U.S. patent application number 17/010702 was filed with the patent office on 2021-02-25 for implantable neuro-stimulation device.
This patent application is currently assigned to Mudjala Medical Pty Limited. The applicant listed for this patent is Mudjala Medical Pty Limited. Invention is credited to Tracy Cameron, Ernest Mantes, David Robinson.
Application Number | 20210052898 17/010702 |
Document ID | / |
Family ID | 1000005197435 |
Filed Date | 2021-02-25 |
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United States Patent
Application |
20210052898 |
Kind Code |
A1 |
Robinson; David ; et
al. |
February 25, 2021 |
IMPLANTABLE NEURO-STIMULATION DEVICE
Abstract
An implantable electrical stimulation device includes an
electrically conductive electrode structure configured for coupling
with a pulse generator device and transmitting an electrical signal
configured to generate a desirable electric field around a target
tissue. The electrode structure includes a porous substrate
constructed of a bio-compatible and bio-survivable material having
a structure that mimics extracellular matrix embedding. The porous
substrate supports an electrically conductive electrode element.
The implantable device may further include a pulse generator also
embedded, enmeshed, and supported within the porous substrate.
Inventors: |
Robinson; David; (Bronte,
AU) ; Mantes; Ernest; (The Colony, TX) ;
Cameron; Tracy; (Toronto, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Mudjala Medical Pty Limited |
Bronte |
|
AU |
|
|
Assignee: |
Mudjala Medical Pty Limited
Bronte
AU
|
Family ID: |
1000005197435 |
Appl. No.: |
17/010702 |
Filed: |
September 2, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15786149 |
Oct 17, 2017 |
10780275 |
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17010702 |
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PCT/US2016/027570 |
Apr 14, 2016 |
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15786149 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61N 1/36128 20130101;
A61N 1/36146 20130101; A61N 1/36139 20130101; A61N 1/0504 20130101;
A61N 1/36057 20130101; A61N 1/36071 20130101; A61N 1/0556 20130101;
A61N 1/36178 20130101; A61N 1/0558 20130101; A61N 1/3615 20130101;
A61N 1/36067 20130101; A61N 1/0551 20130101; A61N 1/0526 20130101;
A61N 1/36082 20130101 |
International
Class: |
A61N 1/36 20060101
A61N001/36; A61N 1/05 20060101 A61N001/05 |
Foreign Application Data
Date |
Code |
Application Number |
Apr 17, 2015 |
AU |
2015901380 |
Jun 27, 2015 |
AU |
201590902501 |
Claims
1. (canceled)
2. A method of neural stimulation for therapeutic outcomes
comprising: generating a first stimulation pattern with a first
desired therapeutic outcome; generating a second stimulation
pattern with a second desired therapeutic outcome combining the
first and second stimulation patterns to produce a composite
stimulation pattern with an enhanced therapeutic outcome; and
transmitting the composite stimulation pattern to an implanted lead
assembly disposed proximate to a target nerve.
3. The method of claim 2, further comprising generating at least
one additional stimulation pattern to achieve at least one
additional enhanced therapeutic outcome and combining said at least
one additional stimulation pattern with the first and second
stimulation patterns to produce the composite stimulation pattern
with an enhanced therapeutic outcome.
4. The method of claim 2, further comprising independently
adjusting parameters of at least one of the first and second
stimulation patterns.
5. The method of claim 4, wherein generating the first stimulation
pattern comprises adjusting at least one of frequency and amplitude
to achieve the first desired therapeutic outcome.
6. The method of claim 4, wherein generating the second stimulation
pattern comprises adjusting at least one of frequency and amplitude
to achieve the second desired therapeutic outcome.
7. The method of claim 2, further comprising tuning the composite
stimulation pattern after the first and second stimulation patterns
have been combined.
8. The method of claim 2, wherein generating the composite
stimulation pattern comprises performing a weighted addition of the
first and second stimulation patterns.
9. The method of claim 2, wherein generating the composite
stimulation pattern comprises interleaving the first and second
stimulation patterns.
10. The method of claim 2, wherein the first stimulation pattern is
configured to block transmission of sensations in a target
nerve.
11. The method of claim 2, wherein the second stimulation pattern
is configured to activate fibers in a target nerve.
12. The method of claim 2, wherein generating the first stimulation
pattern comprises generating a charge-balanced direct current
(CBDC) stimulation pattern and generating the second stimulation
pattern comprises generating a charge-balanced alternating current
(CBAC) stimulation pattern, and generating the composite
stimulation pattern comprises combining the CBDC and CBAC
stimulation patterns.
13. The method of claim 2, wherein the first and second stimulation
patterns are combined in a pulse generator and the composite
stimulation pattern transmitted from the pulse generator to a
target tissue.
14. The method of claim 2, wherein the first and second stimulation
patterns are generated separately in a pulse generator and
delivered separately to a target tissue where they combine to form
the composite stimulation pattern.
15. An implantable neural stimulation system comprising a pulse
generator configured to be coupled to a lead assembly and to
generate two or more stimulation patterns each with a desired
therapeutic outcome, wherein the two or more stimulation patterns
may be combined to produce a composite stimulation pattern having
an enhanced therapeutic outcome.
16. The system of claim 15, further comprising the lead
assembly.
17. The system of claim 16, wherein the lead assembly is configured
to deliver the composite stimulation pattern from the pulse
generator to a target tissue.
18. The system of claim 16, wherein the first and second
stimulation patterns are generated separately in the pulse
generator and the lead assembly is configured to deliver the first
and second stimulation patterns separately to a target tissue to
form the composite stimulation pattern.
19. The system of claim 15, wherein the pulse generator is
configured to generate the composite stimulation pattern by
weighted addition of the two or more stimulation patterns.
20. The system of claim 15, wherein the pulse generator is
configured to generate the composite stimulation pattern by
interleaving the two or more stimulation patterns.
21. The system of claim 15, wherein the first stimulation pattern
generated by pulse generator is configured to block transmission of
sensations in a target nerve.
22. The system of claim 15, wherein the second stimulation pattern
generated by pulse generator is configured to activate fibers block
in a target nerve.
23. The system of claim 15, wherein the pulse generator is
configured to independently modify parameters of each of the first
and second stimulation patterns.
24. The system of claim 15, wherein the pulse generator is
configured to generate the first stimulation pattern using at least
one of constant voltage signal and constant current signal
technique.
25. The system of claim 15, wherein the pulse generator is
configured to generate a charge-balanced direct current (CBDC)
stimulation pattern and a charge-balanced alternating current
(CBAC) stimulation pattern, and generate a composite stimulation
pattern with an enhanced therapeutic outcome by combining the CBDC
and CBAC stimulation patterns.
26. The system of claim 15, wherein the pulse generator is
configured to generate the stimulation patterns based on at least
one of square, triangle, sinusoidal waveforms, or a composite
thereof.
27. The system of claim 15, wherein the pulse generator is
configured to generate the stimulation patterns based on one of
symmetrical and asymmetrical waveforms.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] The present application is a continuation of U.S. patent
application Ser. No. 15/786,149, filed Oct. 17, 2017, entitled
"Implantable Neuro-Stimulation Device", which is a
continuation-in-part of PCT/US2016/027570, filed on Apr. 14, 2016,
entitled "An Implantable Neurostimulation Device," which claims the
benefit of Australian Provisional Patent Application No.
201590902501, filed Jun. 27, 2015, entitled "A Method and Apparatus
for Providing Paraesthesia Pain Relief by Neuromodulation," and of
Australian Provisional Patent Application No. 2015901380 filed Apr.
17, 2015, entitled "A System and Method of Manufacture for a
Peripheral Nervous System Neurostimulation," the full disclosures
of which are incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0002] The present disclosure relates to the field of
neuromodulation or neuro-stimulation for therapeutic benefit, and
in particular to: a structure and method of manufacture of an
implantable neuro-stimulation lead in a porous substrate; an
implantable peripheral neuromodulation system and method of
manufacturing; a method and apparatus for providing complex
therapeutic outcomes; and a method and apparatus for neural circuit
processing.
[0003] Neuromodulation or neuro-stimulation is a therapeutic
activation of parts of the nervous system by delivering electrical
stimulation using microelectrodes. The use of neuro-stimulation for
therapeutic benefit has a long history. The use of
neuro-stimulation to provide relief of chronic intractable pain by
selective stimulation of nerves in the spinal cord has been
practiced since Melzack and Wall proposed the Gate Control Theory
in 1965. The Gate Control Theory proposes that nerves carrying
painful stimuli (classified as "C" fibers) and nerves carrying
non-painful stimuli such as touch, pressure, and vibratory
sensations (classified as afferent "A-.beta." fibers) both
terminate in the dorsal horn or "gate" of the spinal cord where
they interact. Theory further proposes that when the afferent
A-.beta. fibers were activated it would have the effect of "closing
the gate" on the C fibers, and thereby reducing or alleviating the
sensation of pain. Vallejo, Bradley, and Kapural, (Spinal Cord
Stimulation in Chronic Pain: Mode of Action Spine: 15 Jul.
2017-Volume 42-Issue-p S53-S60) have further concluded that "the
activation of A-beta fibers to induce paresthesia also involves
neurotransmitter release via segmental and supraspinal pathways."
It is widely believed that the release of neurotransmitters as a
result of neurostimulation is a key element of many
neurostimulation therapies.
[0004] The term "neuromodulation" is defined by the International
Neuromodulation Society as "the alteration of nerve activity
through the delivery of electrical stimulation or chemical agents
to targeted sites of the body." Electrical neuromodulation
therapies can therefore be defined as any alteration of nerve
activity through the delivery of electrical stimulation which
delivers a therapeutic benefit to the patient. Electrical
neuromodulation therapies may be delivered externally, using an
electrode placed on the skin over/near the target nerve, or
internally, using an implanted electrode placed subcutaneously near
the target nerve or nerves or directly on the target nerve, which
is connected to an Implantable Pulse Generator (IPG). Implantable
neuromodulation devices came into modern usage in the 1980's and
the techniques and applications of this technology have continued
to develop and expand.
[0005] Spinal cord stimulation (SCS) is a form of neuromodulation
therapy in use since the 1980's. Its principal use is as a
reversible, non-pharmacological therapy for chronic pain management
that delivers mild electrical pulses to the spinal cord. Another
neuromodulation treatment developed in the 1980's is deep brain
stimulation (DBS), which may be used to help limit symptoms of
movement disorder in Parkinson's disease, dystonia, or essential
tremor. Since elements of the nervous system can be broadly
classified as belonging to either the central nervous system or
peripheral nervous system, electrical neuromodulation therapies may
also be classified as Central Nervous System Stimulation (CNSS) and
Peripheral Nervous System Stimulation (PNSS). Spinal Cord
Stimulation (SCS) and Deep Brain Stimulation (DBS) (the oldest and
most common electrical neuromodulation therapies in use today) are
both examples of CNSS. Other known applications of neuromodulation
therapy include occipital nerve stimulation (ONS), peripheral nerve
stimulation (PNS), vagus nerve stimulation (VNS), sacral nerve
stimulation (SNS), which are examples of PNSS.
