DEVICES, SYSTEMS AND METHODS FOR THE TARGETED TREATMENT OF MOVEMENT DISORDERS

• US 20120158094A1
• Filed: 02/02/2012
• Published: 06/21/2012
• 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.
• Granted Patent: US 9,327,110 B2
• Time in Patent Office: Days
• US Class Current: 607/48
• 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 patient having a movement disorder comprising:

presenting the patient having the movement disorder;

positioning a lead having at least one electrode within the patient so that the at least one electrode is disposed near a target dorsal root ganglion associated with the movement disorder; and

providing stimulation energy to the at least one electrode so as to selectively stimulate at least a portion of the target dorsal root ganglion so as to reduce a symptom of the movement disorder while providing no or imperceptible amounts of stimulation energy directly to a ventral root.

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 the target dorsal root ganglion is associated with a reflex arc and wherein providing stimulation energy comprises activating the reflex arc.

5. A method as in claim 4, 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.

6. A method as in claim 5, wherein the at least one sensory neuron comprises an Ia sensory fiber.

7. A method as in claim 5, wherein the at least one sensory neuron comprises an Ib sensory fiber.

8. A method as in claim 1, wherein providing stimulation energy comprises providing a stimulation signal having at least one parameter selected to selectively stimulate the at least a portion of the target dorsal root ganglion so as to reduce a symptom of the movement disorder.

9. A method as in claim 8, wherein the at least one parameter comprises frequency.

10. A method as in claim 9, wherein the at least one parameter comprises frequency having a value of less than or equal to approximately 100 Hz.

11. A method as in claim 1, wherein providing stimulation energy comprises choosing size of the at least one electrode, shape of the at least one electrode, and/or position of the at least one electrode so as to selectively stimulate the at least a portion of the target dorsal root ganglion so as to reduce the symptom of the movement disorder.

12. A method as in claim 1, wherein providing stimulation energy comprises providing stimulation energy in response to at least one sensor configured to sense an indicator of the movement disorder.

13. A method as in claim 12, wherein the indicator comprises an onset of the symptom of the movement disorder, and wherein the stimulation signal is provided to reduce or avoid the onset of the symptom.

14. A method as in claim 12, wherein the indicator comprises a status of the symptom of the movement disorder, and wherein the stimulation signal is provided to treat the symptom in real time.

15. A method as in claim 1, wherein providing stimulation energy comprises providing stimulation energy in response to at least one sensor configured to sense an activity or an activity level of the patient.

16. A method as in claim 1, wherein providing stimulation energy comprises providing stimulation energy in response to at least one sensor configured to detect a position of at least a portion of a body of the patient.

18. A method as in claim 16, wherein the movement disorder includes Parkinson'"'"'s Disease, Multiple Sclerosis or a Demylenating Movement Disorder.

19. A method as in claim 16, wherein the movement disorder includes Cerebral Palsy, Chorea, Dystonia, Spasm, Tic disorder or Tremor.

20. A method as in claim 16, wherein the at least a portion of the spinal nerve comprises at least a portion of a dorsal root ganglion associated with the movement disorder.

21. A method as in claim 16, wherein providing stimulation energy comprises adjusting at least one signal parameter to reduce the symptom of the movement disorder.

22. A method as in claim 21, wherein adjusting the at least one signal parameter comprises adjusting a frequency of the stimulation energy.

23. A method as in claim 22, wherein adjusting a frequency of the stimulation energy comprises selecting a frequency less than or equal to approximately 100 Hz.

24. A method as in claim 23, wherein adjusting a frequency of the stimulation energy comprises selecting a frequency less than or equal to approximately 50 Hz.

17. A method of treating a movement disorder of a patient comprising:

advancing a sheath having a curved distal end along an epidural space of the patient;

positioning the curved distal end so as to direct a lead advanced therethrough toward a spinal nerve associated with the disorder;

advancing the lead having at least one electrode through the sheath so that the at least one electrode is disposed near the spinal nerve; and

providing stimulation energy to the at least one electrode so as to stimulate at least a portion of the spinal nerve in a manner which reduces a symptom of the movement disorder.

