Automatic selection of lead configuration for a neural stimulation lead

• US 9,731,135 B2
• Filed: 06/08/2015
• Issued: 08/15/2017
• 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 J., Hincapie Ordonez, Juan Gabriel, Ruble, Stephen B.
• Primary Examiner(s): Getzow, Scott
• Application Number:
  US14/733,160
• Publication Number:
  US 20150290462A1
• Time in Patent Office: 799 Days
• 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:

an implantable neural stimulation device having a plurality of electrodes and a neural stimulation circuit, the plurality of electrodes configured for positioning proximate a portion of the autonomic nervous system, the neural stimulation circuit configured to deliver neural stimulation pulses through the plurality of electrodes;

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

a controller configured to;

reduce a number of potential electrode combinations of the plurality of electrodes from a plurality of potential electrode combinations to a subset of potential electrode combinations for further testing, including;

control the neural stimulation circuit to deliver a first plurality of neural stimulation pulses to a neural target through the plurality of potential electrode combinations;

receive information indicative of physiological activity that is induced in response to the delivery of the first plurality of neural stimulation pulses;

use the information indicative of physiological activity to determine for each of the plurality of electrode combinations whether the first plurality of neural stimulation pulses captures neural tissue to induce physiological activity; and

group electrode combinations using the received information into the subset of potential electrode combinations that are associated with capturing neural tissue;

determine that the subset has at least a minimum number of potential electrode combinations for further testing, and identify on the display the subset of potential electrode combinations associated with capturing neural tissue; and

further test the subset of potential electrode combinations that has a least the minimum number of potential electrode combinations to further reduce the number of potential electrode combinations for delivering neurostimulation pulses to the neural target.

2. The neurostimulation system of claim 1, further comprising one or more physiological activity sensors configured to sense a signal indicative of the physiological activity and generate the information indicative of the physiological activity.

3. The neurostimulation system of claim 1, wherein the received information further comprises undesirable physiological activity induced in response to delivery of the first plurality of neural stimulation pulses.

4. The neurostimulation system of claim 3, wherein the controller is configured to remove from the subset any electrode combination associated with inducing the undesirable physiological activity.

5. The neurostimulation system of claim 1, wherein the physiological activity is associated with motor fiber activity.

6. The neurostimulation system of claim 1, wherein the controller is configured to:

control the neural stimulation circuit to deliver a second plurality of neural stimulation pulses to the neural target to further test the subset of potential electrode combinations, and receive additional information related to physiological activity that is induced in response to delivery of the second plurality of neural stimulation pulses.

7. The neurostimulation system of claim 6, wherein the second plurality of neural stimulation pulses are delivered at a higher pulse amplitude than the first plurality of neural stimulation pulses.

8. The neurostimulation system of claim 6, wherein the second plurality of neural stimulation pulses are delivered at a plurality of different amplitudes.

9. The neurostimulation system of claim 6, wherein the controller is configured to prioritize the electrode combinations of the subset based on the additional information.

10. The neurostimulation system of claim 6, wherein the controller is configured to control the neural stimulation circuit to deliver the first plurality of neural stimulation before the implantable neural stimulation device is fully implanted and to deliver the second plurality of neural stimulation after the implantable neural stimulation device is fully implanted.

11. The neurostimulation system of claim 1, wherein the controller is configured to prioritize the electrode combinations of the subset that induce intended physiological activity based on a second capture threshold and indicate the second subset on the display.

12. The neurostimulation system of claim 11, wherein the controller is configured to control the neural stimulation circuit to deliver therapy through at least one electrode combination of the subset.

13. The neurostimulation system of claim 1, wherein the controller is an external controller and is configured to communicate with the implantable neural stimulation device.

14. The neurostimulation system of claim 1, wherein the controller is part of the implantable neural stimulation device.

15. A method of automatic assessment of a plurality of electrodes of an implantable neural stimulation device, the method comprising:

reducing a number of potential electrode combinations of the plurality of electrodes from a plurality of potential electrode combinations to a subset of potential electrode combinations for further testing, including;

delivering a first plurality of neural stimulation pulses to a neural target through the plurality of electrode combinations;

receiving information, at a controller, that is indicative of physiological activity that is induced in response to delivery of the first plurality of neural stimulation pulses;

using the information indicative of physiological activity to determine for each of the plurality of electrode combinations whether the first plurality of neural stimulation pulses captures neural tissue to induce physiological activity; and

grouping electrode combinations using the received information, including identifying, with the controller, the subset of potential electrode combinations associated with capturing neural tissue; and

determining that the subset has a at least a minimum number of potential electrode combinations for further testing, and displaying, on a display, identification of the subset of more than one of the plurality of electrode combinations associated with capturing neural tissue; and

further testing the subset of potential electrode combinations that has at least the minimum number of potential electrode combinations to further reduce the number of potential electrode combinations for delivering neurostimulation pulses to the neural target.

16. The method of claim 15, wherein the received information further comprises undesirable physiological activity induced in response to the delivery of the first plurality of neural stimulation pulses, and wherein identifying the subset further comprises removing from the subset any electrode combination associated with inducing the undesirable physiological activity.

17. The method of claim 15, wherein further testing the subset of potential electrode combinations includes:

delivering a second plurality of neural stimulation pulses to the neural target through the subset of electrode combinations; and

receiving additional information, at the controller, related to physiological activity that is induced in response to delivery of the second plurality of neural stimulation pulses.

18. The method of claim 17, wherein the second plurality of neural stimulation pulses is delivered at a higher pulse amplitude than the first plurality of neural stimulation pulses.

19. The method of claim 17, wherein the second plurality of neural stimulation pulses is delivered at a plurality of different amplitudes.

20. The method of claim 17, further comprising:

prioritizing the electrode combinations of the subset based on the additional information; and

displaying, on the display, an indication of the prioritization of the electrode combinations.