SUMMARY OF THE INVENTION
[0006] In accordance with one aspect of the present invention, an
implantable electrical stimulation device comprises a porous
substrate constructed of a bio-compatible and bio-survivable
material. At least one electrically conductive electrode is
embedded in the porous substrate and configured for coupling with a
pulse generator device. The pulse generator device is configured
for transmitting an electrical signal from the pulse generator
device to generate an electric field around a target tissue, and
the porous substrate is further configured to fully support the at
least one electrically conductive electrode to provide structural
integrity to the implantable electrical stimulation device.
[0007] In specific embodiments, the porous substrate may mimic
extracellular matrix.
[0008] In specific embodiments, the porous substrate has a pore
size selected to control tissue in growth. For example, the pore
size may selected to allow only superficial cellular ingrowth.
Alternatively, the pore size may selected to allow only cellular
ingrowth in selected areas the substrate. Exemplary pore sizes are
in a range from 2 .mu.m to 10 .mu.m.
In specific embodiments, the porous substrate is constructed of
non-woven fibers. For example, the non-woven fibers may be
polymeric fibers. Exemplary polymeric fibers may be selected from a
group consisting of polyurethane (thermoplastic and thermoset),
polyethylene terephthalate, polyether ether ketone,
polytetrafluoroethylene and poly-methyl-methacrylate.
[0009] In specific embodiments, the porous substrate may support
the one or more conductive electrodes in such a way that part of
one or more electrodes and the surrounding porous substrate can be
removed without compromising the integrity of the overall
structure, for example a blend of 60% polyurethane and 40%
polyethylene terephthalate.
[0010] In specific embodiments, the porous substrate comprises two
or more materials, at least one of which may be selected to
facilitate bonding with another part of the membrane or another
membrane by the application of heat, pressure, bonding agent or
other means.
[0011] In specific embodiments, at least one electrically
non-conductive inclusion that is impervious to electrolyte
penetration disposed on or within the porous substrate.
[0012] In specific embodiments, an electrically conductive field
shaping element may be embedded within the porous substrate and
configured for shaping the electric field generated by the
electrically conductive electrode.
[0013] In specific embodiments, the implantable electrical
stimulation may further comprise an electrically insulated lead
embedded within the porous substrate and configured for shaping the
electric field generated by the electrically conductive
electrode.
[0014] In specific embodiments, the implantable electrical
stimulation may further comprise an electrically conductive
inclusion configured to function as an electrical connecting
element disposed within the porous substrate.
[0015] In specific embodiments, the implantable electrical
stimulation may further comprise a biocompatible and resorbable
inclusion configured to function as a structural element disposed
within the porous substrate
[0016] In specific embodiments, the implantable electrical
stimulation may further comprise a biocompatible and non-resorbable
inclusion configured to function as a structural element disposed
within the porous substrate.
[0017] In specific embodiments, the porous substrate may be
substantially free from structural element disposed therein.
[0018] In specific embodiments, the implantable electrical
stimulation may further comprise a biocompatible inclusion
configured to function as an anchor structure at least partly
disposed within the porous substrate.
[0019] In specific embodiments, the implantable electrical
stimulation may further comprise a biocompatible inclusion in the
form of barbed structures configured to function as an anchor
structure at least partly disposed within the porous substrate.
[0020] In specific embodiments, a pore size of at least one region
of at least one of the porous substrate is different than a pore
size in another region of the porous substrate.
[0021] In specific embodiments, at least one selected region of the
porous substrate is impervious to electrolyte penetration.
[0022] In specific embodiments, least one selected region of the
porous substrate is coated with an electrically non-conductive
material for the purpose of shaping the electric field.
[0023] In specific embodiments, at least one selected region of the
porous substrate is coated with an electrically non-conductive
material for the purpose of modifying surface properties of the
lead assembly.
[0024] In specific embodiments, the implantable electrical
stimulation may further comprise a second porous substrate
constructed around at least some of the lead structure to allow
retraction and removal of the lead structure post-implantation.
[0025] In specific embodiments, the lead assembly may be in the
form and structure of one of a patch lead, paddle lead, cuff lead,
helical lead, transvenous lead, conformal lead and catheter
lead.
[0026] In specific embodiments, the lead assembly may be configured
for generating an electric field around a target nerve.
[0027] In specific embodiments, the implantable electrical
stimulation may further comprise a pulse generator circuit embedded
within the porous substrate and electrically connected to the at
least one electrically conductive electrode.
[0028] In specific embodiments, the pulse generator circuit may
further include a power supply.
[0029] In specific embodiments, at least one selected region of the
porous substrate may be coated with an electrically non-conductive
material for the purpose of modifying surface properties of the
lead assembly.
[0030] In specific embodiments, the implantable electrical
stimulation may further comprise a second porous substrate
constructed around at least some of the lead structure to allow
retraction and removal of the lead structure post-implantation.
[0031] In specific embodiments, the lead assembly may be in the
form and structure of one of a patch lead, paddle lead, cuff lead,
helical lead, transvenous lead, conformal lead and catheter
lead.
[0032] In specific embodiments, the lead assembly is configured for
generating an electric field around a target nerve.
[0033] In specific embodiments, the implantable electrical
stimulation may further comprise a pulse generator circuit embedded
within the porous substrate and electrically connected to the at
least one electrically conductive electrode.
[0034] In specific embodiments, the pulse generator circuit further
includes a power supply.
[0035] Other aspects of the present invention are set forth in the
following numbered clauses:
[0036] Clause 1: An implantable electrical stimulation device
comprising at least one electrically conductive electrode
configured for coupling with a pulse generator device and
transmitting an electrical signal configured to generate a
desirable electric field around a target tissue; and a porous
substrate constructed of a bio-compatible and bio-survivable
material having a structure that mimics extracellular matrix
embedding and supporting the electrically conductive electrode.
[0037] Clause 2: The implantable electrical stimulation device of
clause 1, wherein the porous substrate is constructed of non-woven
fibers.
[0038] Clause 3: The implantable electrical stimulation device of
clause 1, further comprising at least one electrically
non-conductive inclusion that is impervious to electrolyte
penetration disposed within the porous substrate.
[0039] Clause 4: The implantable electrical stimulation device of
clause 1, further comprising at least one intermediate non-porous
layer disposed within the porous substrate.
[0040] Clause 5: The implantable electrical stimulation device of
clause 1, further comprising an electrically conductive field
shaping element embedded within the porous substrate and configured
for shaping the electric field generated by the electrically
conductive electrode.
[0041] Clause 6: The implantable electrical stimulation device of
clause 1, further comprising an electrically insulated buried lead
embedded within the porous substrate and configured for shaping the
electric field generated by the electrically conductive
electrode.
[0042] Clause 7: The implantable electrical stimulation device of
clause 1, further comprising an electrically conductive inclusion
configured to function as an electrical connecting element disposed
within the porous substrate.
[0043] Clause 8: The implantable electrical stimulation device of
clause 1, further comprising a biocompatible and resorbable
inclusion configured to function as a structural element disposed
within the porous substrate.
[0044] Clause 9: The implantable electrical stimulation device of
clause 1, further comprising a biocompatible and non-resorbable
inclusion configured to function as a structural element disposed
within the porous substrate.
[0045] Clause 10: The implantable electrical stimulation device of
clause 1, further comprising a biocompatible inclusion configured
to function as an anchor structure at least partly disposed within
the porous substrate.
[0046] Clause 11: The implantable electrical stimulation device of
clause 1, further comprising a bio-compatible inclusion in the form
of barbed structures configured to function as an anchor structure
at least partly disposed within the porous substrate.
[0047] Clause 12: The implantable electrical stimulation device of
clause 1, wherein a pore size of at least one selected region of at
least one of the porous substrate is different than the rest of the
porous substrate.
[0048] Clause 13: The implantable electrical stimulation device of
clause 1, wherein at least one selected region of the porous
substrate is impervious to electrolyte penetration.
[0049] Clause 14: The implantable electrical stimulation device of
clause 1, wherein at least one selected region of the porous
substrate is coated with an electrically non-conductive material
for the purpose of shaping the electric field.
[0050] Clause 15: The implantable electrical stimulation device of
clause 1, wherein at least one selected region of the porous
substrate is coated with an electrically non-conductive material
for the purpose of modifying surface properties of the lead
assembly.
[0051] Clause 16: The implantable electrical stimulation device of
clause 1, further comprising a second porous substrate constructed
around at least some of the lead structure to allow retraction and
removal of the lead structure post-implantation.
[0052] Clause 17: The implantable electrical stimulation device of
clause 1, wherein the lead assembly is in the form and structure of
one of a patch lead, paddle lead, cuff lead, helical lead,
transvenous lead, conformal lead and catheter lead.
[0053] Clause 18: The implantable electrical stimulation device of
clause 1, wherein the lead assembly is configured for generating an
electric field around a target nerve.
[0054] Clause 19: The implantable electrical stimulation device of
clause 1, further comprising a pulse generator circuit enclosed in
an hermetical enclosure also embedded within the porous substrate
and configured to generate an electrical signal.
[0055] Clause 20: The implantable electrical stimulation device of
clause 19, wherein the pulse generator circuit further includes a
power supply.
[0056] Clause 21: The implantable electrical stimulation device of
clause 19, wherein the pulse generator circuit further includes an
inductive coil configured to be energized by energy transmitted by
an energy source that is external to the body.
[0057] Clause 22: The implantable electrical stimulation device of
clause 21, wherein the external energy source is incorporated in a
wearable accessory selected from the group consisting of a hat, a
headband, a necklace, eyeglasses, sports headphone-like structure,
a purse, a collar, and a Velcro patch.
[0058] Clause 23: A method of manufacturing an implantable
neuro-stimulation device, comprising: forming a first part of a
porous substrate over a mandrel of a suitable shape using a
biocompatible and bio-survivable material, the porous substrate
having a structure that mimics extracellular matrix; disposing at
least one electrically conductive bio-compatible and bio-survivable
element within the porous substrate, the at least one element
configured for coupling with a pulse generator device and
transmitting an electrical signal configured to generate a
desirable electric field around a target nerve; and forming a final
part of the porous substrate to embed, enmesh, and support the at
least one electrically conductive element.
[0059] Clause 24: The method of clause 23, further comprising
disposing at least one electrically conductive bio-compatible and
bio-survivable element within the porous substrate configured to
impart desirable mechanical and electrical properties to the lead
assembly.
[0060] Clause 25: The method of clause 23, further comprising
disposing at least one electrically non-conductive bio-compatible
and bio-survivable element within the porous substrate configured
to impart desirable mechanical and electrical properties to the
lead assembly.
[0061] Clause 26: The method of clause 23, wherein forming the
porous substrate comprises laying thin strands of fibers in a
random pattern to form a non-woven material.
[0062] Clause 27: The method of clause 23, further comprising
forming at least one intermediate non-porous layer within the
porous substrate.
[0063] Clause 28: The method of clause 23, further comprising
forming an electrically conductive field shaping element configured
for shaping the electric field generated by the electrically
conductive element within the porous substrate.
[0064] Clause 29: The method of clause 23, further comprising
forming an electrically conductive inclusion configured to function
as an electrical connecting element within the porous
substrate.
[0065] Clause 30: The method of clause 23, further comprising
forming an electrically non-conductive inclusion that is impervious
to electrolyte penetration within the porous substrate.
[0066] Clause 31: The method of clause 23, further comprising
forming a bio-compatible and resorbable inclusion configured to
function as a structural element within the porous substrate.
