US20120165899A1 - Neural stimulation system and method responsive to collateral neural activity - Google Patents
Neural stimulation system and method responsive to collateral neural activity Download PDFInfo
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- US20120165899A1 US20120165899A1 US13/414,319 US201213414319A US2012165899A1 US 20120165899 A1 US20120165899 A1 US 20120165899A1 US 201213414319 A US201213414319 A US 201213414319A US 2012165899 A1 US2012165899 A1 US 2012165899A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
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- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/36128—Control systems
- A61N1/36146—Control systems specified by the stimulation parameters
- A61N1/36182—Direction of the electrical field, e.g. with sleeve around stimulating electrode
- A61N1/36185—Selection of the electrode configuration
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- A61B5/377—Electroencephalography [EEG] using evoked responses
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- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
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- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/375—Constructional arrangements, e.g. casings
- A61N1/3756—Casings with electrodes thereon, e.g. leadless stimulators
Definitions
- the present disclosure is related to systems and methods for detecting and responding to collateral neural activity that may arise in association with or as a result of stimulation applied to a region of the cortex or other area of the brain.
- a wide variety of mental and physical processes are controlled or influenced by neural activity in particular regions of the brain.
- the neural-functions in some areas of the brain i.e., the sensory or motor cortices
- the neural-functions in some areas of the brain are organized according to physical or cognitive functions.
- the areas of the occipital lobes relate to vision
- the regions of the left interior frontal lobes relate to language
- the regions of the cerebral cortex appear to be consistently involved with conscious awareness, memory, and intellect.
- Strokes are generally caused by emboli (e.g., obstruction of a vessel), hemorrhages (e.g., rupture of a vessel), or thrombi (e.g., clotting) in the vascular system of a specific region of the brain, which in turn generally cause a loss or impairment of a neural function (e.g., neural functions related to facial muscles, limbs, speech, etc.).
- a neural function e.g., neural functions related to facial muscles, limbs, speech, etc.
- Stroke patients are typically treated using various forms of physical therapy to rehabilitate the loss of function of a limb or another affected body part. Stroke patients may also be treated using physical therapy plus drug treatment. For most patients, however, such treatments are not sufficient, and little can be done to improve the function of an affected body part beyond the limited recovery that generally occurs naturally without intervention.
- the neural activity in the brain can be influenced by electrical energy that is supplied from a waveform generator or other type of device.
- Various patient perceptions and/or neural functions can thus be promoted or disrupted by applying an electrical current to the cortex or other region of the brain.
- researchers have attempted to treat various neurological conditions using electrical or magnetic stimulation signals to control or affect brain functions.
- Neural activity is governed by electrical impulses or “action potentials” generated in and propagated by neurons. While in a quiescent state, a neuron is negatively polarized, and exhibits a resting membrane potential that is typically between ⁇ 70 and ⁇ 60 mV. Through electrical or chemical connections known as synapses, any given neuron receives from other neurons excitatory and inhibitory input signals or stimuli. A neuron integrates the excitatory and inhibitory input signals it receives, and generates or fires a series of action potentials in the event that the integration exceeds a threshold potential. A neural firing threshold may be, for example, approximately ⁇ 55 mV. Action potentials propagate to the neuron's synapses, where they are conveyed to other neurons to which the neuron is synaptically connected.
- a neural stimulation signal may comprise a series or train of electrical or magnetic pulses that deliver an energy dose to neurons within a target neural population.
- the stimulation signal may be defined or described in accordance with stimulation signal parameters including pulse amplitude, pulse frequency, duty cycle, stimulation signal duration, and/or other parameters.
- Electrical or magnetic stimulation signals applied to a population of neurons can depolarize neurons within the population toward their threshold potentials. Depending upon stimulation signal parameters, this depolarization can cause neurons to generate or fire action potentials.
- Neural stimulation that elicits or induces action potentials in a functionally significant proportion of the neural population to which the stimulation is applied is referred to as supra-threshold stimulation; neural stimulation that fails to elicit action potentials in a functionally significant proportion of the neural population is defined as sub-threshold stimulation.
- supra-threshold stimulation of a neural population triggers or activates one or more functions associated with the neural population, but sub-threshold stimulation by itself fails to trigger or activate such functions.
- Supra-threshold neural stimulation can induce various types of measurable or monitorable responses in a patient. For example, supra-threshold stimulation applied to a patient's motor cortex can induce muscle fiber contractions.
- neural stimulation may be directed toward producing an intended type of neural activity, such stimulation may result in unintended collateral neural activity.
- neural stimulation for treating a condition can induce seizure activity or other types of collateral neural activity. It will be appreciated that such collateral neural activity is undesirable and/or inconvenient in a neural stimulation situation.
- Seizure activity may originate at a seizure focus, which is typically a collection of neurons (e.g., on the order of 1000 neurons) exhibiting a characteristic type of synchronous firing activity.
- a seizure focus typically a collection of neurons (e.g., on the order of 1000 neurons) exhibiting a characteristic type of synchronous firing activity.
- each neuron within a seizure focus exhibits a firing response known as a paroxysmal depolarizing shift (PDS).
- PDS paroxysmal depolarizing shift
- Properly functioning feedback and/or feed-forward inhibitory signaling mechanisms cause afterhyperpolarization through which the neuron's membrane potential returns to a hyperpolarized state below its firing threshold. Following afterhyperpolarization, the neuron may undergo another PDS.
- Various systems and/or devices directed toward treating neurological conditions exist, including those capable of detecting and responding to particular types of neurological events.
- some neural stimulators attempt to treat involuntary motion disorders such as Parkinson's disease by applying stimulation signals to the thalamus or other area of a patient's brain.
- U.S. Pat. No. 6,134,474 describes an implantable device capable of detecting a neurological event, such as seizure activity, and generating a responsive electrical signal intended to terminate the detected event.
- European Patent Application Publication EP1145736 describes an implantable device capable of detecting electrical activity in the brain; applying a nonresponsive signal to reduce the likelihood of a seizure occurring; and applying a responsive signal in the event that epileptiform activity is detected.
- present neural stimulation systems and methods fail to automatically detect and/or respond to seizure activity or other collateral neural activity induced in association with and/or as a result of neural stimulation procedures directed toward purposes other than epileptic seizure management.
- conventional neural stimulation systems fail to automatically detect seizure activity induced by neural stimulation procedures directed toward patient neural function rehabilitation and/or enhancement, or modulation of patient sensory perceptions.
- FIG. 1 is a schematic illustration of a neural stimulation system responsive to specific neural activity according to an embodiment of the invention.
- FIG. 2 is a graph illustrating several parameters that may describe or characterize a stimulation signal.
- FIG. 3A is a plan view of a grid electrode configured as a stimulation interface according to an embodiment of the invention.
- FIG. 3B is a plan view of an implantable stimulation and monitoring interface configured for stimulating a target neural population and detecting signals corresponding to specific neural activity according to an embodiment of the invention.
- FIG. 4 is a flowchart of a neural stimulation process responsive to specific neural activity according to an embodiment of the invention.
- FIG. 5 is a flowchart of a neural stimulation process responsive to specific neural activity according to another embodiment of the invention.
- FIG. 6 is a flowchart of a neural stimulation process responsive to specific neural activity according to another embodiment of the invention.
- a neural stimulation procedure may involve the application of stimuli to one or more target neural populations within a patient, and may be directed toward rehabilitating, restoring, and/or enhancing one or more neural functions in the patient by facilitating and/or effectuating a neuroplastic change or reorganization.
- a neural stimulation procedure may alternatively or additionally be directed toward modulating or ameliorating a patient sensory perception such as pain, or affecting a neurological condition that is present on a continuous or essentially continuous basis in the absence of the applied stimuli.
