Automatic selection of lead configuration for a neural stimulation lead

• US 9,050,472 B2
• Filed: 05/13/2013
• Issued: 06/09/2015
• Est. Priority Date: 09/15/2010
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Arcot-Krishnamurthy, Shantha, Ternes, David J., Hamann, Jason, Hincapie Ordonez, Juan Gabriel, Ruble, Stephen B.
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US13/893,080
• Publication Number:
  US 20130253615A1
• Time in Patent Office: 757 Days
• Field of Search: 607/45, 607/59, 607/2, 607 62- 64, 607 27- 29
• US Class Current: 1/1
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/36128 Control systems
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/36146 specified by the stimulation parameters
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/37235 Aspects of the external programmer
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient

Abstract

A neurostimulation system includes a neural stimulation lead having a proximal portion and a distal portion and including a plurality of electrodes along the distal portion. The plurality of electrodes are configured for positioning proximate a portion of the autonomic nervous system. A neural stimulation circuit, coupled to the plurality of electrodes, delivers neural stimulation pulses to the plurality of electrodes. A processor and controller is configured to control the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations. Each electrode configuration includes one or more of the plurality of electrodes. The processor and controller is further configured to receive information related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses to each of the plurality of electrode configurations and to identify the electrode configurations that induce the motor fiber activity.

Claims

1. A neurostimulation system comprising:

a neural stimulation lead having a plurality of electrodes, the plurality of electrodes configured for positioning proximate a portion of the autonomic nervous system;

a neural stimulation circuit, coupled to the plurality of electrodes, to deliver neural stimulation pulses to the plurality of electrodes;

a user interface, the user interfacing including a display; and

a processor and controller configured to;

control the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations, each electrode configuration comprising one or more of the plurality of electrodes,

receive information related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses to each of the plurality of electrode configurations,

prioritize the plurality of electrode configurations based on a first capture threshold of the motor fiber activity,

control the neural stimulation circuit to deliver second neural stimulation pulses to induce additional physiological activity to a subset of the plurality of electrode configurations identified with a lowest capture threshold for motor fiber activity, the second neural stimulation pulses having an amplitude greater than the first neural stimulation pulses,

receive information related to one or more physiological responses induced in response to delivery of the second neural stimulation pulses to the subset of electrode configurations, the one or more physiological responses including intended physiological activity and undesirable physiological activity,

prioritize the subset of electrode configurations that avoid the undesirable physiological activity and induce intended physiological activity based on the amplitude being above a second capture threshold for the intended physiological activity, and

represent the prioritization of the subset of electrode configurations as a recommendation on the display.

2. The neurostimulation system of claim 1, further comprising:

one or more physiological activity sensors configured to sense a signal indicative of the one or more physiological responses and generate the information related to the one or more physiological responses.

3. The neurostimulation system of claim 2, wherein the one or more physiological responses include intended physiological activity and undesirable physiological activity, and wherein the processor and controller is further configured to eliminate the electrode configurations that induce undesirable physiological activity and prioritize the subset of electrode configurations that induce intended physiological activity based on a second capture threshold for the intended physiological activity.

4. The neurostimulation system of claim 3, wherein the processor and controller are configured to deliver therapy to at least one of the subset of electrode configurations that induce intended physiological activity at a lowest second capture threshold.

5. The neurostimulation system of claim 1, further comprising an activity sensor configured to sense a signal indicative of motor fiber activity and generate the information related to the motor fiber activity.

6. The neurostimulation system of claim 1, wherein the controller is an external controller.

7. The neurostimulation system of claim 1, wherein the controller is an implantable controller.

8. The neurostimulation system of claim 1, wherein the undesirable physiological activity comprises intolerable physiological activity.

9. The neurostimulation system of claim 1, wherein the prioritization represented on the display includes a physiological activity profile for each of the subset of electrode configurations.

10. A method comprising:

coupling a plurality of electrodes to a neural stimulation circuit that delivers neural stimulation pulses to the plurality of electrodes, the plurality of electrodes positioned proximate a portion of the autonomic nervous system;

controlling the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations, each electrode configuration comprising one or more of the plurality of electrodes, the first neural stimulation pulses being delivered at more than one energy level to each of the plurality of electrode configurations;

receiving information related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses to each of the plurality of electrode configurations;

controlling the neural stimulation circuit to deliver second neural stimulation pulses to induce additional physiological activity to subset of the plurality of electrode configurations associated with a lowest capture threshold for motor fiber activity based on the received information related to motor fiber activity;

receiving information related to one or more physiological responses induced in response to delivery of the second neural stimulation pulses to each of the plurality of electrode configurations, the one or more physiological responses including intended physiological activity and undesirable physiological activity;

prioritizing the subset of electrode configurations based on avoidance of the undesirable physiological activity and inducement of intended physiological activity, and

representing the prioritization of the subset of electrode configurations as a recommendation on a display.

11. The method of claim 10, wherein prioritizing the subset of electrode configurations based on the inducement of intended physiological activity comprises prioritizing the subset of electrode configurations based on a second capture threshold for the intended physiological activity.

12. The method of claim 10, wherein prioritizing the subset of electrode configurations based on avoidance of the undesirable physiological activity comprises eliminating the subset of electrode configurations that induce intolerable physiological activity.

13. The method of claim 10, wherein the information related to motor fiber activity is received from an activity sensor that is configured to sense a signal indicative of motor fiber activity.

14. The method of claim 10, wherein the controlling and prioritizing steps are performed by an external controller.

15. The method of claim 10, wherein the prioritization represented on the display includes a physiological activity profile for each of the subset of electrode configurations.

16. A neurostimulation system comprising:

a neural stimulation lead having a plurality of electrodes, the plurality of electrodes configured for positioning proximate a portion of the autonomic nervous system;

a neural stimulation circuit, coupled to the plurality of electrodes, to deliver neural stimulation pulses to the plurality of electrodes;

a user interface, the user interfacing including a display; and

a controller configured to;

control the neural stimulation circuit to deliver first neural stimulation pulses to a plurality of electrode configurations, each electrode configuration comprising one or more of the plurality of electrodes,

receive information indicative of intended motor fiber activity induced in response to delivery of the first neural stimulation pulses to the plurality of electrode configurations,

prioritize the plurality of electrode configurations based on a lowest capture threshold for the intended motor fiber activity,

control the neural stimulation circuit to deliver second neural stimulation pulses to induce additional physiological activity through a subset of the plurality of electrode configurations, the subset of electrode configurations based on the prioritization of the plurality of electrode configurations,

receive information indicative of one or more additional physiological responses induced in response to delivery of the second neural stimulation pulses, the one or more physiological responses different from the intended motor fiber activity induced in response to delivery of the first neural stimulation pulses,

prioritize the subset of electrode configurations based on which electrode combinations induce the one or more physiological responses, and

represent the prioritization of the subset of electrode configurations as a recommendation on the display.

17. The neurostimulation system of claim 16, wherein the controller is an external controller.

18. The neurostimulation system of claim 16, wherein the controller is an implantable controller.

19. The neurostimulation system of claim 16, wherein the physiological activity comprises undesirable physiological activity.

20. The neurostimulation system of claim 16, wherein the prioritization represented on the display includes a physiological activity profile for each of the subset of electrode configurations.