[0067] Clause 32: The method of clause 23, further comprising
forming a bio-compatible and non-resorbable inclusion configured to
function as a structural element within the porous substrate.
[0068] Clause 33: The method of clause 23, further comprising
forming a bio-compatible inclusion configured to function as an
anchor structure at least partly within the porous substrate.
[0069] Clause 34: The method of clause 23, wherein forming the
porous substrate comprises forming a pore size of at least one
selected region of the porous substrate different than the rest of
the porous substrate.
[0070] Clause 35: The method of clause 23, wherein forming the
porous substrate comprises forming at least one selected region of
the porous substrate impervious to electrolyte penetration.
[0071] Clause 36: The method of clause 23, wherein forming the
porous substrate comprises coating at least one selected region of
the porous substrate with an electrically non-conductive material
for the purpose of shaping the electric field.
[0072] Clause 37: The method of clause 23, wherein forming the
porous substrate comprises coating at least one selected region of
the porous substrate with an electrically non-conductive material
for the purpose of modifying surface properties of the lead
assembly.
[0073] Clause 38: The method of clause 23, further comprising
forming a second porous substrate around at least part of the
electrically conductive element to allow retraction and removal
thereof post-implantation.
[0074] Clause 39: The method of clause 23, wherein the lead
assembly is manufactured in the form and structure of one of a
patch lead, paddle lead, cuff lead, helical lead, transvenous lead,
conformal lead and catheter lead.
[0075] Clause 40: The method of clause 23, further comprising
disposing a pulse generator within the porous substrate and forming
the final part of the porous substrate to embed, enmesh, and
support the pulse generator within the porous substrate.
[0076] Clause 41: An implantable electrical stimulation device
comprising at least one electrically conductive electrode
configured for coupling with a pulse generator device and
transmitting an electrical signal configured to generate a
desirable electric field around a target tissue; a pulse generator
circuit enclosed in an hermetical enclosure and configured to
generate an electrical signal; a porous substrate constructed of a
bio-compatible and bio-survivable material having a structure that
mimics extracellular matrix embedding and supporting the
electrically conductive electrode and the pulse generator
circuit.
[0077] Clause 42: A method of manufacturing an implantable
neuro-stimulation device, comprising: forming a first part of a
porous substrate over a mandrel of a suitable shape using a
biocompatible and bio-survivable material, the porous substrate
having a structure that mimics extracellular matrix; disposing at
least one electrically conductive bio-compatible and bio-survivable
element within the porous substrate; disposing a pulse generator
configured for coupling with the at least one electrically
conductive bio-compatible and bio-survivable element, the pulse
generator configured for generating an electrical signal to produce
a desirable electric field around a target nerve; and forming a
final part of the porous substrate to embed, enmesh, and support
the pulse generator and the at least one electrically conductive
element.
[0078] Clause 43: An implantable neural stimulation system
comprising a lead assembly; and a pulse generator coupled to the
lead assembly configured to generate two or more stimulation
patterns each with a desired therapeutic outcome, and generate a
further stimulation pattern with an enhanced therapeutic outcome by
combining the two or more stimulation patterns.
[0079] Clause 44: The system of clause 43, wherein the pulse
generator is configured to generate the further stimulation pattern
by weighted addition of the two or more stimulation patterns.
[0080] Clause 45: The system of clause 43, wherein the pulse
generator is configured to generate the further stimulation pattern
by interleaving the two or more stimulation patterns.
[0081] Clause 46: The system of clause 43, wherein the pulse
generator is configured to generate a first stimulation pattern
intended to block transmission of sensations in a target nerve.
[0082] Clause 47: The system of clause 43, wherein the pulse
generator is configured to generate a second stimulation pattern
intended to activate fibers in a target nerve.
[0083] Clause 48: The system of clause 43, wherein the pulse
generator is configured to independently modify parameters of each
of the first and second stimulation patterns.
[0084] Clause 49: The system of clause 43, wherein the pulse
generator is configured to generate the first stimulation pattern
using at least one of constant voltage signal and constant current
signal technique.
[0085] Clause 50: The system of clause 43, wherein the pulse
generator is configured to generate a charge-balanced direct
current (CBDC) stimulation pattern and a charge-balanced
alternating current (CBAC) stimulation pattern, and generate a
composite stimulation pattern with an enhanced therapeutic outcome
by combining the CBDC and CBAC stimulation patterns.
[0086] Clause 51: The system of clause 43, wherein the pulse
generator is configured to generate the stimulation patterns based
on at least one of square, triangle, sinusoidal waveforms or some
composite thereof.
[0087] Clause 52: The system of clause 43, wherein the pulse
generator is configured to generate the stimulation patterns based
on one of symmetrical and asymmetrical waveforms.
[0088] Clause 53: A method of neural stimulation for therapeutic
outcomes comprising generating a first stimulation pattern with a
first desired therapeutic outcome; generating a second stimulation
pattern with a second desired therapeutic outcome; generating a
third stimulation pattern with an enhanced therapeutic outcome by
combining the first and second stimulation patterns; and
transmitting the third stimulation pattern to an implanted lead
assembly disposed proximate to a target nerve.
[0089] Clause 54: The method of clause 53, wherein generating the
third stimulation pattern comprises performing a weighted addition
of the first and second stimulation patterns.
[0090] Clause 55: The method of clause 53, wherein generating the
third stimulation pattern comprises interleaving the first and
second stimulation patterns.
[0091] Clause 56: The method of clause 53, further comprising
independently adjusting parameters of each of the first and second
stimulation patterns.
[0092] Clause 57: The method of clause 53, wherein generating the
first, second, and third stimulation patterns comprises generating
a charge-balanced direct current (CBDC) stimulation pattern and a
charge-balanced alternating current (CBAC) stimulation pattern, and
generating a composite stimulation pattern with an enhanced
therapeutic outcome by combining the CBDC and CBAC stimulation
patterns.
[0093] Clause 58: A method comprising stimulating an input element
of a neural circuit with a stimulation waveform having a
predetermined characteristic; measuring a response at an output
element of the neural circuit; analyzing the measured response; and
inferring a state of the neural circuit based on the measured
response.
[0094] Clause 59: The method of clause 58, wherein inferring a
state of the neural circuit comprises inferring information from
the measured response for diagnostic purposes.
[0095] Clause 60: The method of clause 58, wherein inferring a
state of the neural circuit comprises inferring information from
the measured response for a purpose of determining a parameter of a
beneficial therapy.
[0096] Clause 61: The method of clause 58, wherein inferring a
state of the neural circuit comprises inferring information from
the measured response for a purpose of determining a control
parameter of a beneficial neuro-stimulation therapy.
[0097] Clause 62: The method of clause 58, wherein inferring a
state of the neural circuit comprises inferring information from
the measured response for a purpose of determining a control
parameter of a beneficial drug delivery device.
[0098] Clause 63: The method of clause 58, wherein inferring a
state of the neural circuit comprises inferring information about
concentration of specific neurotransmitters between neurons in the
neural circuit.
[0099] Clause 64: The method of clause 58, wherein stimulating the
input element of a neural circuit comprises stimulating the input
element of the neural circuit with a stimulation waveform that has
an auto-correlation function with a single well-defined peak.
[0100] Clause 65: The method of clause 58, wherein stimulating the
input element of a neural circuit comprises stimulating the input
element of the neural circuit with a pseudo-random binary noise
sequence signal.
[0101] Clause 66: The method of clause 65, wherein analyzing the
measured response comprises cross-correlating the pseudo-random
binary noise sequence signal at the input element with a measured
response at the output element.
[0102] Clause 67: The method of clause 58, wherein stimulating the
input element of a neural circuit comprises modulating the
stimulation waveform between on and off states.
[0103] Clause 68: The method of clause 67, wherein analyzing the
measured response comprises estimating a difference of a specific
characteristic of the measured response when the stimulation
waveform is on and when it is off.
[0104] Clause 69: The method of clause 67, wherein analyzing the
measured response comprises estimating a difference in signal power
in the measured response when the stimulation waveform is on and
when it is off.
[0105] Clause 70: The method of clause 69, wherein estimating a
difference in signal power comprises determining a sum of
squares.
[0106] Clause 71: The method of clause 58, wherein inferring a
state of the neural circuit comprises measuring an evoked compound
action potential of the input neuron.
[0107] Clause 72: The method of clause 58, wherein inferring a
state of the neural circuit comprises detecting presence of a
signal of interest and determining a quality of the signal of
interest if present.
[0108] Clause 73: The method of clause 72, wherein inferring a
state of the neural circuit comprises determining a control
parameter of a beneficial neuro-stimulation therapy in response to
one of detecting presence and absence of the signal of
interest.
[0109] Clause 74: A system comprising an implantable
neuro-stimulation device configured to stimulate an input element
of a neural circuit with a stimulation waveform having a
predetermined characteristic, and measuring a response at an output
element of the neural circuit; and a processor coupled to the
implantable neuro-stimulation device to analyzing the measured
response, and inferring a state of the neural circuit based on the
measured response.
[0110] Clause 75: The system of clause 74, wherein the processor
further infers information from the measured response for
diagnostic purposes.
[0111] Clause 76: The system of clause 74, wherein the processor
further infers information for a purpose of determining a parameter
of a beneficial therapy.
[0112] Clause 77: The system of clause 74, wherein the processor
further infers information for a purpose of determining a control
parameter of a beneficial neuro-stimulation therapy.
[0113] Clause 78: The system of clause 74, wherein the processor
further infers information for a purpose of determining a control
parameter of a beneficial drug delivery device.
[0114] Clause 79: The system of clause 74, wherein the processor
further infers information about concentration of specific
neurotransmitters between neurons in the neural circuit.
[0115] Clause 80: The system of clause 74, wherein the implantable
neuro-stimulation device stimulates the input element of the neural
circuit with a stimulation waveform that has an auto-correlation
function with a single well-defined peak.
[0116] Clause 81: The system of clause 74, wherein the implantable
neuro-stimulation device stimulates the input element of the neural
circuit with a pseudo-random binary noise sequence signal.
[0117] Clause 82: The system of clause 81, wherein the processor
further cross-correlates the pseudorandom binary noise sequence
signal at the input element with a measured response at the output
element.
[0118] Clause 83: The system of clause 74, wherein the implantable
neuro-stimulation device modulates the stimulation waveform between
on and off states.
[0119] Clause 84: The system of clause 83, wherein the processor
further estimates a difference of a specific characteristic of the
measured response when the stimulation waveform is on and when it
is off.
[0120] Clause 85: The system of clause 83, wherein the processor
further estimates a difference in signal power in the measured
response when the stimulation waveform is on and when it is
off.
[0121] Clause 86: The system of clause 85, wherein the processor
further estimates a difference in signal power comprises
determining a sum of squares.
[0122] Clause 87: The system of clause 74, wherein the processor
further measures an evoked compound action potential of the input
neuron.
[0123] Clause 88: The system of clause 74, wherein the processor
further detects presence of a signal of interest and determining a
quality of the signal of interest if present.
[0124] Clause 89: The system of claim 88, wherein the processor
further determines a control parameter of a beneficial
neuro-stimulation therapy in response to one of detecting presence
and absence of the signal of interest.
INCORPORATION BY REFERENCE
[0125] All publications, patents, and patent applications mentioned
in this specification are herein incorporated by reference to the
same extent as if each individual publication, patent, or patent
application was specifically and individually indicated to be
incorporated by reference.