- Collateral neural activity may comprise seizure activity, migraine activity, and/or essentially any other type of neural activity that may be undesirable, unwanted, unintended, and/or counterproductive relative to an intended or desired neural activity or outcome associated with the neural stimulation procedure.
- FIG. 1 is a schematic illustration of a neural stimulation system 100 for detecting and responding to collateral neural activity according to an embodiment of the invention.
- the system 100 comprises a stimulus unit 140 configured to deliver stimulation signals to a patient 190 using a stimulation interface 110 .
- the system 100 may additionally comprise a sensing unit 180 configured to identify or detect parameters associated with collateral neural activity in the patient 190 using a monitoring interface 112 .
- the sensing unit 180 is configured to communicate with the stimulus unit 140 upon detection of collateral neural activity and/or periodically throughout a stimulation procedure.
- the stimulus unit 140 may be coupled to the stimulation interface 110 by a first link 114 ; the monitoring interface 112 may be coupled to the sensing unit 180 by a second link 116 ; and the sensing unit 180 may be coupled to the stimulus unit 140 by a third link 118 , where one or more of such links 114 , 116 , 118 may be wire-based or wireless.
- stimulation signals may include treatment signals and/or response signals.
- Treatment signals may comprise electrical and/or magnetic stimuli applied to one or more target neural populations and directed toward treating and/or rehabilitating one or more neurological conditions.
- the treatment signals may also affect or influence particular types of neurological activity.
- treatment signals may be directed toward affecting or altering one or more neurological conditions that exist within the patient 190 on a continuous, essentially continuous, or nearly continuous basis (i.e., non-intermittent or essentially non-intermittent through potentially cyclical) in the absence of the treatment signal.
- Treatment signals may be directed toward facilitating and/or effectuating neuroplasticity in the patient 190 , for example, in a manner described in U.S. patent application Ser.
- Treatment signals may alternatively or additionally be directed toward affecting or modulating a patient sensation such as pain; or eliminating or ameliorating the effects of neurodegenerative disorders, for example, involuntary movements and/or other symptoms associated with Parkinson's disease.
- response signals may comprise electrical, magnetic, and/or other (e.g., sonic or vibratory) stimuli directed toward disrupting, desynchronizing, abating, and/or eliminating collateral neural activity arising in association with or as a result of the application of treatment signals to the patient 190 .
- response signals may be applied proximate or directly to one or more target neural populations and/or particular patient sensory systems or body locations.
- electromagnetic response signals considers electromagnetic response signals; however, the present invention may employ other or additional types of response signals in a manner understood by those skilled in the art.
- FIG. 2 is a graph illustrating several parameters that may define, describe, or characterize stimulation signals.
- a stimulus start time t 0 defines an initial point at which a stimulation signal is applied to the stimulation interface 110 .
- the stimulation signal may be a biphasic waveform comprising a series of biphasic pulses, and which may be defined, characterized, or described by parameters including a pulse width t 1 for a first pulse phase; a pulse width t 2 for a second pulse phase; and a pulse width t 3 for a single biphasic pulse.
- the parameters can also include a stimulus repetition rate 1/t 4 corresponding to a pulse repetition frequency; a stimulus pulse duty cycle equal to t 3 divided by t 4 ; a stimulus burst time t 5 that defines a number of pulses in a pulse train; and/or a pulse train repetition rate 1/t 6 that defines a stimulus burst frequency.
- Other parameters include a peak current intensity I 1 for the first pulse phase and a peak current intensity I 2 for the second pulse phase.
- pulse intensity or amplitude may decay during one or both pulse phases, and a pulse may be a charge-balanced waveform.
- pulses can be monophasic or polyphasic.
- Additional stimulation parameters may include applying the stimulation to selected configurations of the stimulation interface 110 for any given stimulation signal and/or time.
- the stimulus unit 140 comprises a controller 150 , a pulse system 160 , and a set of controls/indicators 170 .
- the controller 150 may include a processor, a memory, and a programmable computer medium.
- the controller 150 may be implemented as a computer or microcontroller, and the programmable medium can be hardware and/or memory resident software that performs, directs, and/or facilitates neural stimulation procedures in accordance with the present invention.
- the controls/indicators 170 can include a graphic user interface, an input/output device, and/or other types of interface elements for exchanging commands and/or output with the controller 150 .
- the pulse system 160 selectively generates stimulation signals and sends, directs, or delivers such stimuli to the stimulation interface 110 .
- the pulse system 160 may be implanted into the patient 190 , in a manner described in U.S. application Ser. No. 09/802,808 incorporated herein by reference.
- the pulse system 160 may be an external unit capable of delivering stimulation signals to the stimulation interface 110 using RF energy, electromagnetism, or wire terminals exposed on the patient's scalp.
- the stimulation interface 110 may comprise one or more stimulus delivery devices configured to apply treatment signals and/or response signals to the patient 190 .
- the stimulation interface 110 may comprise a type of neural-stimulation device described in U.S. application Ser. No. 09/802,808.
- the pulse system 160 is a component of a Transcranial Magnetic Stimulation (TMS) device that delivers magnetic stimulation signals to a patient 190 .
- TMS Transcranial Magnetic Stimulation
- the stimulation interface 110 in this embodiment may comprise an electromagnetic coil arrangement in a manner understood by those skilled in the art.
- the pulse system 160 forms a portion of an electrical stimulation device.
- the stimulation interface 110 of this embodiment may comprise an electrode arrangement or configuration capable of delivering electrical stimulation signals to the patient 190 .
- the stimulation interface 110 may be implanted into the patient 190 to provide cortical stimulation, deep brain stimulation, and/or other types of neural stimulation.
- Various portions or elements of the stimulation interface 110 may be configured to deliver treatment signals only, response signals only, or either treatment or response signals.
- One or more portions of the stimulation interface 110 may reside upon or proximate to one or more target neural populations in and/or through which a) neuroplasticity may be occurring and/or may be expected to occur; and/or b) a patient sensation such as pain may be modulated or influenced.
- FIG. 3A is a plan view of an exemplary grid electrode 120 capable of implementing one or more portions of a stimulation interface 110 according to an embodiment of the invention.
- the grid electrode 120 comprises a support member or substrate 122 that carries a plurality of electrical contacts 124 . Those skilled in the art will understand that the number of contacts 124 may vary in accordance with embodiment details.
- the grid electrode 120 further comprises a set of leads (not shown) that couple the contacts 124 to the pulse system 160 in a manner understood by those skilled in the art.
- a grid electrode 120 of the type shown in FIG. 3A is available from AdTech Medical Instrument Corporation of Racine, Wis. (www.adtechmedical.com).
- the contacts 124 can be divided so that one group of contacts 124 delivers treatment signals while another group of contacts 124 delivers response signals.
- a central contact group 126 may deliver treatment signals to a target neural population while an outer contact group 128 may deliver response signals in a manner that may enhance or promote surround inhibition.
- response signals may be delivered in a time-shared or a concurrent manner relative to treatment signal delivery.
- the grid electrode 120 may be configured to deliver treatment signals or response signals to all contacts 124 in a time-shared manner, or configured to deliver treatment signals only or response signals only.
- the sensing unit 180 comprises a system, device, or apparatus configured to detect or identify collateral neural activity or parameters of such activity that occur in association with and/or as a result of a neural stimulation procedure.
- the sensing unit 180 may include a processor, a memory, and a programmable computer medium.
- the programmable medium of the sensing unit 180 can comprise hardware and/or software capable of analyzing signals corresponding to neural activity and determining whether collateral neural activity or evidence of such activity exists.
