Devices, systems and methods for the targeted treatment of movement disorders

• US 9,327,110 B2
• Filed: 02/02/2012
• Issued: 05/03/2016
• Est. Priority Date: 10/27/2009
• Status: Active Grant

• Current Assignee: TC1 LLC (Abbott Laboratories Incorporated)
• Original Assignee: St. Jude Medical Luxembourg Holdings SMI S.A.R.L.
• Inventors: Kramer, Jeffery M., Levy, Robert M.
• Primary Examiner(s): Alter, Alyssa M
• Application Number:
  US13/365,163
• Publication Number:
  US 20120158094A1
• Time in Patent Office: 1,552 Days
• Field of Search: 607 48- 49, 607117-118, 607/46
• US Class Current: 1/1
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/1118 Determining activity level
• CPC Class Codes: A61B 5/1123 Discriminating type of movement, e.g. walking or running A61B5/1116, A61B5/112 take precedence
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/395 Details of stimulation, e.g. nerve stimulation to elicit EMG response
• CPC Class Codes: A61B 5/4082 Diagnosing or monitoring movement diseases, e.g. Parkinson, Huntington or Tourette
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/36017 with leads or electrodes penetrating the skin
• CPC Class Codes: A61N 1/36067 Movement disorders, e.g. tremor or Parkinson disease stimulating motor muscle A61N1/36003
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/36171 Frequency

Abstract

Devices, systems and methods are provided for the targeted treatment of movement disorders. Typically, the systems and devices are used to stimulate one or more dorsal root ganglia while minimizing or excluding undesired stimulation of other tissues, such as surrounding or nearby tissues, ventral root and portions of the anatomy associated with body regions which are not targeted for treatment. The dorsal root ganglia are utilized in particular due to their specialized role in movement. It is in these areas that sensory fibers are isolated from motor fibers. Sensory fibers are involved in a variety of reflexes that are involved in movement control, and these reflexes can be utilized in the treatment of various movement disorders. Thus, by stimulating sensory fibers in these areas, fundamental reflexes can be affected to lessen the symptoms of movement disorders.

Claims

1. A method of treating a movement disorder of a patient using selective stimulation of a soma within a dorsal root ganglion associated with an involved sensory neuron of the movement disorder, comprising:

positioning an introducing needle into an epidural space of the patient;

advancing a sheath through the introducing needle and along the epidural space of the patient to a spinal level having the dorsal root ganglion related to the involved sensory neuron of the movement disorder;

advancing a lead through the needle and sheath toward the dorsal root ganglion so that the at least one electrode is disposed near the dorsal root ganglion; and

providing stimulation energy to the at least one electrode so as to stimulate at least a portion of the dorsal root ganglion to access a lower motor neuron via a reflex arc in a manner which reduces a symptom of the movement disorder at least partially caused by damage or disease affecting upper neurons.

2. A method as in claim 1, wherein the movement disorder includes Parkinson'"'"'s Disease, Multiple Sclerosis or a Demylenating Movement Disorder.

3. A method as in claim 1, wherein the movement disorder includes Cerebral Palsy, Chorea, Dystonia, Spasm, Tic disorder or Tremor.

4. A method as in claim 1, wherein providing stimulation energy comprises adjusting at least one signal parameter to reduce the symptom of the movement disorder.

5. A method as in claim 4, wherein adjusting the at least one signal parameter comprises adjusting a frequency of the stimulation energy.

6. A method as in claim 5, wherein adjusting a frequency of the stimulation energy comprises selecting a frequency less than or equal to approximately 100 Hz.

7. A method as in claim 6, wherein adjusting a frequency of the stimulation energy comprises selecting a frequency less than or equal to approximately 50 Hz.

8. A method as in claim 1 wherein providing stimulation energy comprises adjusting at least one signal parameter provided to the at least one electrode to inhibit improper action potentials directed to the lower motor neuron.

9. A method as in claim 8 wherein the improper action potentials directed to the lower motor neuron causes a synergistic muscle pair involved in the movement disorder to contract.

10. A method as in claim 8 wherein the improper action potentials directed to the lower motor neuron causes an antagonistic muscle involved in the movement disorder to relax.

11. A method as in claim 1 wherein providing stimulation energy comprises adjusting at least one signal parameter provided to the at least one electrode based on an input from one or more sensors configured to sense a status of a symptom of the movement disorder of the patient.

12. A method as in claim 11 wherein the symptom is the onset of the symptoms of the movement disorder.

13. A method as in claim 12, wherein the stimulation signal is provided to reduce or avoid the onset of the symptom.

14. A method as in claim 12, wherein the stimulation signal is provided to treat the symptom in real time.

15. A method as in claim 11 wherein the symptom is the extent of contraction of a synergistic muscle.

16. A method as in claim 11 wherein the symptom is the extent of the relaxation of an antagonistic muscle.

17. A method as in claim 1 further comprising providing stimulation energy to the at least one electrode so as to stimulate at least a portion of the dorsal root ganglion to access a lower motor neuron via a reflex arc while providing no or imperceptible amounts of stimulation energy directly to a ventral root.

18. A method as in claim 1 wherein advancing the lead through the needle and sheath toward the dorsal root ganglion so that the at least one electrode is disposed near the dorsal root ganglion such a portion of the dorsal root ganglion is between the at least one electrode and a ventral root adjacent to the dorsal root ganglion.

19. A method as in claim 1, wherein providing stimulation energy comprises activating the reflex arc.

20. A method as in claim 19, wherein activating the reflex arc comprises stimulating at least one sensory neuron so as to activate at least one soma of an alpha motor neuron.

21. A method as in claim 20, wherein the at least one sensory neuron comprises an Ia sensory fiber.

22. A method as in claim 20, wherein the at least one sensory neuron comprises an Ib sensory fiber.