Differential neurostimulation therapy driven by physiological therapy

• US 9,878,160 B2
• Filed: 08/24/2016
• Issued: 01/30/2018
• Est. Priority Date: 04/05/2000
• Status: Expired due to Fees

• Current Assignee: Neuropace Inc.
• Original Assignee: Neuropace Inc.
• Inventors: Pless, Benjamin D., Tcheng, Thomas K.
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US15/246,315
• Publication Number:
  US 20160361547A1
• Time in Patent Office: 524 Days
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/0022 Monitoring a patient using a global network, e.g. telephone networks, internet
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/026 Measuring blood flow A61B3/1233, A61B3/1241 take precedence
• CPC Class Codes: A61B 5/076 Permanent implantations telemetry using implanted circuitry A61B5/0031; implanted stimulators for therapy A61N1/3605, A61N1/362, A61N1/372
• CPC Class Codes: A61B 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61B 5/14546 for measuring analytes not otherwise provided for, e.g. ions, cytochromes
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/369 Electroencephalography [EEG] devices for psychotechnics A61B5/16
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4812 Detecting sleep stages or cycles
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/743 Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61N 1/0529 Electrodes for brain stimulation
• CPC Class Codes: A61N 1/0531 Brain cortex electrodes
• CPC Class Codes: A61N 1/0539 Anchoring of brain electrode systems, e.g. within burr hole
• CPC Class Codes: A61N 1/36064 Epilepsy
• CPC Class Codes: A61N 1/36067 : Movement disorders, e.g. tremor or Parkinson disease stimulating motor muscle A61N1/36003
• CPC Class Codes: A61N 1/36078 : Inducing or controlling sleep or relaxation non-implantable stimulator A61M21/00
• CPC Class Codes: A61N 1/36135 : using physiological parameters
• CPC Class Codes: A61N 1/36139 : with automatic adjustment

Abstract

An implantable neurostimulator system adapted to provide therapy for various neurological disorders is capable of varying therapy delivery strategies based on the context, physiological or otherwise, into which the therapy is to be delivered. Responsive and scheduled therapies can be varied depending on various sensor measurements, calculations, inferences, and device states (including elapsed times and times of day) to deliver an appropriate course of therapy under the circumstances.

Claims

1. An implantable neurostimulator for treating a neurological disorder in a patient, the implantable neurostimulator comprising:

a detection subsystem configured to;

sense an electrographic signal of the patient, and

detect a neurological event in the electrographic signal through one or more of a plurality of detection channels;

a processor configured to;

identify which one, if any, of the plurality of detection channels detected a neurological event, and

select a therapy from a plurality of possible therapies deliverable to the patient through the implantable neurostimulator, the therapy selected based on a parameter representative of a characteristic of the electrographic signal derived by the identified detection channel, and at least one of a time of detection of the neurological event and a time since a last delivery of a therapy to the patient; and

a therapy subsystem configured to deliver the selected therapy to the patient.

2. The implantable neurostimulator of claim 1, wherein the characteristic of the electrographic signal derived by the identified detection channel comprises one or more of:

a measurement of density of half waves in the electrographic signal, a measure of frequency content of the electrographic signal, a measure of frequency variability of the electrographic signal, a measure of amplitude variation of the electrographic signal, and a measure of waveform energy of the electrographic signal.

3. The implantable neurostimulator of claim 2, wherein:

the detection subsystem is further configured to store data corresponding to the characteristic of the electrographic signal in a data storage area of the implantable neurostimulator; and

the processor is configured to select a therapy by being further configured to obtain the data corresponding to the electrographic signal from the data storage area.

4. The implantable neurostimulator of claim 1, wherein the processor is configured to select a therapy by being further configured to:

transform the parameter into a numeric quantity; and

select the therapy based on the numeric quantity.

5. The implantable neurostimulator of claim 1, wherein selection of a therapy is based on one or more of a trend of the parameter over time, and a historical pattern of the parameter.

6. The implantable neurostimulator of claim 1, wherein selection of a therapy is further based on at least one second parameter of the patient comprising an EMG measurement, a blood pressure measurement, a blood flow measurement, a blood oxygenation measurement, a drug concentration measurement, a neurotransmitter concentration measurement, an orientation measurement, and a sleep state indication.

7. The implantable neurostimulator of claim 1, wherein the selected therapy comprises electrical stimulation.

8. The implantable neurostimulator of claim 7, wherein:

the one of the plurality of detection channels comprises a plurality of electrodes, and

the therapy subsystem is configured to deliver the selected therapy to the patient by being further configured to apply electrical stimulation through the plurality of electrodes.

9. The implantable neurostimulator of claim 1, further comprising a stimulation timing channel corresponding to one of the plurality of detection channels and configured to derive stimulation timing, wherein the processor is further configured to deliver the selected therapy based on the derived stimulation timing.

10. The implantable neurostimulator of claim 9, wherein the stimulation timing channel is different from the identified detection channel.

11. A method of treating a neurological disorder in a patient through an implantable neurostimulator, the method comprising:

sensing an electrographic signal of the patient;

detecting a neurological event in the electrographic signal through one or more of a plurality of detection channels of the implantable neurostimulator;

identifying which one, if any, of the plurality of detection channels detected a neurological event;

selecting a therapy from a plurality of possible therapies deliverable to the patient through the implantable neurostimulator, the therapy selected based on a parameter representative of a characteristic of the electrographic signal derived by the identified detection channel, and at least one of a time of detection of the neurological event and a time since a last delivery of a therapy to the patient; and

delivering the selected therapy to the patient.

12. The method of claim 11, wherein the characteristic of the electrographic signal derived by the identified detection channel comprises one or more of:

a measurement of density of half waves in the electrographic signal, a measure of frequency content of the electrographic signal, a measure of frequency variability of the electrographic signal, a measure of amplitude variation of the electrographic signal, and a measure of waveform energy of the electrographic signal.

13. The method of claim 12, further comprising storing data corresponding to the characteristic of the electrographic signal in a data storage area of the implantable neurostimulator, and wherein selecting a therapy comprises obtaining data corresponding to the electrographic signal from the data storage area.

14. The method of claim 11, wherein selecting a therapy further comprises:

transforming the parameter into a numeric quantity; and

selecting the therapy based on the numeric quantity.

15. The method of claim 11, wherein selection of a therapy is based on one or more of a trend of the parameter over time, and a historical pattern of the parameter.

16. The method of claim 11, wherein selection of a therapy is further based on at least one second parameter of the patient comprising an EMG measurement, a blood pressure measurement, a blood flow measurement, a blood oxygenation measurement, a drug concentration measurement, a neurotransmitter concentration measurement, an orientation measurement, and a sleep state indication.

17. The method of claim 11, wherein the selected therapy comprises electrical stimulation.

18. The method of claim 17, wherein the one of the plurality of detection channels comprises a plurality of electrodes, and delivering the selected therapy to the patient comprises applying electrical stimulation through the plurality of electrodes.

19. The method of claim 11, further comprising deriving stimulation timing through a stimulation timing channel corresponding to one of the plurality of detection channels, wherein the selected therapy is delivered to the patient based on the derived stimulation timing.

20. The method of claim 19, wherein the stimulation timing channel is different from the identified detection channel.