- the sensing unit 180 may communicate with the stimulus unit 140 upon detecting collateral neural activity so that the stimulus unit 140 may respond to the sensing unit 180 .
- the sensing unit 180 may monitor for collateral neural activity or evidence of such activity on a periodic or continuous basis.
- the sensing unit 180 can operate under the direction of or in cooperation with the controller 150 . Communication between the stimulus unit 140 and the sensing unit 180 may occur through the third link 118 . Such communication may involve the exchange of operational parameters, synchronization information, status information, and/or information associated with the detection of collateral neural activity.
- the sensing unit 180 may receive from the monitoring interface 112 one or more types of physiological signals and/or physiological correlate signals useful for indicating the presence of collateral neural activity. In general, a meaningful, significant and/or sustained change in a physiological or physiological correlate signal relative to the signal's normal or background behavior can indicate the onset and/or occurrence of collateral neural activity.
- the sensing unit 180 may comprise hardware and/or software that performs signal filtering, processing, and/or analysis operations. Depending upon the nature of the physiological and/or physiological correlate signals under consideration, the sensing unit 180 and/or the monitoring interface 112 may exhibit various embodiments.
- the monitoring interface 112 can have several embodiments. For example, one or more portions of the monitoring interface 112 may be oriented or positioned relative or proximate to a set of target neural populations to which a neural stimulation procedure is directed so that the monitoring interface 112 may detect or receive signals corresponding or related to such neural populations. Alternatively or additionally, one or more portions of the monitoring interface 112 may be oriented or positioned within or upon the patient's body to detect one or more types of patient responses correlated to neural activity.
- the sensing unit 180 comprises an electroencephalogram (EEG) monitoring and/or analysis device and the monitoring interface 112 comprises one or more surface, cortical, and/or subcortical electrodes, electrode arrays, and/or electrical probes capable of receiving or detecting EEG signals.
- EEG electroencephalogram
- the sensing unit 180 may analyze EEG signals received from the monitoring interface 112 and determine whether collateral neural activity or evidence of such activity exists.
- EEG activity such as interictal spikes and/or energy spectrum shifts, may be indicative of seizure activity.
- CBF cerebral blood flow
- the monitoring unit 112 may comprise a CBF monitor, which may include a set of electrodes, a thermistor, and/or a thermal diffusion probe; a set of near infrared sources and sensors; a set of piezoelectric ultrasonic emitters and sensors (to facilitate, for example, transit time measurements); and/or one or more other types of CBF monitoring devices.
- the sensing unit 180 may comprise a CBF signal analysis system or device.
- the monitoring unit 112 may comprise a neural tissue oxygenation monitor, and the sensing unit 180 may correspondingly comprise a neural tissue oxygenation analysis system or device.
- the sensing unit 180 comprises an electromyography (EMG) device configured to detect, monitor, and/or analyze motor evoked potentials (MEPs) associated with muscle fiber innervation, in a manner understood by those skilled in the art.
- EMG electromyography
- MEPs motor evoked potentials
- the monitoring interface 112 correspondingly comprises a set of surface, percutaneous, and/or implanted electrodes or probes that may be positioned or configured to measure electrical activity associated with the innervation of one or more muscles and/or muscle groups.
- the sensing unit 180 comprises a motion analysis system and the monitoring interface 112 comprises a set of motion detectors, strain gauges, and/or accelerometers configured to detect or monitor one or more types of patient movements.
- the sensing unit 180 may analyze motion signals received from the monitoring interface 112 and determine whether patient motions under consideration are indicative of seizure activity.
- the sensing unit 180 and monitoring interface 112 may comprise one or more types of neural imaging systems, such as a functional Magnetic Resonance Imaging (fMRI) system, a Positron Emission Tomography (PET) system, and/or a Magnetoencephalography (MEG) system.
- fMRI Magnetic Resonance Imaging
- PET Positron Emission Tomography
- MEG Magnetoencephalography
- the sensing unit 180 and/or the monitoring interface 112 may be configured to receive, detect, monitor, measure, and/or analyze one or more types of signals useful of indicating the presence of collateral neural activity.
- the stimulation interface 110 and the monitoring interface 112 may be implemented as devices and/or modules that reside upon physically separate substrates or carriers positioned within and/or upon the patient 190 . Alternatively or additionally, one or more portions of such interfaces 110 , 112 may be implemented together upon a single implantable carrier or substrate.
- FIG. 3B is a plan view of an implantable stimulation and monitoring interface 130 configured for stimulating a target neural population and detecting signals corresponding to neural activity according to an embodiment of the invention.
- the stimulation and monitoring interface 130 comprises a support member 132 carrying a stimulating element 134 and a monitoring element 136 .
- the stimulating element 134 may comprise one or more electrodes organized in accordance with a particular pattern, and the monitoring element 126 may comprise a set of electrodes and/or a CBF monitoring device positioned proximate or adjacent to the stimulating element 134 .
- a set of leads 138 may couple the stimulating element 134 and the monitoring element 136 to the stimulus unit 140 and the sensing unit 180 , respectively.
- a stimulation and monitoring interface 120 may be positioned or oriented within a patient 190 such that a stimulating element 124 can deliver or apply stimulation signals to one or more particular target neural populations, and the monitoring element 126 can detect signals indicative of neural activity associated with the targeted neural populations.
- one or more portions of the monitoring interface 112 may comprise an electrode arrangement, which may include a grid electrode 120 of the type shown in FIG. 3A , a deep brain electrode, and/or one or more other electrode types.
- a stimulation and monitoring interface 130 may comprise a grid electrode 120 of the type shown in FIG. 3A .
- particular contacts 124 within the grid electrode 120 may be designated for neural activity monitoring and other contacts 124 may be configured to deliver treatment and/or response signals.
- the delivery of stimulation signals to a target neural population may interfere with the detection of signals corresponding to neural activity.
- the controller 150 and/or the pulse system 160 may periodically interrupt a neural stimulation procedure, such that during stimulation procedure interruptions, the sensing unit 180 may analyze signals received from the monitoring interface 112 relative to collateral neural activity. Outside of such interruptions, the sensing unit 180 may be prevented from receiving or processing signals received from the monitoring interface 112 .
- the sensing unit 180 may compensate for the presence of stimulation signals, for example, through signal subtraction and/or other compensation operations, to facilitate detection of collateral neural activity or evidence of collateral neural activity simultaneous with the delivery of stimulation signals to a target neural population.
- the stimulation and monitoring interface 120 may be implemented using a single electrode arrangement or configuration in which any given electrode element used to deliver stimulation signals during the neural stimulation procedure may also be used to detect neural activity during a neural stimulation procedure interruption.
- the stimulation interface 110 and the monitoring interface 112 may physically be one and the same.
- One or more portions of the controller 150 , the pulse system 160 , the stimulation interface 110 , monitoring interface 112 , and/or the sensing unit 180 can be integrated into a single implantable stimulation delivery, monitoring, and/or management apparatus in a manner identical analogous or similar to the devices described in U.S. application Ser. No. 09/802,808.
- Such an integrated apparatus may be configured for implantation into a patient's skull so that the stimulation interface 110 and/or the monitoring interface 112 can contact the patient's dura matter or pia matter in one or more cortical regions.
- An integrated apparatus of this type can have an internal power source that can be implanted into the patient 190 , and/or an external power source coupled to the pulse system 160 via electromagnetic coupling or a direct connection.
- FIG. 4 is a flowchart of a neural stimulation process 400 responsive to collateral neural activity according to an embodiment of the invention.
