation comprises:

monitoring one or more physiological signals;

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

producing one or more trends of the one or more side effect parameters; and

approximately optimizing the identified value of the sensor-driven parameter using the one or more trends of the one or more side effect parameters.

15. The method of claim 12, wherein titrating the neurostimulation comprises:

monitoring a degree of an intended effect of the neurostimulation; and

approximately optimizing the identified value of the sensor-driven parameter based on the degree of the intended effect of the neurostimulation.

16. The method of claim 15, wherein titrating the neurostimulation comprises:

monitoring one or more physiological signals;

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

producing one or more trends of the one or more intended effect parameters; and

approximately optimizing the identified value of the sensor-driven parameter using the one or more trends of the one or more intended effect parameters.

17. The method of claim 12, wherein delivering the neurostimulation comprises delivering the neurostimulation from an implantable medical device, and titrating the neurostimulation comprises automatically titrating the neurostimulation using a control circuit of the implantable medical device programmed to titrate the neurostimulation.

18. The method of claim 17, wherein determining the current value of the sensor parameter comprises:

sensing a posture signal indicative of a posture of the patient; and

determining the current value of the sensor parameter using the posture signal.

19. The method of claim 17, wherein determining the current value of the sensor parameter comprises:

sensing an activity signal indicative of an activity level of the patient; and

determining the current value of the sensor parameter using the activity signal.

20. The method of claim 17, comprising approximately optimizing the plurality of values of the sensor-driven parameter by automatically titrating the neurostimulation for a corresponding plurality of values of the sensor parameter.