25. A stimulation system for treating a patient having a movement disorder comprising:

a lead having at least one electrode, wherein the lead is configured for implantation so as to position at least one of the at least one electrode adjacent a dorsal root ganglion associated with the movement disorder; and

a pulse generator electrically connected to the at least one of the at least one electrode, wherein the pulse generator provides a signal to the at least one of the at least one electrode which stimulates at least a portion of the dorsal root ganglion so as to reduce a symptom of the movement disorder.

26. A stimulation system as in claim 25, wherein the target dorsal root ganglion is associated with a reflex arc and wherein the signal is configured to activate the reflex arc.

27. A stimulation system as in claim 26, wherein activation of the reflex arc comprises stimulation of at least one sensory neuron so as to activate at least one soma of an alpha motor neuron.

28. A stimulation system as in claim 27, wherein the at least one sensory neuron comprises an Ia sensory fiber.

29. A stimulation system as in claim 27, wherein the at least one sensory neuron comprises an Ib sensory fiber.

30. A stimulation system as in claim 27, wherein the at least of the at least one electrode has a size that selectively stimulates the at least one sensory neuron.

31. A stimulation system as in claim 27, wherein the at least of the at least one electrode has a shape that selectively stimulates the at least one sensory neuron.

32. A stimulation system as in claim 27, wherein the signal has at least one parameter that is programmable to selectively stimulate the at least one sensory neuron.

33. A stimulation system as in claim 32, wherein the at least one parameter comprises frequency.

34. A stimulation system as in claim 33, wherein the frequency is programmable with a value up to approximately 100 Hz.

35. A stimulation system as in claim 34, wherein the frequency is programmable with a value up to approximately 50 Hz.

36. A stimulation system as in claim 25, further comprising at least one sensor configured to sense an indicator of the movement disorder.

37. A system as in claim 36, wherein the at least one sensor comprises an accelerometer, a strain gauge, or an electrical device which measures electrical activity in a muscle or nerve.

38. A system as in claim 36, wherein the indicator indicates an onset of the symptom of the movement disorder, and wherein the stimulation signal is provided to reduce or avoid the onset of the symptom.

39. A system as in claim 36, wherein the indicator indicates a status of the symptom of the movement disorder, and wherein the stimulation signal is provided to treat the symptom in real time.

40. A system as in claim 36, wherein the indicator indicates a position of at least a portion of a body of the patient.

41. A system as in claim 25, further comprising at least one sensor configured to sense an activity or an activity level of the patient.

42. A system for treating a patient having a movement disorder, the system comprising:

a lead having at least one electrode, wherein the lead is configured to be positioned so that at least one of the at least one electrodes is able to stimulate at least a portion of a target dorsal root associated with the movement disorder;

at least one sensor configured to sense a symptom of the movement disorder; and

an implantable pulse generator connectable with the lead, wherein the generator includes electronic circuitry configured to receive information from the at least one sensor and provide a stimulation signal to the lead in response to the sensed symptom of the movement disorder, wherein the stimulation signal has an energy below an energy threshold for stimulating a ventral root associated with the target dorsal root while the lead is so positioned.

43. A system as in claim 42, wherein the at least one sensor senses an onset of the symptom of the movement disorder, and wherein the stimulation signal is provided to reduce or avoid the onset of the symptom.

44. A system as in claim 42, wherein the at least one sensor senses a status of the symptom of the movement disorder, and wherein the stimulation signal is provided to treat the symptom in real time.

45. A system as in claim 42, wherein the at least one sensor senses an activity or an activity level of the patient.

46. A system as in claim 42, wherein the at least one sensor detects a position of at least a portion of a body of the patient.

47. A system as in claim 42, wherein the at least one sensor comprises an accelerometer, a strain gauge, or an electrical device which measures electrical activity in a muscle or nerve.