- the process 400 begins with a stimulation operation 402 by initiating or continuing a neural stimulation procedure in which stimulation signals are delivered to one or more target neural populations within a patient 190 in accordance with a given set of stimulation signal parameters.
- the process 400 also includes a detection query 404 that determines whether collateral neural activity or evidence of such activity exists.
- the detection query 404 may be performed in a simultaneous or sequential manner relative to the stimulation operation 402 . If collateral neural activity or evidence thereof does not exist, the process 400 continues with a termination query 406 that decides whether the neural stimulation procedure is complete.
- the process 400 returns to the stimulation operation 402 ; otherwise, if the process 400 is complete, it is terminated. If the detection query 404 the process 400 determines that collateral neural activity exists, the process 400 halts the neural stimulation procedure in a termination operation 410 , and generates and/or issues a notification signal indicative of such activity in a notification procedure 412 . Following the notification procedure 412 , the process 400 ends.
- FIG. 5 is a flowchart of a neural stimulation process 500 responsive to collateral neural activity according to another embodiment of the invention.
- the process 500 begins with a stimulation operation 502 by initiating or continuing a neural stimulation procedure in which stimulation signals are delivered to one or more target neural populations within a patient 190 in accordance with a first set of stimulation signal parameters.
- the process 500 includes a detection query 504 that determines whether collateral neural activity or evidence thereof exists. If not, the process 500 proceeds to a termination query 506 to determine whether the neural stimulation procedure is complete. If the neural stimulation procedure is not complete, the process 500 returns to the stimulation procedure 502 ; otherwise, the stimulation process 500 is terminated.
- the process 500 includes a termination operation 510 that halts the neural stimulation procedure and a notification procedure 512 that generates and/or issues a notification signal indicative of such activity.
- the stimulation process 500 proceeds to a collateral activity query 520 that subsequently determines whether the collateral neural activity has been abated or eliminated. If so, the process 500 proceeds to a query 530 that determines whether to resume the neural stimulation procedure.
- Such a determination may be based upon, for example, an elapsed time between initiation of a neural stimulation procedure and detection of collateral neural activity; stored information characterizing and/or specifying frequency and/or history information associated with detection of collateral neural activity in the patient 190 undergoing the neural stimulation procedure; an authorization signal received from a doctor or therapist through the controls/indicators 170 ; and/or other information.
- the process 500 continues with a modification operation 532 in which one or more stimulation signal parameters may be modified.
- a modification may involve changing (e.g., decreasing) a stimulation current level or intensity; changing (e.g., increasing) a stimulation signal pulse repetition frequency; and/or modifying one or more other parameters shown in FIG. 2 .
- the process 500 includes time query 534 to determine whether a minimum time interval has elapsed.
- the time query 534 may provide a quiescent period during which the patient's neural activity becomes predominantly normal and/or representative of an acceptable baseline condition. If a minimum time interval has not elapsed, the process 500 remains at the time query 534 ; otherwise, the process 500 returns to the stimulation operation 502 .
- the process 500 proceeds with a response query 540 that determines whether to apply to the patient 190 one or more response signals directed toward abating or terminating the collateral neural activity. If not, the process 500 ends. Otherwise, the process 500 proceeds with a signal selection procedure 542 that determines one or more appropriate response signal types and corresponding signal parameters, and a response procedure 544 that applies one or more response signals to the patient 190 .
- Response signals may include one or more neural stimulation and/or other types of signals applied to the patient 190 through the stimulation interface 110 . Following the response procedure 544 , the process 500 returns to the stimulation operation 520 .
- a neural stimulation procedure in accordance with the present invention may facilitate and/or effectuate neuroplastic change or reorganization within a patient 190 , which in turn may rehabilitate, restore, and/or enhance one or more patient neural functions and/or behaviors.
- a neural stimulation procedure may be performed cooperatively with a behavioral therapy, such as described in U.S. application Ser. No. 90/802,808.
- a behavioral therapy may encompass, for example, physical therapy, cognitive therapy, and/or a variety of behavioral tasks.
- FIG. 6 is a flowchart of a neural stimulation process 600 responsive to collateral neural activity according to another embodiment of the invention.
- the process 600 begins with a stimulation operation 602 by initiating or continuing a neural stimulation procedure in conjunction or association with a behavioral therapy.
- stimulation signals are delivered to one or more target neural populations within a patient 190 in accordance with a first set of stimulation signal parameters.
- other steps within the process 600 may proceed in manners described above with reference to FIG. 5 .
Abstract
A neural stimulation system responsive to collateral neural activity that may arise in association with a neural stimulation procedure includes a stimulation interface configured to deliver stimulation signals to a target neural population, a monitoring interface positioned to receive signals corresponding to a neural activity within the target neural population, a stimulus unit coupled to deliver stimulation singals to the stimulation interface, and a sensing unit coupled to the monitoring device and the stimulus unit. The neural stimulation procedure may be directed toward rehabilitating, restoring, and/or enhancing one or more neural functions by facilitating and/or effectuating a neuroplastic change or reorganization; and/or affecting a neurological condition that exists on a continuous or essentially continuous basis absent the stimulation procedure. The sensing unit determines whether evidence of an collateral neural activity exists, whereupon the stimulus unit attempts to abate the collateral neural activity.
Description
- This application is a continuation of Ser. No. 12/941,577, filed Nov. 8, 2010, pending, which is a divisional of U.S. application Ser. No. 10/271,394, filed Oct. 15, 2002, now U.S. Pat. No. 7,831,305, which is a continuation-in-part of U.S. application Ser. No. 09/978,134, filed Oct. 15, 2001, now U.S. Pat. No. 7,305,268, which is a continuation-in-part of U.S. application Ser. No. 09/802,808, filed Mar. 8, 2001, which claims the benefit of U.S. Provisional Application No. 60/217,981, filed Jul. 13, 2000, the disclosures of which are incorporated herein by reference.
- The present disclosure is related to systems and methods for detecting and responding to collateral neural activity that may arise in association with or as a result of stimulation applied to a region of the cortex or other area of the brain.
- A wide variety of mental and physical processes are controlled or influenced by neural activity in particular regions of the brain. For example, the neural-functions in some areas of the brain (i.e., the sensory or motor cortices) are organized according to physical or cognitive functions. There are also several other areas of the brain that appear to have distinct functions in most individuals. In the majority of people, for example, the areas of the occipital lobes relate to vision, the regions of the left interior frontal lobes relate to language, and the regions of the cerebral cortex appear to be consistently involved with conscious awareness, memory, and intellect.
- Many problems or abnormalities with body functions can be caused by damage, disease and/or disorders in the brain. Effectively treating such abnormalities may be very difficult. For example, a stroke is a very common condition that damages the brain. Strokes are generally caused by emboli (e.g., obstruction of a vessel), hemorrhages (e.g., rupture of a vessel), or thrombi (e.g., clotting) in the vascular system of a specific region of the brain, which in turn generally cause a loss or impairment of a neural function (e.g., neural functions related to facial muscles, limbs, speech, etc.). Stroke patients are typically treated using various forms of physical therapy to rehabilitate the loss of function of a limb or another affected body part. Stroke patients may also be treated using physical therapy plus drug treatment. For most patients, however, such treatments are not sufficient, and little can be done to improve the function of an affected body part beyond the limited recovery that generally occurs naturally without intervention.
- The neural activity in the brain can be influenced by electrical energy that is supplied from a waveform generator or other type of device. Various patient perceptions and/or neural functions can thus be promoted or disrupted by applying an electrical current to the cortex or other region of the brain. As a result, researchers have attempted to treat various neurological conditions using electrical or magnetic stimulation signals to control or affect brain functions.