BRIEF DESCRIPTION OF THE DRAWINGS
[0126] The novel features of the invention are set forth with
particularity in the appended claims. A better understanding of the
features and advantages of the present invention will be obtained
by reference to the following detailed description that sets forth
illustrative embodiments, in which the principles of the invention
are utilized, and the accompanying drawings of which:
[0127] FIG. 1 is a schematic diagram of an exemplary embodiment of
an implantable lead assembly 10 for a neuro-stimulation system
according to the teachings of the present disclosure;
[0128] FIG. 2 is an exploded schematic diagram of a more detailed
exemplary embodiment of an implantable lead assembly 20 for a
neuro-stimulation system according to the teachings of the present
disclosure;
[0129] FIG. 3 is a schematic diagram of an exemplary embodiment of
an implantable lead structure 30 with an electrode structure
optimized for occipital nervous stimulation (ONS) for a
neuro-stimulation system according to the teachings of the present
disclosure;
[0130] FIG. 4 is a schematic diagram of another exemplary
embodiment of an implantable lead structure 40 suitable for
occipital nervous stimulation (ONS) for a neuro-stimulation system
according to the teachings of the present disclosure;
[0131] FIG. 4A is a schematic diagram of a method of making a
multi-electrode device wherein the stimulation lead may be cut at
well-defined locations and still be safe to use.
[0132] FIG. 5 is a diagrammatic illustration of an exemplary
electrode construction 50 according to the teachings of the present
disclosure;
[0133] FIG. 6 is a schematic diagram of an exemplary
electrospinning system 60 according to the teachings of the present
disclosure;
[0134] FIG. 7 is a flowchart of an exemplary process for
manufacturing an implantable neuro-stimulation lead assembly or
implantable neuro-stimulation system according to the teachings of
the present disclosure;
[0135] FIG. 8 is a diagrammatic illustration of an exemplary
embodiment of a paddle lead structure 90 for neuro-stimulation
according to the teachings of the present disclosure;
[0136] FIG. 9 is a diagrammatic illustration of another exemplary
embodiment of a patch lead structure 100 according to the teachings
of the present disclosure;
[0137] FIG. 10 is a diagrammatic illustration of an exemplary
embodiment of another patch lead structure 110 for
neuro-stimulation according to the teachings of the present
disclosure;
[0138] FIG. 11 is a diagrammatic illustration of an exemplary
embodiment of a cuff lead structure 120 for neuro-stimulation
according to the teachings of the present disclosure;
[0139] FIG. 12 is a diagrammatic illustration of an exemplary
embodiment of a catheter style lead structure 130 for
neuro-stimulation according to the teachings of the present
disclosure;
[0140] FIG. 13 is a diagrammatic illustration of an exemplary
embodiment of a helical lead structure 140 for neuro-stimulation
according to the teachings of the present disclosure;
[0141] FIG. 14 is an exploded view of an exemplary embodiment of an
implantable lead assembly 150 with a field shaping element
according to the teachings of the present disclosure;
[0142] FIG. 15 is an exploded view of an exemplary embodiment of an
implantable lead assembly 160 with an intermediate layer or feature
according to the teachings of the present disclosure;
[0143] FIG. 16 is an exploded view of an exemplary embodiment of an
implantable lead assembly 170 with temporary or permanent
mechanical properties according to the teachings of the present
disclosure;
[0144] FIG. 17 is a diagrammatic illustration of an exemplary
embodiment of an implantable transvenous lead structure 180 for
neuro-stimulation according to the teachings of the present
disclosure;
[0145] FIG. 18 is a schematic diagram of an exemplary embodiment of
an implantable neuro-stimulation system 210 according to the
teachings of the present disclosure;
[0146] FIG. 19 is a diagrammatic diagram of an exemplary embodiment
of an implantable neuro-stimulation system 220 according to the
teachings of the present disclosure;
[0147] FIG. 20 is a diagrammatic illustration of an exemplary
embodiment of an implantable neuro-stimulation system 230 for ONS
application according to the teachings of the present
disclosure;
[0148] FIG. 21 is a diagrammatic illustration of a preferred
placement location of an implantable neuro-stimulation system 203
for ONS application according to the teachings of the present
disclosure;
[0149] FIGS. 22 and 23A-D are diagrammatic illustrations of an
exemplary embodiment of a neuro-stimulation system 240
incorporating a wearable external transmitting device according to
the teachings of the present disclosure;
[0150] FIG. 24 is a flowchart of an exemplary process for
establishing and combining multiple stimulation patterns into a
composite stimulation pattern for a neuro-stimulation system
according to the teachings of the present disclosure;
[0151] FIG. 25 is a diagrammatic illustration of an exemplary
composite waveform that includes a CBAC (charge-balanced
alternating current) waveform superimposed onto one phase of a CBDC
(charge-balanced direct current) waveform for neuro-stimulation
according to the teachings of the present disclosure;
[0152] FIG. 26 is a diagrammatic illustration of
independently-generated exemplary CBAC waveform and exemplary CBDC
waveform for neuro-stimulation according to the teachings of the
present disclosure;
[0153] FIG. 27 is a diagrammatic illustration of an exemplary
composite waveform that includes a CBAC waveform superimposed onto
one phase of a CBDC waveform for neuro-stimulation according to the
teachings of the present disclosure;
[0154] FIG. 28 is a diagrammatic illustration of a neural
circuit;
[0155] FIG. 29 is a diagrammatic illustration of a representative
output signal on the output neurons of a neural arc in response to
electrical stimulation of the input neuron of the neural arc
according to the teachings of the present disclosure;
[0156] FIG. 30 is a diagrammatic illustration of a representative
cross-correlation signal processing technique to reliably measure
the influence of the interneurons element according to the
teachings of the present disclosure;
[0157] FIG. 31 is a diagrammatic representation of a sum of squares
circuit/processor according to the teachings of the present
disclosure;
[0158] FIG. 32 is a diagrammatic illustration of using a sum or
squares signal processing technique to measure the performance of a
neural circuit according to the teachings of the present
disclosure;
[0159] FIG. 33 is a schematic diagram representation of an
equivalent circuit 350 of an electrode tissue interface according
to the teachings of the present disclosure;
[0160] FIG. 34 is a schematic diagram of an equivalent circuit for
a stimulation pulse passing through two electrodes with impedance
Ze, through the tissue impedance Zt, through two sensing electrodes
Z; then into a measurement amplifier according to the teachings of
the present disclosure;
[0161] FIG. 35 is a block diagram of a system for enhancing
detection performance with a signal present estimator according to
the teachings of the present disclosure; and
[0162] FIGS. 36-43 are amplitude and phase spectra of estimates of
ECAP and Artifact signals according to the teachings of the present
disclosure.
DETAILED DESCRIPTION OF THE INVENTION
[0163] An effective implantable neuro-stimulation lead structure
should possess a number of desirable characteristics, including
bio-compatibility and bio-survivability. The lead should create an
electric field appropriate to stimulate the target nerves, and
generate minimal adverse response from the tissues to the implant.
The lead structure should also have a form factor appropriate to
the area of the body in which it is implanted, and should have
appropriate mechanical properties to survive implantation and
possible explanation.
[0164] When a lead is used that is not appropriate for a particular
application, adverse events can result. For example, in occipital
nerve stimulation (ONS) trials, implantable lead-related adverse
events tend to stem from the fact that these procedures are
currently done with commercial leads and stimulators approved for
Spinal Cord Stimulation (SCS) and used "off label." In the ONS
application, these leads are intended for use in central nervous
system stimulation (CNSS) where they are designed to deliver
stimulation targeted to very specific locations. This means the
leads used in CNSS have multiple electrodes configured to allow the
accurate placement of fairly localized electrical fields. Moreover,
these leads are typically mechanically stiff both to ensure the
lead does not move once implanted and, in some cases, to allow them
to pass easily through a tuohy needle to the target tissue. These
relatively stiff leads, when placed under the skin or in other
locations such as for ONS, are prone to breakage, skin erosion
(often resulting in infections) and lead instability due to
difficulty in anchoring.
[0165] It has also been recognized that in peripheral nervous
system stimulation (PNSS) applications, depending on the
application, either localized or more generalized fields are used
to ensure that the target nerve is properly stimulated. To achieve
these larger fields using lead developed for the CNSS (designed to
produce localized fields), multiple electrodes need to be activated
simultaneously generally results in higher power demand and reduced
battery life. Accordingly, the lead structures described herein are
particularly suited to ONS therapies and PNS applications more
generally. However, those skilled in the art should understand that
the lead structures described herein are applicable to other forms
of neuro-stimulation therapies, including for example, tibial nerve
stimulation for over active bladder, glossopharyngeal stimulation
for obstructive sleep apnea, trigeminal nerve stimulation for
facial pain, and supraorbital nerve stimulation for headache and
facial pain. The lead structure disclosed herein can also be used
to stimulate or otherwise modulate nerves in or on an organ or
other anatomical structure by direct stimulation of the surface of
anatomical structure. For example, a conformable porous lead in
accordance with the present invention may be shaped to conform to a
surface contour or topology of said anatomical structure so that
stimulatory current may be delivered to the surface and the
associated nerves.
[0166] FIG. 1 is a schematic diagram of an exemplary embodiment of
an implantable lead assembly 10 for a neuro-stimulation system
according to the teachings of the present disclosure. The
neuromodulation lead assembly 10 includes an electrode structure
12, a cable section 14, and a connector 16. The cable section 14
and connector 16 can be optional. The implantable lead assembly has
good tensile strength, is extremely compliant, and able to resist
fatigue. The lead assembly 10 also can be effectively anchored
without the need for special anatomical features and can be cost
effectively manufactured in a range of physical forms and electrode
configurations. Moreover, the implantable lead assemblies described
herein provoke a significantly reduced tissue reaction than
traditional implantable leads. The minimal tissue reaction reduces
the formation of fibrous tissues or capsule around the implanted
lead, which may effectively increase the effective impedance of the
leads.
[0167] FIG. 2 is an exploded schematic diagram of a more detailed
exemplary embodiment of an implantable lead 20 for a
neuro-stimulation system according to the teachings of the present
disclosure. The exemplary implantable lead assembly 20 includes an
electrode assembly 22 that includes two electrode elements 23 and
24 and two electrical connection elements 26 and 27 embedded in the
porous substrate shown in parts 28 and 29. The electrode assembly
may be formed from suitable bio-compatible conductive materials
such as, but not limited to, Pt or Ptlr, and are configured to be
suitable for the specific application for which the particular lead
is designed. According to one aspect of this disclosure it is
possible to create electrode structures that generate optimal field
structures for the target nerve. When the two substrate layers 28
and 29 form a continuous substrate, the electrode assembly 22 is
held securely in place. The porous substrate formed by parts 28 and
29 has the structure of a tissue scaffold that imitates the
ExtraCellular Matrix (ECM). This scaffold minimizes the fibrotic
tissue reaction and allows only superficial cellular ingrowth
causing the substrate to adhere to the adjacent tissues. Because
the porous substrate can be engineered for good cell adhesion, a
lead structure can be effectively anchored, without tissue damage,
across all of the porous substrate that is exposed to the
surrounding tissue. Such a lead will significantly reduce lead
migrations adverse events. Such a lead may be anchored
subcutaneously without a separate anchor, on internal organs, in
muscles, intravenously, and around nerves. It can also be
effectively anchored within the central nervous system. The ability
to anchor the lead without the need for a separate anchor device
also means much smaller leads can be effectively anchored. The
porous substrates allows the body's electrolyte to contact the
electrode integrated into the substrate and it also provides
mechanical support for the electrodes and other inclusions, giving
the whole lead structural integrity. The porous substrates 28 and
29 may be formed from polyurethane (PU), polytetrafluorethylene
(PTFE), Polyethylene terephthalate (PET) and other suitable
bio-compatible and non-biodegradable materials now known or later
developed. Substrates made from this material should have pore
sizes that prevent the ingrowth of vascularized tissue. Pore sizes
less than 15 .mu.m will typically achieve this goal, and pores
sizes in the range 2-10 .mu.m are preferred. The pore size chosen
for a specific lead will depend on the specific design goals for a
particular lead: in general smaller pore sizes will deliver higher
dielectric constants and higher lead impedances, while, in some
porous substrates, such as electrospun non-woven materials, a
smaller pore size provide a higher substrate strength.
