Automatic selection of lead configuration for a neural stimulation lead

• US 8,452,406 B2
• Filed: 08/29/2011
• Issued: 05/28/2013
• 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
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US13/220,423
• Publication Number:
  US 20120065702A1
• Time in Patent Office: 638 Days
• Field of Search: 607/45, 607/59, 607 62- 64, 607/2, 607 27- 29
• US Class Current: 607/28
• 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 proximal portion and a distal portion and including a plurality of electrodes along the distal portion, 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; 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, the first neural stimulation pulses being delivered at more than one energy level to each of the plurality of electrode configurations,

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,

identify the electrode configurations that induce the motor fiber activity,

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 one or more electrode configurations 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 each of the plurality of electrode configurations, the one or more physiological responses including intended physiological activity and intolerable physiological activity,

eliminate the electrode configurations that induce intolerable physiological activity, and

prioritize the one or more electrode configurations that induce intended physiological activity based on a second capture threshold for the intended physiological activity.

2. The neurostimulation system of claim 1, and 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 1, wherein the processor and controller is programmable to deliver therapy to at least one of the one or more electrode configurations that induce intended physiological activity at a lowest second capture threshold.

4. The neurostimulation system of claim 1, and 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.

5. 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;

identifying the electrode configurations that induce the motor fiber activity;

prioritizing the plurality of electrode configurations based on a first capture threshold of the motor fiber activity;

controlling the neural stimulation circuit to deliver second neural stimulation pulses to induce additional physiological activity to one or more electrode configurations with a lowest capture threshold for motor fiber activity, the second neural stimulation pulses having an amplitude greater than the first neural stimulation pulses;

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 intolerable physiological activity;

eliminating the electrode configurations that induce intolerable physiological activity; and

prioritizing the one or more electrode configurations that induce intended physiological activity based on a second capture threshold for the intended physiological activity.

6. The method of claim 5, and further comprising:

delivering therapy to at least one of the one or more electrode configurations that induce intended physiological activity at a lowest second capture threshold.

7. A method comprising:

positioning a plurality of electrodes proximate a portion of the autonomic nervous system, the plurality of electrodes disposed along a distal portion of a neural stimulation lead;

coupling the neural stimulation lead to an external device configured to deliver first neural stimulation pulses to the plurality of electrodes;

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

providing information to the external device 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;

generating an output on the external device that prioritizes the plurality of electrode configurations based on a first capture threshold for motor fiber activity;

coupling the neural stimulation lead to an implantable medical device (IMD);

controlling the IMD with the external device after the IMD has been implanted for a period of time to deliver the first neural stimulation pulses at more than one energy level to each of the plurality of electrode configurations;

providing information from the IMD to the external device related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses by the IMD to each of the plurality of electrode configurations;

generating an output on the external device that prioritizes the plurality of electrode configurations based on the first capture threshold for the motor fiber activity;

programming the IMD with the external device to deliver second neural stimulation pulses to induce additional physiological activity to one or more of the electrode configurations with a lowest first capture threshold for motor fiber activity;

receiving information on the external device related to one or more physiological responses that are induced in response to delivery of the second neural stimulation pulses to each of the plurality of electrode configurations, wherein the one or more physiological responses include intended physiological activity and intolerable physiological activity; and

generating an output on the external device that prioritizes the one or more electrode configurations that induce intended physiological activity based on a second capture threshold for the intended physiological activity.

8. The method of claim 7, and further comprising:

programming the IMD with the external device to deliver therapy to at least one of the one or more electrode configurations that induce intended physiological activity at a lowest second capture threshold.