- Neural activity is governed by electrical impulses or “action potentials” generated in and propagated by neurons. While in a quiescent state, a neuron is negatively polarized, and exhibits a resting membrane potential that is typically between −70 and −60 mV. Through electrical or chemical connections known as synapses, any given neuron receives from other neurons excitatory and inhibitory input signals or stimuli. A neuron integrates the excitatory and inhibitory input signals it receives, and generates or fires a series of action potentials in the event that the integration exceeds a threshold potential. A neural firing threshold may be, for example, approximately −55 mV. Action potentials propagate to the neuron's synapses, where they are conveyed to other neurons to which the neuron is synaptically connected.
- A neural stimulation signal may comprise a series or train of electrical or magnetic pulses that deliver an energy dose to neurons within a target neural population. The stimulation signal may be defined or described in accordance with stimulation signal parameters including pulse amplitude, pulse frequency, duty cycle, stimulation signal duration, and/or other parameters. Electrical or magnetic stimulation signals applied to a population of neurons can depolarize neurons within the population toward their threshold potentials. Depending upon stimulation signal parameters, this depolarization can cause neurons to generate or fire action potentials. Neural stimulation that elicits or induces action potentials in a functionally significant proportion of the neural population to which the stimulation is applied is referred to as supra-threshold stimulation; neural stimulation that fails to elicit action potentials in a functionally significant proportion of the neural population is defined as sub-threshold stimulation. In general, supra-threshold stimulation of a neural population triggers or activates one or more functions associated with the neural population, but sub-threshold stimulation by itself fails to trigger or activate such functions. Supra-threshold neural stimulation can induce various types of measurable or monitorable responses in a patient. For example, supra-threshold stimulation applied to a patient's motor cortex can induce muscle fiber contractions.
- While electrical or magnetic stimulation of neural tissue may be directed toward producing an intended type of neural activity, such stimulation may result in unintended collateral neural activity. In particular, neural stimulation for treating a condition can induce seizure activity or other types of collateral neural activity. It will be appreciated that such collateral neural activity is undesirable and/or inconvenient in a neural stimulation situation.
- Seizure activity may originate at a seizure focus, which is typically a collection of neurons (e.g., on the order of 1000 neurons) exhibiting a characteristic type of synchronous firing activity. In particular, each neuron within a seizure focus exhibits a firing response known as a paroxysmal depolarizing shift (PDS). The PDS is a large magnitude, long duration depolarization that triggers a neuron to fire a train or burst of action potentials. Properly functioning feedback and/or feed-forward inhibitory signaling mechanisms cause afterhyperpolarization through which the neuron's membrane potential returns to a hyperpolarized state below its firing threshold. Following afterhyperpolarization, the neuron may undergo another PDS.
- Afterhyperpolarization limits the duration of the PDS, thereby helping to ensure that synchronous neural firing activity remains localized to the seizure focus. Inhibitory feedback signaling provided by neurons surrounding a seizure focus, commonly referred to as “surround inhibition,” is particularly important in constraining seizure activity to the seizure focus. In the event that inhibitory signaling mechanisms fail and/or are unable to overcome or counter PDS activity, neurons within the seizure focus recruit other neurons to which they are synaptically coupled into their synchronous firing pattern. As a result, synchronous firing activity spreads beyond the seizure focus to other areas of the brain. This can lead to a cascade effect in which seizure activity becomes increasingly widespread, and accompanying clinical manifestations become increasingly significant.
- In view of the foregoing, it may be important to detect and/or respond to seizure activity. Various systems and/or devices directed toward treating neurological conditions exist, including those capable of detecting and responding to particular types of neurological events. For example, some neural stimulators attempt to treat involuntary motion disorders such as Parkinson's disease by applying stimulation signals to the thalamus or other area of a patient's brain. As another example, U.S. Pat. No. 6,134,474 describes an implantable device capable of detecting a neurological event, such as seizure activity, and generating a responsive electrical signal intended to terminate the detected event. Additionally, European Patent Application Publication EP1145736 describes an implantable device capable of detecting electrical activity in the brain; applying a nonresponsive signal to reduce the likelihood of a seizure occurring; and applying a responsive signal in the event that epileptiform activity is detected.
- Unfortunately, present neural stimulation systems and methods fail to automatically detect and/or respond to seizure activity or other collateral neural activity induced in association with and/or as a result of neural stimulation procedures directed toward purposes other than epileptic seizure management. In particular, conventional neural stimulation systems fail to automatically detect seizure activity induced by neural stimulation procedures directed toward patient neural function rehabilitation and/or enhancement, or modulation of patient sensory perceptions.
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FIG. 1 is a schematic illustration of a neural stimulation system responsive to specific neural activity according to an embodiment of the invention. -
FIG. 2 is a graph illustrating several parameters that may describe or characterize a stimulation signal. -
FIG. 3A is a plan view of a grid electrode configured as a stimulation interface according to an embodiment of the invention. -
FIG. 3B is a plan view of an implantable stimulation and monitoring interface configured for stimulating a target neural population and detecting signals corresponding to specific neural activity according to an embodiment of the invention. -
FIG. 4 is a flowchart of a neural stimulation process responsive to specific neural activity according to an embodiment of the invention. -
FIG. 5 is a flowchart of a neural stimulation process responsive to specific neural activity according to another embodiment of the invention. -
FIG. 6 is a flowchart of a neural stimulation process responsive to specific neural activity according to another embodiment of the invention. - The following disclosure describes a system and method for detecting and responding to collateral neural activity that may arise in association with and/or as a result of a neural stimulation procedure. In the context of the present invention, a neural stimulation procedure may involve the application of stimuli to one or more target neural populations within a patient, and may be directed toward rehabilitating, restoring, and/or enhancing one or more neural functions in the patient by facilitating and/or effectuating a neuroplastic change or reorganization. A neural stimulation procedure may alternatively or additionally be directed toward modulating or ameliorating a patient sensory perception such as pain, or affecting a neurological condition that is present on a continuous or essentially continuous basis in the absence of the applied stimuli. Collateral neural activity may comprise seizure activity, migraine activity, and/or essentially any other type of neural activity that may be undesirable, unwanted, unintended, and/or counterproductive relative to an intended or desired neural activity or outcome associated with the neural stimulation procedure.
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FIG. 1 is a schematic illustration of aneural stimulation system 100 for detecting and responding to collateral neural activity according to an embodiment of the invention. In one embodiment, thesystem 100 comprises astimulus unit 140 configured to deliver stimulation signals to a patient 190 using astimulation interface 110. Thesystem 100 may additionally comprise asensing unit 180 configured to identify or detect parameters associated with collateral neural activity in the patient 190 using amonitoring interface 112. Thesensing unit 180 is configured to communicate with thestimulus unit 140 upon detection of collateral neural activity and/or periodically throughout a stimulation procedure. Thestimulus unit 140 may be coupled to thestimulation interface 110 by afirst link 114; themonitoring interface 112 may be coupled to thesensing unit 180 by asecond link 116; and thesensing unit 180 may be coupled to thestimulus unit 140 by athird link 118, where one or more ofsuch links - The
stimulus unit 140 generates and outputs stimulation signals. As considered herein, stimulation signals may include treatment signals and/or response signals. Treatment signals may comprise electrical and/or magnetic stimuli applied to one or more target neural populations and directed toward treating and/or rehabilitating one or more neurological conditions. The treatment signals may also affect or influence particular types of neurological activity. In general, treatment signals may be directed toward affecting or altering one or more neurological conditions that exist within the patient 190 on a continuous, essentially continuous, or nearly continuous basis (i.e., non-intermittent or essentially non-intermittent through potentially cyclical) in the absence of the treatment signal. Treatment signals may be directed toward facilitating and/or effectuating neuroplasticity in the patient 190, for example, in a manner described in U.S. patent application Ser. No. 09/978,134, which is incorporated herein by reference. Treatment signals may alternatively or additionally be directed toward affecting or modulating a patient sensation such as pain; or eliminating or ameliorating the effects of neurodegenerative disorders, for example, involuntary movements and/or other symptoms associated with Parkinson's disease. - In general, response signals may comprise electrical, magnetic, and/or other (e.g., sonic or vibratory) stimuli directed toward disrupting, desynchronizing, abating, and/or eliminating collateral neural activity arising in association with or as a result of the application of treatment signals to the patient 190. Depending upon their nature, response signals may be applied proximate or directly to one or more target neural populations and/or particular patient sensory systems or body locations. The description that follows considers electromagnetic response signals; however, the present invention may employ other or additional types of response signals in a manner understood by those skilled in the art.