[0168] FIG. 3 is a schematic diagram of an exemplary embodiment of
an implantable lead structure 30 with an electrode structure
optimized for occipital nervous stimulation (ONS) for a
neuro-stimulation system according to the teachings of the present
disclosure. In this example taking the form of a "patch" electrode,
the elongated lead structure 30 includes two parallel electrode
elements 32 and 33 embedded in a porous substrate 34. The lead
structure 30 may have an exemplary length, I, in the 6-7 cm range,
and an exemplary height, h, in the 6 mm range. In the exemplary
placement shown in FIG. 3, the implantable lead structure 30 is
able to cover the least occipital, greater occipital, and lesser
occipital nerves, and generate a therapeutic electric field around
these nerves.
[0169] FIG. 4 is a schematic diagram of another exemplary
embodiment of an implantable lead structure 40 suitable for
occipital nervous stimulation (ONS) for a neuro-stimulation system
according to the teachings of the present disclosure. The lead
structure 40 is similar to that shown in FIG. 3, and includes
parallel electrode elements 42 and 43 embedded in a porous
substrate 44. Implantable lead structure 40 further includes masked
regions 46 that can be selectively positioned in order to cover
parts of the conductive electrode elements with materials to reduce
or remove porosity in the substrate 44. Regions of reduced porosity
may be used to insulate selected sections of the electrode element
from electrolyte, reduce the effective surface area of the
electrode, and/or reduce the level of adhesion within the electrode
and the adjoining tissue. The "masked" region may be created by
selectively making portions of the porous substrate less porous
and/or adding a suitable non-porous layer within the porous
substrate 44 or outside the porous substrate 44. An intermediate
porous layer may be embedded within the layers forming the outer
porous substrate 44, where the intermediate porous layer may have
defined thereon selected regions of reduced porosity or
non-porosity.
[0170] According to another aspect of this invention, an
implantable neurostimulation lead may be constructed in the form of
FIG. 4 with one or more substantially parallel, linear electrodes,
for example in the form shown in FIG. 5, wherein the materials used
are all bio-compatible and the lead structure ensures the
electrodes are continuously supported by the enclosing porous
substrate. Such may be made arbitrarily long and be trimmed to the
appropriate length at the time of implantation. The fact that
electrode structure is continuously supported by the porous
substrate (i.e. there are no discrete support structures) and the
use of only biocompatible materials means trimming the length of
the lead will not compromise its mechanical or biocompatibility
status.
[0171] FIG. 4A shows a particular embodiment of a linear electrode
porous lead where two or more pairs of electrodes 441 are each
connected to identical current sources, 442, by connecting wires,
443. The charge on each pair or electrodes is a function of the
magnitude of the current supplied by the current source and the
time for which the current is allowed to flow, as controlled by the
control circuit 444. If the current sources and electrodes are
configured to be identical, then the one control circuit can ensure
the same charge is established on each pair of electrodes. In such
a configuration, the porous lead may be cut at any of the cutting
lines, 445, without affecting the performance of the remaining
pairs of leads. For safety the control circuit must be able to
detect the absence of a pair of electrodes and disable the
associated current source.
[0172] Those skilled in the art will understand that reducing
length of the linear electrodes will necessarily reduce the total
surface area of the electrode structure. This in turn means that
the total charge that can be safely put onto the electrode will
also decrease to ensure the safe charge density for the particular
electrode material is not exceeded. Those skilled in the art will
also understand that adjusting the length of the electrode
structure will also cause the impedance of the lead to change.
[0173] According to another aspect of this invention the safe
charge limit for a stimulator attached to a length adjustable lead
as is described herein may be determined either manually, for
example by the clinician who trims the lead measuring the revised
length of the lead and calculating a safe charge limit, or
automatically by the stimulator from some parameter of the lead
that the stimulator can measure, for example by measuring the
impedance of the adjusted lead the stimulator may infer the new
length of the lead and therefore also the safe charge limit.
[0174] FIG. 5 is a diagrammatic illustration of an exemplary
electrode construction 50 according to the teachings of the present
disclosure. A preferred construction of the electrode element 50 is
formed of a suitable mono- or multi-filament wire supported by
and/or formed on a non-conductive filament. The insulated wire 52
is made from a suitable bio-compatible conductive material with
some of its insulation removed to expose the inner conductive wire
54. The inner conductive wire 54 is then wound helically with a
non-conductive support filament 56. This arrangement has several
advantages. There is no joint required within the electrode and the
electrical connection element. The wire helix formed this way is
more likely to resist fatigue. The supporting filament 56 may be
made from an appropriate material that the filament can induce
bonding to the porous substrate, helping to anchor the lead
structure in place. It should be understood that other methods for
forming the electrode structures exist. For example, electrodes of
more complex shape can be formed from bulk materials using a
process such as Electro-Discharge Machining (EDM), milling, and
stamping. Electrodes so formed can be joined to electrical
connection elements by welding or other joining techniques. It will
be understood by those skilled in the art that while one aspect of
this invention is the use of the porous substrate to provide the
greater part of the finished lead's mechanical integrity, some
elements, for example the non-conductive support filament described
above, may be used to provide some measure of mechanical integrity,
especially during the manufacturing process.
[0175] The porous substrate is formed from a biocompatible and
non-biodegradable material by one of a number of techniques,
including phase separation, uniaxial freezing, micro-molding, gas
freezing, and non-woven textile techniques including
electrospinning, and additive manufacturing techniques. The choice
of material and manufacturing method depend on the particular form
and mechanical properties required by the specific application.
Similarly, the choice of particular substrate parameters such as
pore size and void fraction is determined by the specific tissue
interfaces required for the application in question.
[0176] FIG. 6 is a schematic diagram of an exemplary
electrospinning system 60 for the manufacture of a non-woven porous
substrate according to the teachings of the present disclosure. The
electrospinning system 60 includes a liquid precursor polymer
solution 62 supplied to one or more spinnerets 64 mounted above a
grounded collector plate 66. A high voltage supply 68 is connected
within the spinnerets 64 and the collector plate 66. The precursor
polymer solution, sol-gel, particulate suspension or melt is fed to
the spinnerets 64 at a controlled rate. The electric field within
the tip of the spinnerets 64 and the collector plate 66 draws very
fine fibers 69 that are produced from the spinnerets 64 and
deposited onto the collector plate 66. As the exuded material or
fiber is deposited, it fuses with other deposited fibers and forms
a porous non-woven material or textile. Alternatively, the
deposited fibers may be subject to appropriate post-deposition
treatment to form or strengthen the bonds within the fibers, such
as specific temperature and/or pressure.
[0177] In the exemplary electrospinning system 60 shown, two or
more different materials may be deposited and used to form the
porous non-woven material. With the right material selection, this
process is able to produce porous substrates with high void
fractions, small pore sizes, and good mechanical properties in
sheets as thin as 100 micrometers. The porous substrate is made
from the random alignment of many layers of nanofibers laid in a
random pattern to produce a non-woven textile with good and
isotropic mechanical properties. This embodiment can be a cost
effective way to create a wide range of lead forms with good
mechanical, electrical, and bio-response properties. When suitable
base materials are used, such as polyurethane, the process has the
property that newly spun fibers will bond to the previously spun
fibers wherever the new fibers contact the fibers previously spun.
The electro-spinning process uses an electrical charge to draw
typically very fine fibers from a liquid form of the polymer used
to form the electro-spun fiber. This liquid form may be achieved by
dissolving the material in a suitable solvent or by using a molten
precursor. Because the process does not require the use of
coagulation chemistry or high temperatures to produce solid threads
from solution, it is particularly suited to the production of
fibers from large and/or complex molecules.
[0178] By adjusting the materials and key electro-spinning
parameters it is possible to use this technique to make porous
substrates that mimic the ExtraCellular Matrix (ECM) of different
tissue types including, but not limited to, sub-cutaneous tissue,
vascular tissue, muscle, neural tissue, and various organs.
According to one aspect of this disclosure, the characteristics of
the porous substrate can be adjusted to generate the desired tissue
response from the tissue type where the lead is to be implanted
including, but not limited to subcutaneous placement, muscular
placement, internal and external vascular placements, placement in
neural tissue, and placement on various organs.
[0179] FIG. 7 is a flowchart of an exemplary process for
manufacturing an implantable neuro-stimulation lead assembly or
implantable neuro-stimulation system according to the teachings of
the present disclosure. The method described herein is applicable
to the manufacture of all different forms of lead structures
described in this disclosure. This approach involves forming the
porous substrate in two or more stages to enclose, enmesh, embed,
and support the electrode elements and any other inclusions of the
neuro-stimulation system. In block 70, a mandrel of suitable
dimensions and shape is prepared. In block 72, if an initial porous
layer is to be formed, such first part of the porous non-woven
substrate is formed over the mandrel in block 74, said mandrel
being of a suitable shape for the lead to be made, for example,
conformal to the shape of an organ or other tissue element whereon
the lead will be placed. Thereafter, appropriate neuro-stimulation
elements and inclusions are positioned on the substrate, as shown
in block 76. Since such inclusions will be enclosed or enmeshed by
a continuation of the electro-spinning process, the inclusions may
have mechanical features designed to entangle with the electrospun
fibers to assist in the integration into the porous substrate. In
block 78, a determination is made as to whether all inclusions have
been added, if not, another part of the porous substrate may be
added in block 74, and additional inclusions incorporated in block
76. The neuro-stimulation inclusions may include electrode
elements, wires, and as described in more detail below, an
implantable pulse generator (IPG). When the last set of inclusions
is placed then a final part of the porous substrate is laid down in
block 79, and the lead fabrication is completed in block 80. Some
methods of forming the porous substrates, such as electro-spinning
polyurethane, naturally bond each successive part of the substrate
so that the different parts are integrated into a single substrate.
Other methods may require a final finishing step to bond the parts
together perhaps by heat, pressure, or ultrasonic welding, or other
suitable process that does not damage the substrate's
structure.
[0180] Another method may be to form the porous matrix on a three
dimensional mandrel, for example a cylinder, with electrodes placed
in appropriate places during the formation of the porous matrix.