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FIG. 2 is a graph illustrating several parameters that may define, describe, or characterize stimulation signals. A stimulus start time t0 defines an initial point at which a stimulation signal is applied to thestimulation interface 110. In one embodiment, the stimulation signal may be a biphasic waveform comprising a series of biphasic pulses, and which may be defined, characterized, or described by parameters including a pulse width t1 for a first pulse phase; a pulse width t2 for a second pulse phase; and a pulse width t3 for a single biphasic pulse. The parameters can also include astimulus repetition rate 1/t4 corresponding to a pulse repetition frequency; a stimulus pulse duty cycle equal to t3 divided by t4; a stimulus burst time t5 that defines a number of pulses in a pulse train; and/or a pulsetrain repetition rate 1/t6 that defines a stimulus burst frequency. Other parameters include a peak current intensity I1 for the first pulse phase and a peak current intensity I2 for the second pulse phase. Those skilled in the art will understand that pulse intensity or amplitude may decay during one or both pulse phases, and a pulse may be a charge-balanced waveform. Those skilled in the art will further understand that in an alternate embodiment, pulses can be monophasic or polyphasic. Additional stimulation parameters may include applying the stimulation to selected configurations of thestimulation interface 110 for any given stimulation signal and/or time. - In one embodiment, the
stimulus unit 140 comprises acontroller 150, apulse system 160, and a set of controls/indicators 170. Thecontroller 150 may include a processor, a memory, and a programmable computer medium. Thecontroller 150 may be implemented as a computer or microcontroller, and the programmable medium can be hardware and/or memory resident software that performs, directs, and/or facilitates neural stimulation procedures in accordance with the present invention. The controls/indicators 170 can include a graphic user interface, an input/output device, and/or other types of interface elements for exchanging commands and/or output with thecontroller 150. - The
pulse system 160 selectively generates stimulation signals and sends, directs, or delivers such stimuli to thestimulation interface 110. Thepulse system 160 may be implanted into the patient 190, in a manner described in U.S. application Ser. No. 09/802,808 incorporated herein by reference. Alternatively, thepulse system 160 may be an external unit capable of delivering stimulation signals to thestimulation interface 110 using RF energy, electromagnetism, or wire terminals exposed on the patient's scalp. Thestimulation interface 110 may comprise one or more stimulus delivery devices configured to apply treatment signals and/or response signals to the patient 190. Thestimulation interface 110 may comprise a type of neural-stimulation device described in U.S. application Ser. No. 09/802,808. - In one embodiment, the
pulse system 160 is a component of a Transcranial Magnetic Stimulation (TMS) device that delivers magnetic stimulation signals to a patient 190. Thestimulation interface 110 in this embodiment may comprise an electromagnetic coil arrangement in a manner understood by those skilled in the art. In another embodiment, thepulse system 160 forms a portion of an electrical stimulation device. Thestimulation interface 110 of this embodiment may comprise an electrode arrangement or configuration capable of delivering electrical stimulation signals to the patient 190. In such an embodiment, thestimulation interface 110 may be implanted into the patient 190 to provide cortical stimulation, deep brain stimulation, and/or other types of neural stimulation. - Various portions or elements of the
stimulation interface 110 may be configured to deliver treatment signals only, response signals only, or either treatment or response signals. One or more portions of thestimulation interface 110 may reside upon or proximate to one or more target neural populations in and/or through which a) neuroplasticity may be occurring and/or may be expected to occur; and/or b) a patient sensation such as pain may be modulated or influenced. -
FIG. 3A is a plan view of anexemplary grid electrode 120 capable of implementing one or more portions of astimulation interface 110 according to an embodiment of the invention. Thegrid electrode 120 comprises a support member orsubstrate 122 that carries a plurality ofelectrical contacts 124. Those skilled in the art will understand that the number ofcontacts 124 may vary in accordance with embodiment details. Thegrid electrode 120 further comprises a set of leads (not shown) that couple thecontacts 124 to thepulse system 160 in a manner understood by those skilled in the art. Agrid electrode 120 of the type shown inFIG. 3A is available from AdTech Medical Instrument Corporation of Racine, Wis. (www.adtechmedical.com). - The
contacts 124 can be divided so that one group ofcontacts 124 delivers treatment signals while another group ofcontacts 124 delivers response signals. For example, acentral contact group 126 may deliver treatment signals to a target neural population while anouter contact group 128 may deliver response signals in a manner that may enhance or promote surround inhibition. In such an embodiment, response signals may be delivered in a time-shared or a concurrent manner relative to treatment signal delivery. Alternatively, thegrid electrode 120 may be configured to deliver treatment signals or response signals to allcontacts 124 in a time-shared manner, or configured to deliver treatment signals only or response signals only. - The
sensing unit 180 comprises a system, device, or apparatus configured to detect or identify collateral neural activity or parameters of such activity that occur in association with and/or as a result of a neural stimulation procedure. Thesensing unit 180 may include a processor, a memory, and a programmable computer medium. The programmable medium of thesensing unit 180 can comprise hardware and/or software capable of analyzing signals corresponding to neural activity and determining whether collateral neural activity or evidence of such activity exists. Thesensing unit 180 may communicate with thestimulus unit 140 upon detecting collateral neural activity so that thestimulus unit 140 may respond to thesensing unit 180. Thesensing unit 180 may monitor for collateral neural activity or evidence of such activity on a periodic or continuous basis. Thesensing unit 180, for example, can operate under the direction of or in cooperation with thecontroller 150. Communication between thestimulus unit 140 and thesensing unit 180 may occur through thethird link 118. Such communication may involve the exchange of operational parameters, synchronization information, status information, and/or information associated with the detection of collateral neural activity. - The
sensing unit 180 may receive from themonitoring interface 112 one or more types of physiological signals and/or physiological correlate signals useful for indicating the presence of collateral neural activity. In general, a meaningful, significant and/or sustained change in a physiological or physiological correlate signal relative to the signal's normal or background behavior can indicate the onset and/or occurrence of collateral neural activity. Thesensing unit 180 may comprise hardware and/or software that performs signal filtering, processing, and/or analysis operations. Depending upon the nature of the physiological and/or physiological correlate signals under consideration, thesensing unit 180 and/or themonitoring interface 112 may exhibit various embodiments. - The
monitoring interface 112 can have several embodiments. For example, one or more portions of themonitoring interface 112 may be oriented or positioned relative or proximate to a set of target neural populations to which a neural stimulation procedure is directed so that themonitoring interface 112 may detect or receive signals corresponding or related to such neural populations. Alternatively or additionally, one or more portions of themonitoring interface 112 may be oriented or positioned within or upon the patient's body to detect one or more types of patient responses correlated to neural activity. - In one embodiment, the
sensing unit 180 comprises an electroencephalogram (EEG) monitoring and/or analysis device and themonitoring interface 112 comprises one or more surface, cortical, and/or subcortical electrodes, electrode arrays, and/or electrical probes capable of receiving or detecting EEG signals. Thesensing unit 180 may analyze EEG signals received from themonitoring interface 112 and determine whether collateral neural activity or evidence of such activity exists. Those skilled in the art will recognize that particular types of EEG activity, such as interictal spikes and/or energy spectrum shifts, may be indicative of seizure activity. - In addition to EEG signals, other types of physiological signals and/or physiological correlate signals may be useful for providing evidence of collateral neural activity. For example, signals corresponding to cerebral blood flow (CBF) may be used to indicate the onset or occurrence of seizure activity, as described by M. E. Weinand et al. in an article entitled “Cerebral blood flow and temporal lobe epileptogenicity” (J. Neurosurg. 1997 February; 86(2): 226-32). In one embodiment, the
monitoring unit 112 may comprise a CBF monitor, which may include a set of electrodes, a thermistor, and/or a thermal diffusion probe; a set of near infrared sources and sensors; a set of piezoelectric ultrasonic emitters and sensors (to facilitate, for example, transit time measurements); and/or one or more other types of CBF monitoring devices. In such an embodiment, thesensing unit 180 may comprise a CBF signal analysis system or device. In a related alternate embodiment, themonitoring unit 112 may comprise a neural tissue oxygenation monitor, and thesensing unit 180 may correspondingly comprise a neural tissue oxygenation analysis system or device. - Particular types of muscle fiber activity may also be indicative of collateral neural activity (e.g., extremely rapid muscle fiber contractions, particularly when sustained). In one embodiment, the
sensing unit 180 comprises an electromyography (EMG) device configured to detect, monitor, and/or analyze motor evoked potentials (MEPs) associated with muscle fiber innervation, in a manner understood by those skilled in the art. Themonitoring interface 112 correspondingly comprises a set of surface, percutaneous, and/or implanted electrodes or probes that may be positioned or configured to measure electrical activity associated with the innervation of one or more muscles and/or muscle groups. In another embodiment, thesensing unit 180 comprises a motion analysis system and themonitoring interface 112 comprises a set of motion detectors, strain gauges, and/or accelerometers configured to detect or monitor one or more types of patient movements. Thesensing unit 180 may analyze motion signals received from themonitoring interface 112 and determine whether patient motions under consideration are indicative of seizure activity. - In other embodiments, the
sensing unit 180 andmonitoring interface 112 may comprise one or more types of neural imaging systems, such as a functional Magnetic Resonance Imaging (fMRI) system, a Positron Emission Tomography (PET) system, and/or a Magnetoencephalography (MEG) system. In general, thesensing unit 180 and/or themonitoring interface 112 may be configured to receive, detect, monitor, measure, and/or analyze one or more types of signals useful of indicating the presence of collateral neural activity. - The
stimulation interface 110 and themonitoring interface 112 may be implemented as devices and/or modules that reside upon physically separate substrates or carriers positioned within and/or upon the patient 190. Alternatively or additionally, one or more portions ofsuch interfaces -
FIG. 3B is a plan view of an implantable stimulation andmonitoring interface 130 configured for stimulating a target neural population and detecting signals corresponding to neural activity according to an embodiment of the invention. In one embodiment, the stimulation andmonitoring interface 130 comprises asupport member 132 carrying astimulating element 134 and amonitoring element 136. Thestimulating element 134 may comprise one or more electrodes organized in accordance with a particular pattern, and themonitoring element 126 may comprise a set of electrodes and/or a CBF monitoring device positioned proximate or adjacent to thestimulating element 134. A set ofleads 138 may couple thestimulating element 134 and themonitoring element 136 to thestimulus unit 140 and thesensing unit 180, respectively. A stimulation andmonitoring interface 120 may be positioned or oriented within a patient 190 such that astimulating element 124 can deliver or apply stimulation signals to one or more particular target neural populations, and themonitoring element 126 can detect signals indicative of neural activity associated with the targeted neural populations. - As previously indicated, one or more portions of the
monitoring interface 112 may comprise an electrode arrangement, which may include agrid electrode 120 of the type shown inFIG. 3A , a deep brain electrode, and/or one or more other electrode types. As a result, a stimulation andmonitoring interface 130 may comprise agrid electrode 120 of the type shown inFIG. 3A . In such an embodiment,particular contacts 124 within thegrid electrode 120 may be designated for neural activity monitoring andother contacts 124 may be configured to deliver treatment and/or response signals. - Depending upon the nature of the
monitoring interface 112, the delivery of stimulation signals to a target neural population may interfere with the detection of signals corresponding to neural activity. As a result, thecontroller 150 and/or thepulse system 160 may periodically interrupt a neural stimulation procedure, such that during stimulation procedure interruptions, thesensing unit 180 may analyze signals received from themonitoring interface 112 relative to collateral neural activity. Outside of such interruptions, thesensing unit 180 may be prevented from receiving or processing signals received from themonitoring interface 112. Alternatively, thesensing unit 180 may compensate for the presence of stimulation signals, for example, through signal subtraction and/or other compensation operations, to facilitate detection of collateral neural activity or evidence of collateral neural activity simultaneous with the delivery of stimulation signals to a target neural population. - In embodiments in which a neural stimulation procedure is periodically interrupted to facilitate detection of collateral neural activity or evidence of such activity, the stimulation and
monitoring interface 120 may be implemented using a single electrode arrangement or configuration in which any given electrode element used to deliver stimulation signals during the neural stimulation procedure may also be used to detect neural activity during a neural stimulation procedure interruption. Thus, thestimulation interface 110 and themonitoring interface 112 may physically be one and the same. - One or more portions of the
controller 150, thepulse system 160, thestimulation interface 110,monitoring interface 112, and/or thesensing unit 180 can be integrated into a single implantable stimulation delivery, monitoring, and/or management apparatus in a manner identical analogous or similar to the devices described in U.S. application Ser. No. 09/802,808. Such an integrated apparatus may be configured for implantation into a patient's skull so that thestimulation interface 110 and/or themonitoring interface 112 can contact the patient's dura matter or pia matter in one or more cortical regions. An integrated apparatus of this type can have an internal power source that can be implanted into the patient 190, and/or an external power source coupled to thepulse system 160 via electromagnetic coupling or a direct connection. -
FIG. 4 is a flowchart of aneural stimulation process 400 responsive to collateral neural activity according to an embodiment of the invention. In one embodiment, theprocess 400 begins with astimulation operation 402 by initiating or continuing a neural stimulation procedure in which stimulation signals are delivered to one or more target neural populations within a patient 190 in accordance with a given set of stimulation signal parameters. After initiating thestimulation operation 402, theprocess 400 also includes adetection query 404 that determines whether collateral neural activity or evidence of such activity exists. Thedetection query 404 may be performed in a simultaneous or sequential manner relative to thestimulation operation 402. If collateral neural activity or evidence thereof does not exist, theprocess 400 continues with atermination query 406 that decides whether the neural stimulation procedure is complete. If the process is not complete, theprocess 400 returns to thestimulation operation 402; otherwise, if theprocess 400 is complete, it is terminated. If thedetection query 404 theprocess 400 determines that collateral neural activity exists, theprocess 400 halts the neural stimulation procedure in atermination operation 410, and generates and/or issues a notification signal indicative of such activity in anotification procedure 412. Following thenotification procedure 412, theprocess 400 ends. -