The open form (a cylinder in the example) structure created on such
a mandrel may then be collapsed in various ways by bonding
different surfaces together, for example an open cylinder of porous
substrate may be collapsed into a ribbon by flattening the cylinder
and bonding the inner surfaces together. According to another
aspect of this invention is possible to alter the material
composition of the porous substrate in different locations such
that two or more parts of the substrate with one material
composition may be fused together or heat-set at a temperature or
by a process that does not affect parts of the substrate with other
material compositions. As an example it will seen that an open
cylindrical structure may be created such that some part of the
material composition of the inner surface of the cylindrical porous
substrate melts at a lower temperature than the outer layer of the
same cylindrical porous substrate. In this case, if the cylinder is
collapsed to a ribbon, the facing inner surfaces of the cylindrical
porous substrate will both have the low melting point material
composition and may be bonded together by heat without affecting
the outer surfaces of the ribbon structure. Those skilled in the
art that other bonding methods such as by the application of
selective solvents may be also be used to achieve this effect.
[0181] Optionally, a non-porous layer may be added to all or
portions of an external surface of the porous substrate.
Alternatively, the porous substrate layers may be formed and then
cut into the proper shape and size before being placed over the
mandrel, and laid over the neuro-stimulation elements. Further, one
or more additional porous parts with masked regions may be added as
intermediate layers within the two outer porous non-woven
substrates.
[0182] The porous substrates may be further modified by
incorporating certain inclusions, such as metal, glass, or ceramic
materials of certain desirable shapes and sizes to create an
enclosure, seal or barrier to moisture and oxygen if high levels of
electrolyte exclusion are desired in certain regions of the
implantable system. In an alternate embodiment, a laminated
multilayer structure may form part of the inclusion within the
porous substrates.
[0183] Another feature that may be added to the porous substrates
is to form one or more anchor pads by modifying the pore size so
that controlled tissue ingrowth can be achieved in selected areas
of the lead structure to provide long term anchoring. In the case
of an electrospun substrate, the anchor pads may be formed by
changing the density of the electro-spun fibers in selected regions
of the substrate. Precision deposition techniques such as
near-field electro-spinning may be used to create the anchor pads.
Another technique involves using a segmented collector plate to
which different potentials are applied in the electro-spinning
equipment. Other known techniques may be used.
[0184] Those skilled in the art will know many enhancements of this
basic technique are possible. Of particular interest are the
ability to form core-shell fibers (fibers with different materials
in their core and outer shell), the control of the deposition
pattern using high-precision deposition techniques, the control of
fiber orientation, and the use of multiple die and die-free
spinning methods.
[0185] FIG. 8 is a diagrammatic illustration of an exemplary
embodiment of a paddle lead structure 90 for neuro-stimulation
according to the teachings of the present disclosure. This
electrode configuration 90 uses the helically wrapped lead
structure shown in FIG. 5 and described above. A preferred
embodiment of the paddle electrode assembly 90 includes two
electrode elements 92 and 93 enclosed, enmeshed, and supported by a
porous substrate 94 in the manner described above.
[0186] FIG. 9 is a diagrammatic illustration of another exemplary
embodiment of a patch lead structure 100 according to the teachings
of the present disclosure. Implantable lead structure 100 further
includes masked regions 102 that can be selectively positioned in
order to cover parts of the conductive electrode element with
reduced porosity. The patch lead structure 100 may include two
conductive electrode elements laid out in the lead structure in a
predetermined pattern in the porous substrate 104 to create a
desired electrical field, with selective regions passed through by
the electrode element masked to create regions of reduced porosity
in the combined substrate layers. Regions of reduced or no porosity
may be used to insulate selected sections of the electrode element
from electrolyte, reduce the effective surface area of the
electrode, and/or reduce the level of adhesion within the electrode
and the adjoining tissue. The "masked" region may be created by
selectively making portions of the porous substrate less porous
and/or adding a suitable non-porous layer in within the porous
substrate or on the surface of the porous substrate. An
intermediate porous layer may be embedded in the porous substrate,
where the intermediate porous layer may have defined thereon
selected regions of reduced porosity or non-porosity.
[0187] FIG. 10 is a diagrammatic illustration of an exemplary
embodiment of another patch lead structure 110 for
neuro-stimulation according to the teachings of the present
disclosure. The patch lead structure 110 includes two electrode
elements 112 and 114 laid out in a predetermined pattern within a
porous substrate 116 to create a desired electrical field. The
patch lead structure 110 includes a first conductive electrode
element 112 laid out in a linear fashion with a terminal point, and
a second conductive electrode element 114 laid out in a circular
arc around the terminal point. As described above, the electrode
elements 112 and 114 are enclosed and enmeshed within two or more
parts of the substrate 116 of suitable shape and dimensions.
[0188] FIG. 11 is a diagrammatic illustration of an exemplary
embodiment of a cuff lead structure 120 for neuro-stimulation
according to the teachings of the present disclosure. The cuff lead
structure 120 is generally cylindrical in shape and substantially
surrounds the circumference of a nerve and suture closed. The cuff
lead structure 120 may be formed by embedding the conductive
electrode elements 122 within the porous substrate 124 of a
desirable shape and size and formed over a cylindrical mandrel as
described above.
[0189] FIG. 12 is a diagrammatic illustration of an exemplary
embodiment of a catheter style lead structure 130 for
neuro-stimulation according to the teachings of the present
disclosure. The catheter style lead structure 130 may be
manufactured by using a cylindrical mandrel which is rotated about
its axis during the electrospinning process to create a porous
substrate in a cylindrical form. The first part of the porous
substrate 132 is formed on the cylindrical mandrel, then an
insulated biocompatible wire is prepared by stripping the
insulation from one end of the wire 134. The uninsulated length of
wire 134 is then wound around the first part of the porous
substrate 132 forming an electrode element 136, and the insulated
part of the wire is laid on the first part of the porous substrate
parallel to the axis of the cylindrical substrate to form the
electrical connecting element 134. This process may be repeated one
or more times to create the desired number of electrode elements.
This process may also be repeated at the distal end of the
cylindrical mandrel to form a second set of lead structures that
may be later uncovered to form connector contacts. Once all of the
electrode inclusions are in place, a second part of the porous
substrate 138 is then laid down on the cylindrical mandrel to cover
the electrode elements. One or more regions of the lead structure
may be masked to create reduced or no porosity. Once removed from
the cylindrical mandrel, the finished lead will have a central
lumen in which a stylet may be placed to temporarily stiffen the
lead structure during implantation.
[0190] FIG. 13 is a diagrammatic illustration of an exemplary
embodiment of a helical lead structure 140 for neuro-stimulation
according to the teachings of the present disclosure. The helical
lead structure 140 includes electrode elements embedded within a
helical shaped porous substrate, which may also be formed over a
suitably shaped mandrel. The helical lead structure 140 may be
formed by forming a first part of the porous substrate around a
cylindrical mandrel of a suitable diameter, rotating the mandrel as
the substrate is formed. The electrode elements and insulated
connector wires are then laid over the first part of the porous
substrate in a predetermined pattern, and formation of the porous
substrate is then continued over the electrode elements.
[0191] According to a further aspect of this disclosure, the lead
assembly 150 shown in FIG. 14 may include a field shaping element
called a "buried electrode" 152 that is connected to the stimulator
but electrically isolated from the tissue by insulating layers 154.
Such an electrode 152 is capacitively coupled to the tissue and
would hold any charge placed on the electrode for a relatively long
time. Accordingly, the buried electrode 152 can be placed in an
appropriate location and pre-charged to an appropriate charge
density, prior to the stimulation cycle, to influence the shape of
the field created during the stimulation cycle. The one or more
field shaping elements or buried electrodes may be made from
suitable bio-compatible conductive materials such as, but not
limited to, Pt or Ptlr which may be coated with suitable
bio-compatible non-conductive or insulative materials, and which
may be connected to sources of specific electrical potentials for
the purpose of shaping the electrical field created by the one or
more electrode elements. These field shaping elements may also
embody features intended to relieve strain and improve their
resistance to fatigue. As in other lead assemblies, lead assembly
150 further includes electrode elements 155 and leads that are
enclosed and encased in porous substrates 156.
[0192] According to another aspect of this disclosure shown in FIG.
15, a lead assembly 160 may include an intermediate layer or
feature 162 of suitable porosity that is embedded in the porous
substrate 164, such that some parts of the intermediate porous
layer of feature 162 extend beyond the porous substrate 164 and any
impervious impregnation material layer 166 described above. The
porosity of the part of this intermediate layer 162 which extends
beyond the impervious impregnation material 166 is chosen to allow
the ingrowth of tissue into that part of the layer to aid in
anchoring the lead in the tissue. It should be understood that this
"anchoring" structure need not be continuous, but tailored to
ensure just as much anchoring force as is required.
[0193] According to a further aspect of this disclosure shown in
FIG. 16, a lead assembly 170 may have temporary and permanent
mechanical properties added to those of the underlying porous
substrate 172 by the inclusion of resorbable or non-resorbable
elements that are made from a biocompatible and resorbable or
non-resorbable material in addition to the electrode elements 174.
These inclusions may be included for several reasons including but
not limited to ensuring that the device permanently holds a
particular shape, to impart specific non-isotropic stiffness
properties, to providing temporary stiffness to the lead to
improved handling during implantation, and/or providing for short
term anchoring after placement. The added features may include
barbed features 176 on the edges of the porous substrate, for
example. The example shown further includes an impervious layer 178
above the porous substrate layer 172.
[0194] The basic cable section of the lead assemblies may be
manufactured as described above and then coated in a bio-compatible
and readily soluble material such as PolyEthelyne Glycol (PEG) Wax
or Polyvinyl Acetate (PVA). Once coated, a second enclosing layer,
possible with an anchor structure as described above, may be formed
around the lead using any of the construction methods described
herein. Once the enclosing layer has been formed, the soluble
material is removed creating a cable section which is entirely
enclosed in but not coupled to the outer enclosing layer. The
advantage of this construction is that if there is a need to
replace the lead post-implantation, the lead can be unplugged from
the implantable pulse generator and the cable section withdrawn by
pulling it through the enclosing layer which will remain in place,
forming a guide-way for the cable section of the replacement lead
to be passed through.
[0195] The connector section can be made by the following steps:
suitable mating structures for the connectors being used, made from
a biocompatible metal (for example Ptlr alloy), are mounted on an
appropriate supporting element such as a polyurethane rod; joining
the conductors in the cable section to the suitable mating
structures using an appropriate bonding method (e.g., laser
welding, pressure welding, spot welding etc.); encasing the
connector section in a suitable flexible biocompatible material
such as polyurethane or silicone; and a finishing process is used
to ensure the metal structures are free from any insulating
materials (such as flash from the previous step) and overall
structure is appropriately smooth.
[0196] In a preferred embodiment, the connector is a canted coil
connector (such as a BalSeal.TM. connector) so that the suitable
mating structure is a cylinder with a diameter of around 1.2 mm and
a length around 2-3 mm. The polyurethane supporting rod should be
sufficiently long and stiff to allow the implanting surgeon to be
able to easily push the connector structure into the connector. The
preferred encapsulating material is silicone for compatibility with
the cable section and the finishing process is cylindrical
grinding.