FIG. 5 is a flowchart of aneural stimulation process 500 responsive to collateral neural activity according to another embodiment of the invention. In one embodiment, theprocess 500 begins with astimulation operation 502 by initiating or continuing a neural stimulation procedure in which stimulation signals are delivered to one or more target neural populations within a patient 190 in accordance with a first set of stimulation signal parameters. Next, theprocess 500 includes adetection query 504 that determines whether collateral neural activity or evidence thereof exists. If not, theprocess 500 proceeds to atermination query 506 to determine whether the neural stimulation procedure is complete. If the neural stimulation procedure is not complete, theprocess 500 returns to thestimulation procedure 502; otherwise, thestimulation process 500 is terminated. - If collateral neural activity or evidence of such activity exists, the
process 500 includes atermination operation 510 that halts the neural stimulation procedure and anotification procedure 512 that generates and/or issues a notification signal indicative of such activity. Thestimulation process 500 proceeds to acollateral activity query 520 that subsequently determines whether the collateral neural activity has been abated or eliminated. If so, theprocess 500 proceeds to aquery 530 that determines whether to resume the neural stimulation procedure. Such a determination may be based upon, for example, an elapsed time between initiation of a neural stimulation procedure and detection of collateral neural activity; stored information characterizing and/or specifying frequency and/or history information associated with detection of collateral neural activity in the patient 190 undergoing the neural stimulation procedure; an authorization signal received from a doctor or therapist through the controls/indicators 170; and/or other information. - If resumption of the neural stimulation procedure is to occur, the
process 500 continues with amodification operation 532 in which one or more stimulation signal parameters may be modified. Such a modification may involve changing (e.g., decreasing) a stimulation current level or intensity; changing (e.g., increasing) a stimulation signal pulse repetition frequency; and/or modifying one or more other parameters shown inFIG. 2 . Following themodification operation 532, theprocess 500 includestime query 534 to determine whether a minimum time interval has elapsed. Thetime query 534 may provide a quiescent period during which the patient's neural activity becomes predominantly normal and/or representative of an acceptable baseline condition. If a minimum time interval has not elapsed, theprocess 500 remains at thetime query 534; otherwise, theprocess 500 returns to thestimulation operation 502. - If the
collateral activity query 520 determines that collateral neural activity has not been abated, theprocess 500 proceeds with aresponse query 540 that determines whether to apply to the patient 190 one or more response signals directed toward abating or terminating the collateral neural activity. If not, theprocess 500 ends. Otherwise, theprocess 500 proceeds with asignal selection procedure 542 that determines one or more appropriate response signal types and corresponding signal parameters, and aresponse procedure 544 that applies one or more response signals to the patient 190. Response signals may include one or more neural stimulation and/or other types of signals applied to the patient 190 through thestimulation interface 110. Following theresponse procedure 544, theprocess 500 returns to thestimulation operation 520. - As previously indicated, a neural stimulation procedure in accordance with the present invention may facilitate and/or effectuate neuroplastic change or reorganization within a patient 190, which in turn may rehabilitate, restore, and/or enhance one or more patient neural functions and/or behaviors. To facilitate and/or effectuate neuroplasticity, a neural stimulation procedure may be performed cooperatively with a behavioral therapy, such as described in U.S. application Ser. No. 90/802,808. A behavioral therapy may encompass, for example, physical therapy, cognitive therapy, and/or a variety of behavioral tasks.
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FIG. 6 is a flowchart of aneural stimulation process 600 responsive to collateral neural activity according to another embodiment of the invention. Relative toFIG. 5 , like reference numbers indicate like steps. In one embodiment, theprocess 600 begins with astimulation operation 602 by initiating or continuing a neural stimulation procedure in conjunction or association with a behavioral therapy. During thestimulation operation 602, stimulation signals are delivered to one or more target neural populations within a patient 190 in accordance with a first set of stimulation signal parameters. Following thestimulation operation 602, other steps within theprocess 600 may proceed in manners described above with reference toFIG. 5 . - From the foregoing, it will be appreciated that specific embodiments of the invention have been described herein for purposes of illustration, but that various modifications may be made without deviating from the spirit and scope of the invention. Accordingly, the invention is not limited except as by the appended claims.
Claims (13)
1. A neural stimulation system for neurostimulation of a patient, comprising:
a first set of electrodes configured to be positioned upon a target neural population corresponding to a site at which neuroplasticity is occurring, a site at which neuroplasticity is expected to occur, and/or a site associated with neuropathic pain;
a monitoring device to receive signals corresponding to a neural activity within a portion of the target neural population, wherein the neural activity is related to an undesired collateral effect of stimulation of the target neural population;
a stimulus unit coupled to deliver stimuli to the first set of electrodes, the stimuli comprising a plurality of groups of pulses occurring according to a burst frequency, wherein (i) multiple pulses are generated within each respective group according to a pulse repetition frequency, (ii) adjacent groups within the plurality of groups are spaced apart from each other in time with a substantially quiescent period; and
a sensing unit coupled receive signals from the monitoring device.
wherein the sensing unit is further coupled to the stimulus unit and the stimulus unit is adapted to vary a burst characteristic of the stimuli in response to feedback from the sensing unit.
2. The neural stimulation system of claim 1 wherein the stimulus unit modifies a burst frequency of the stimuli in response to the feedback from the sensing unit.
3. The neural stimulation system of claim 1 wherein the stimulus unit modifies the pulse repetition frequency in response to the feedback from the sensing unit.
4. The neural stimulation system wherein the stimulus unit and the sensing unit are adapted for implantation within the patient.
5. The neural stimulation system of claim 1 wherein the monitoring device comprises a second set of electrodes.
6. The neural stimulation system of claim 1 , wherein the monitoring device comprises a cerebral blood flow monitor.
7. A method of reducing seizure activity during neural stimulation to treat a neural condition in a patient comprising:
applying electrical stimuli to a target neural population within the patient by positioning at least a first set of electrodes in contact with the patient's dura matter or pia matter, the electrical stimuli directed to altering the neural condition other than a seizure, the electrical stimuli comprising a plurality of groups of pulses occurring according to a burst frequency, wherein (i) multiple pulses are generated within each respective group according to a pulse repetition frequency, (ii) adjacent groups within the plurality of groups are spaced apart from each other in time with a substantially quiescent period;
monitoring a parameter associated with seizure activity;
determining if seizure activity is present;
reducing seizure activity, if present, by performing modifying at least one burst characteristic of the electrical stimuli.
8. The method of claim 7 wherein the monitoring a parameter associated with seizure activity comprises monitoring an electrophysiological signal of the patient.
9. The method of claim 7 wherein the monitoring a parameter comprises monitoring cerebral blood flow.
10. The method of claim 7 wherein the neural condition comprises pain.
11. The method of claim 7 wherein the neural condition comprises a functional deficit.
12. The method of claim 7 wherein the reducing modifies the burst frequency of the stimuli in response to the feedback from the sensing unit.
13. The method of claim 7 wherein the reducing modifies the pulse repetition frequency in response to the feedback from the sensing unit.
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Also Published As
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AU2003295349B2 (en) | 2009-02-05 |
CA2502557A1 (en) | 2004-04-29 |
US20110054562A1 (en) | 2011-03-03 |
WO2004036765A3 (en) | 2005-03-03 |
US7831305B2 (en) | 2010-11-09 |
WO2004036765A2 (en) | 2004-04-29 |
US20030074032A1 (en) | 2003-04-17 |
AU2003295349A1 (en) | 2004-05-04 |
EP1554011A2 (en) | 2005-07-20 |
EP1554011A4 (en) | 2008-06-04 |
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