[0197] FIG. 17 is a diagrammatic illustration of an exemplary
embodiment of an implantable transvenous lead structure 180 for
neuro-stimulation according to the teachings of the present
disclosure. The transvenous lead structure 180 is constructed by
embedding electrically conductive elements of the appropriate
structure and other inclusions in a porous bio-compatible substrate
such as described above. In an exemplary embodiment, two wire stent
electrodes 182 are embedded in a suitable porous substrate 184 and
the entire assembly is mounted over one or more balloons 186 that
are attached to a suitable catheter (similar to a balloon catheter
used in angioplasty procedures). The transvenous lead structure 180
may be introduced into a vein or other blood vessel, advanced to a
desired stimulation site, and then anchored in place by expanding
the balloon to secure the stents against the wall of the vein or
other blood vessel. Since nerve and blood vessels often join
visceral organs in much the same place, this approach provides an
alternative to reaching stimulation sites that are difficult to
access otherwise. In an alternate embodiment, the two wire stent
electrodes 182 are replaced with a simple wire electrode mounted on
a resorbable stent structure and embedded in a suitable porous
substrate. This structure is implanted in the same manner as
described above with the resorbable stent structures designed to
secure the lead in place until the porous substrate has adhered to
the wall of the blood vessel, after which time the stent structure
is resorbed leaving less structure within the blood vessel. In both
embodiments it will be plain to those skilled in the art that more
than two electrode structures can be integrated into a single
lead.
[0198] FIG. 18 is a schematic diagram of an exemplary embodiment of
an implantable neuro-stimulation system 210, which may include an
energy storage device such as a battery, sometimes referred to as
an active implantable medical device (AIMD), or a passive device
without an included energy source and be powered by transcutaneous
electromagnetic power transfer, sometime called an "RF device,"
according to the teachings of the present disclosure. The
implantable neuro-stimulation system 210 is suitable for
implantation in a wide variety of locations in the human body and
particularly suitable for peripheral neuro-stimulation. The
implantable neuro-stimulation system 210 includes an implantable
pulse generator (IPG) 212 which is coupled to a lead assembly 214
by a connector assembly 216. The lead assembly 214 further connects
the implantable pulse generator 212 to one or more electrode
elements 218. The implantable neuro-stimulation system 210,
including the implantable pulse generator 212, connector assembly
216, lead assembly 214, and electrode elements 218, are designed
and manufactured to be implanted in a patient's body for
neuro-stimulation therapies. The implantable pulse generator 212 is
designed to be implanted in the patient's body at a suitable
implantation site, and the electrode elements 218 are generally
implanted and located away from the implantation site and close to
a preferred stimulation site rather than remotely at another
location in the patient's body.
[0199] FIG. 19 is a diagrammatic diagram of an exemplary embodiment
of an implantable neuro-stimulation system 220 according to the
teachings of the present disclosure. An initial part of the porous
substrate 222 is formed or laid down. Two electrode assemblies 224
and an impervious package 226 are then placed on the initial part
of the porous substrate 222. The two electrodes 224 each comprises
an electrode element and an electrical connection element, and the
electrical connection element is further connected to electrical
feedthroughs in the impervious package 226. A second part of the
porous substrate 228 is formed or laid down over the electrode
inclusions. In the figure this second part 228 is shown cut-away
for clarity. When the parts 222 and 228 are completed, the
inclusions 224 and 226 are held in place by the now single
substrate that encloses and supports the electrode assemblies. In
the example described herein a layer of non-porous material 229 may
be further added to one side of the porous substrate 228. The
implantable neuro-stimulation system 220 therefore encompasses the
lead assembly integrated with the implantable pulse generator to
form a single device that may be implanted at the stimulation site.
One or more additional lead assemblies may be connected to the same
pulse generator at the first stimulation site but implanted in
other stimulation site(s) if desired.
[0200] It will be evident to those skilled in the art that such an
implantable device 220 will be thin and extremely compliant, it
will create a broad electric field running parallel to the narrow
dimension of the substrate, and it will have good tissue adhesion
on the bottom face. If the porous substrate is made from a
non-woven textile, this device will also have good tensile
strength. In the preferred embodiment, the porous substrate is
formed from a non-woven fabric or material produced using, for
example, the electro-spinning process that uses an electrical
charge to draw typically very fine fibers from a liquid form of the
polymer used to form the electro-spun fibers. This liquid form may
be achieved by dissolving the material in a suitable solvent or by
using a molten precursor. Because the process does not require the
use of coagulation chemistry or high temperatures to produce solid
threads from solution it is particularly suited to the production
of fibers from large and/or complex molecules. Those skilled in the
art will appreciate that other electric fields, appropriate to the
application, can be created by different electrode arrangements
within the porous substrate.
[0201] FIG. 20 is a diagrammatic illustration of an exemplary
embodiment of an implantable neuro-stimulation system 230 for ONS
application according to the teachings of the present disclosure.
The implantable neuro-stimulation system 230 includes four
electrode structures 232 and an impervious package 234 (enclosing
the circuitry of an implantable pulse generator) enmeshed,
enclosed, and supported by a suitable porous substrate 236 and 238.
In this embodiment, the impervious package 234 is used to contain
and protect the electronic circuitry operable and configured to
generate the electrical pulse waveforms used for neuro-stimulation
therapies. In this embodiment, one side of the substrate is further
covered or infiltrated with a non-porous material 239 shown in
cut-away. The four electrodes 232 are disposed as two pairs of
electrodes where the electrodes in each pair are substantially
parallel and typically separated by a desirable distance, e.g., 3
mm. For ONS, the two pairs of electrodes are typically 6-7 cm long
and are placed above and to the left and right of a centrally
located impervious package 234 as shown in FIG. 20. Such an
electrode configuration is configured to generate a broad
stimulation field within the two parallel electrodes on each side
of the device.
[0202] It is well known that polymers have inherently high
permeability to moisture and if high levels of electrolyte
exclusion are required in a particular design, for example to
protect electronic components incorporated in the device, then
specific hermetic, impervious, or moisture resistant structures may
be included in the porous matrix. These inclusions may include
metal, glass or ceramic enclosures, or enclosures formed using a
laminate design. Such laminated designs are multilayered structures
with materials specifically chosen to achieve a seal or barrier.
Such layers may include metal foils as moisture and oxygen
barriers.
[0203] To achieve a suitably small volume, the implantable
neuro-stimulation system 230 may be powered by the transfer of
electromagnetic energy through the skin from an external
transmitting device. In this case the impervious package may also
contain a coupling device, an antenna, coil or other device, to
receive the transmitted electro-magnetic energy. It should be noted
that the implantable neuro-stimulation system 230 may incorporate
lead assemblies and other inclusions described above and may take
the form of any variety of shapes.
[0204] FIG. 21 is a diagrammatic illustration of a preferred
placement location of an implantable neuro-stimulation system 230
for ONS application according to the teachings of the present
disclosure. The implantable neuro-stimulation system 230 is
implanted so that the electrode elements cover the three branches
of the occipital neve. The device 230 is placed below the skin and
above the branches of the occipital nerve with the side with the
non-porous coating facing away from the occipital nerve. In this
location the device will generate a field parallel to those nerves.
Since the resulting device 230 is very thin (less than 0.5 mm thick
in the lead structure) and very compliant, it also addresses the
skin erosion and lead fracture adverse events. Finally, since the
porous substrate can be engineered for good cell adhesion, a lead
based on this invention will be effectively anchored across its
entire face and will significantly reduce lead migrations adverse
events
[0205] Optional areas of non-porous coating or infiltration on one
or more surfaces of the device 230 may be used to insulate one side
of the electrode structure from electrolyte and thereby direct the
stimulation field away from that side, or it may be done to modify
the surface properties of the structure to achieve a different
degree of cell adhesion. This can be achieved, for example, by
spraying, applying or infiltrating liquid silicone to the
appropriate surfaces of the structure. It may also be achieved by
over-molding suitable materials, such as polyurethane, over the
appropriate surfaces of the structure. Such coating or infiltration
processes may also be used to ensure the electrode structure
assumes a particular form.
[0206] FIGS. 22 and 23A-D are diagrammatic illustrations of an
exemplary embodiment of a neuro-stimulation system 240
incorporating a wearable external transmitting device according to
the teachings of the present disclosure. To reduce the volume of
the implanted component it is possible to remove the battery from
the implanted hermetic container and instead power the implanted
components by wireless induction through the skin. An electrical
coil or other means of receiving energy and/or information are
enclosed inside the implanted package, which receives power and/or
data by inductive or radio-frequency (RF) coupling to a
transmitting coil placed outside the body. According to another
aspect of the disclosure, the electromagnetic energy required to
power the implanted neuro-stimulation device can be provided by a
transmitting device 240 in the general form shown in FIGS. 22 and
23A-D. The external transmitting device 240 shown in FIG. 23A
includes ear hooks 242 to secure the device 240 to the wearer's
ears, an enclosure to contain electronic circuitry and power
storage elements 244 as are required for the proper operation of
the transmitting device 240. The device 240 further includes
adjustment devices 245 on either sides of the electronic circuitry
package 244 allows the adjustment and repositioning of the coupling
assembly 246 so that it sits comfortably at the base of the
wearer's skull. The external transmitting device 240 is coupled to
a coupling assembly 246 that includes an antenna, coil, or other
devices to transmit power to and receive data from the implanted
neuro-stimulation system. It will be understood by those skilled in
the art that other forms of external transmitting device are
possible, including transmitting devices integrated into
headphones, hat, headband, necklace, eyeglasses, purse, collar,
Velcro patch, or other apparatus (examples shown in FIGS. 23B-D)
capable of supporting the transmitting coil proximal to the
implanted receiving coil.
[0207] Neuro-stimulation therapies involve delivering a particular
pattern of stimulation pulses to a neural tissue in question. Such
patterns are defined by the width, the repetition rate (or
frequency) and amplitude of the stimulation pulses.
Neuro-stimulators are commonly able to store one or more such
patterns as a "program" and a patient may be able to select within
different programs for different circumstances. Sometimes these
patterns are made more complex by having the neuro-stimulator cycle
within two or more pre-defined patterns to address two therapeutic
goals at once. This is commonly known as "cycling." Sometimes the
neuro-stimulator may cycle within a predefined pattern and no
stimulation. This is commonly known as "burst mode." According to
one aspect of this disclosure, a neuro-stimulator may concurrently
run two or more stimulation patterns to achieve more complex
therapeutic outcomes.
[0208] FIG. 24 is a flowchart of an exemplary process for
establishing and combining multiple stimulation patterns into a
composite stimulation pattern for a neuro-stimulation system
according to the teachings of the present disclosure. In block 250,
the neuro-stimulation lead structure or implantable
neuro-stimulation system is implanted at the target simulation
location in the patient's body. In block 251, a first stimulation
pattern is selected. Thereafter, the various parameters of the
first stimulation pattern, such as frequency and amplitude are
adjusted to achieve the desired effect, as shown in block 252. A
determination is made in block 253 as to whether the process is
completed. If the process is not complete, the next stimulation
waveform is added, as shown in block 254. In block 252 the
parameters of the next pattern are adjusted to achieve the desired
effect. In block 253, another verification is made whether all of
the desired stimulation patterns have been added. If not, then
further waveforms are added, but if all of the waveforms have been
added, then the patterns are combined in block 255. In block 256,
the combined stimulation patterns can be fine-tuned to the desired
outcome.
[0209] FIG. 25 is a diagrammatic illustration of an exemplary
composite waveform that includes a CBAC (charge-balanced
alternating current) waveform superimposed onto one phase of a CBDC
(charge-balanced direct current) waveform for neuro-stimulation
according to the teachings of the present disclosure. Because
stimulation paradigms that have a prolonged net DC component may
lead to the production of toxic electro-chemical products, it is
necessary to ensure no net DC is present in a stimulation paradigm.
This can be achieved by active charge balancing (where each anodic
stimulation pulse is balanced by cathodic stimulation pulse of
equal charge) or by passive charge balancing where a capacitor of
appropriate size is installed in the electrode circuit. Charge is
stored in the capacitor during the stimulation pulse then
"recovered" after the pulse as the capacitor discharges. Typically,
the time constants for the capacitive recovery circuit are such
that it can only be used for relatively low frequency stimulation
paradigms. Since a stimulation paradigm should not present a net DC
component in the long term, it will be understood by those skilled
in the art that the term "DC stimulation" refers to a
charge-balanced direct current (CBDC) stimulation paradigm where
relatively long stimulation pulses, in the order of 10 seconds, are
balanced with pulses of equal and opposite charge. CBDC waveforms
may be more accurately described as low or very low frequency
charge balanced alternating current (CBAC) waveforms. For clarity
the terms CBDC (Charge Balanced Direct Current) is used for the
nerve block stimulation and CBAC (Charge Balanced Alternating
Current) is used for the nerve recruitment stimulation
waveform.
[0210] According to one aspect of this invention, a stimulation
paradigm that combines a CBDC nerve block pulse with a burst, cycle
or continuous non-DC nerve recruitment stimulation pattern
(hereinafter referred to as CBAC stimulation) can selectively block
the larger afferent A-.beta. fibers (and so reduce or remove the
paraesthesia response), while providing activation of smaller
diameter fibers sufficient to deliver pain relief by the gate
control theory mechanism. In SCS applications this minimizes the
paraesthesia sensation while still providing pain reduction. As
shown in FIG. 25, the implantable pulse generator 260 is connected
to the stimulation lead 262 and presents an electrical waveform
that represents the combined CBDC and CBAC waveforms 264
transmitted to the electrode elements. It should be understood by
that the different parameters of each waveform, including the
frequency and amplitude of each component of this combined
waveform, can be independently adjusted, so the final combined
waveform can be considered to be a weighted sum of the two or more
component waveforms.
[0211] FIG. 26 is a diagrammatic illustration of
independently-generated exemplary CBAC waveform and exemplary CBDC
waveform for neuro-stimulation according to the teachings of the
present disclosure. According to another aspect of this disclosure,
since electrical fields from different sources combine with the
principle of linear superposition, the CBDC and CBAC stimulation
patterns can be created by two independent implanted pulse
generators 270 and 271 and applied within more than two electrodes
(where, for example the CBDC pattern is presented to one electrode
and the CBAC pattern to another electrode and a third electrode
acts as the return electrode). The first implantable pulse
generator 270 generates the CBAC signal 272 which is connected the
electrode 274 on the stimulation lead. The second implantable pulse
generator generates the CBDC signal 276 that is connected to the
electrode 278 on the stimulation lead. Different parameters of each
waveform, including frequency and amplitude of each component
waveform can be independently adjusted, so the final field created
in the tissue by the resultant combined waveform can be considered
to be a weighted sum of the two or more component fields.
[0212] FIG. 27 is a diagrammatic illustration of an exemplary
composite waveform that includes a CBAC waveform superimposed onto
one phase of a CBDC waveform for neuro-stimulation according to the
teachings of the present disclosure. According to another aspect of
this disclosure, the CBAC component of the combined waveform may be
continuous or intermittent. The implantable pulse generator 280
presents a signal 282 which is a continuous combination of CBAC and
CBDC waveforms to the electrode 284. FIG. 27 shows an example of
the intermittent case where the implantable pulse generator 280
presents a signal that has a continuous CBDC component, which is
added to an intermittent CBAC component to the electrode 284.
[0213] It should be understood by those skilled in the art that
there are many ways in which two or more waveforms may be combined
continuously and intermittently to achieve the desired effect for
neuro-stimulation therapies. Any known or later developed methods
to combine two or more waveforms is encompassed herein. Further,
the waveform shapes used to create the CBDC and CBAC stimulation
patterns may be square, triangular, sinusoidal, or any other
symmetric or asymmetric waveform shape.
[0214] Nerves in biological organisms typically consist of many
neural fibers of varying size. Since the exact shape of the CBAC
and CBDC waveforms will affect the diameter of the fibers, the
recruit and the block respectively, by varying said CBAC and CBDC
waveforms and the way they are combined it is possible to
selectively recruit particular diameter fibers in a nerve. In some
cases such a selection of particular fibers will promote the
production of particular neurotransmitters, selected for specific
therapeutic benefit.
[0215] Since neuro-stimulation is undertaken to deliver a
therapeutic benefit it may be desirable for neuro-stimulators to
have some method of determining the extent to which the stimulation
being delivered is achieving its intended goal. Such a capability
may be beneficial to ensure the patient receives sufficient therapy
and to avoid any potential harm or power wastage that may be
associated with over delivery of a therapy. The process of
automatically measuring some outcome from a neuro-stimulation
therapy and using that measurement to control the delivery of
either the neuro-stimulation therapy or another therapy is often
referred to as "closed-loop stimulation." According to one aspect
of this invention neural circuit processing may be used for this
and other purposes.
[0216] The mechanisms of neuro-stimulation are various and
understood to different degrees, depending on the particular
therapy in question. One application of peripheral nerve
stimulation for pain is to effect a "nerve block" whereby the
stimulation is used to effectively block neural transmission,
thereby preventing occurrence of action potentials. In other cases,
it is understood that neuro-stimulation can promote neural
transmission creating action potentials. The result of neural
activation is the production of neurotransmitters. A
neurotransmitter can be any endogenous chemical that is used to
enable neurotransmission, such as GABA (gamma-Aminobutyric acid) or
other neurally active agents such as endorphins. It has been shown
that occipital nerve stimulation (ONS) stimulates the production of
GABA in the Trigeminal Nucleus Caudalis (TNC). It is known that
reduced levels of the inhibitory neurotransmitter GABA are linked
to migraine severity and frequency of migraine events. The role of
neurotransmitters such as GABA is to modify the way neural signals
are passed within two or more neurons. The neurotransmitter is
released into the synapse (the minute gap at the junction within
two nerve cells) by the first neurons and carries the neural
impulse to the second neurons by diffusion across the synapse.
Different neurotransmitters can modulate the transmission of neural
impulses in different ways.
[0217] Information about a neural circuit may be derived by
comparing the input to the neural circuit with the output of the
neural circuit. An example of such a complex neural circuit
measurement is the "h reflex" or Hoffman reflex. When electrical
stimulation is applied via the stimulation electrode to the input
or sensory neurons of a nerve in a muscle, at least two responses
may be measured by the measurement electrode in the motor neurons
to that nerve. Typically, the sensory neurons and the motor neurons
for a muscle are bundled together, so stimulation of sufficient
intensity will activate both the sensory neurons in the antidromic
direction (towards the spinal cord) and the motor neurons in the
orthodromic direction (towards the muscle). The direct activation
of motor neurons generates a first response at the measurement
electrode called the m-wave, which typically occurs 3-6 msec, after
the onset of stimulation. The activation of the sensory neurons
activates the reflex arc and generates a second response in the
motor neurons called the h-wave, typically 28-35 msec, after
stimulation.
[0218] In a neural circuit shown in FIG. 28, the receptor
structures 300 of an input neuron detect a trigger input and an
electrical signal is transmitted along the input neurons 302 to the
spinal cord, via the spinal cord ganglion 304. In the spinal cord
the input signal generally follows two pathways. One pathway, not
shown in the figure, takes the input signal to the brain, while the
other pathway is through the interneuron 306. The input signal
triggers the interneurons 306 that in turn triggers an output
neuron 308. The output neuron 308, in turn, conveys the signal to
an effector, for example a muscle 310. This second pathway, from
the receptor 300 via the spinal cord interneurons 306 to the
effector 310, is called the reflex arc. The reflex arc allows the
body to react quickly to key sensory inputs. It should be
understood that in this example, the input (here sensory) and
output (here motor) neurons form part of the peripheral neurons
system (PNS), while the interneuron in the spinal cord forms part
of the central nervous system (CNS).
[0219] Peripherally placed neuro-stimulation and recording
electrodes may be used to monitor the performance of neural
circuits that may include one, two, or more nerve fibers. An
example of such a neural circuit is the reflex arc. In the
description that follows a reference to a reflex arc shall be
understood to refer to any system of interconnected nerve fibers
where there are a first neural element that may be considered to be
an input to the system (hereinafter referred to as the input
neuron); a second neural element that may be considered the output
to the neural circuit in question, on whose neural activity may be
measured and which synapses to the first element (hereinafter
referred to as the output neuron); and possible third or further
elements that synapse within the input neuron and the output neuron
(hereinafter referred to as the interneuron) and where the behavior
of the circuit may be affected by either the stimulation input to
the neural circuit or by some other apparatus, for example a drug
pump.
[0220] FIG. 29 is a diagrammatic illustration of a preferred
placement of stimulation and recording electrodes on the neural arc
according to the teachings of the present disclosure. An implanted
electronics module 320 provides a stimulation pattern to the input
neurons 322 via the stimulation electrode 324, and measures the
electrical activity on the measurement electrode 326 on the output
neuron 328, where the signal traveled from the input neuron 322 to
the output neuron 328 via the interneuron 330.
[0221] A measurement system and method as is disclosed herein that
may be used to monitor the performance of central nervous system
neurons that is in the neural circuit. The physical environment of
any neuron may have a profound impact on the operation of that
neuron. In particular, the operation of various chemicals
(collectively called neuro-transmitters) to assist or inhibit the
transfer of nerve impulses across the synapses within nerves or to
assist or inhibit the transmission of impulses along the neuron
axon (by, for example, altering the ability of Na and K ions to
move across the cell membrane) affects the performance of a neural
circuit that contains synapses. An example of such a chemical is
Gamma-aminobutyric acid (GABA). This amino acid is the second most
prevalent neurotransmitter in the brain and it has an inhibiting
effect that calms excited nerve impulses. A deficiency of GABA can
cause headaches, depression, irritability, palpitations, and other
symptoms. Such a deficiency may be treated by the prescription of
other neuro-inhibitors (e.g., tranquilizers in the benzodiazepine
family) or dietary supplements of substances that stimulate the
body's own production of GABA. Accordingly, the capacity to measure
a neural circuit as described herein can be applied to a neural
circuit that crosses the CNS. Such a measurement may permit
inferences to be drawn about the presence or absence of
neurotransmitters such as GABA in the region of the CNS. This
methodology may be further extended to the measurement of a wide
range of parameters of the neural circuit and permit the drawing of
inferences related to many other biological conditions.
[0222] It should be understood by those skilled in the art that the
capacity to measure a neural circuit as described herein can also
be applied to a circuit that involves the autonomic nervous system.
As mentioned above, such inferences can be used to understand the
effects of stimulation of one point in the autonomic nervous system
and its influence on another point of the system. For example,
stimulation of the hepatic nerve may activate changes in glucose
levels in the blood, the level of glucose detected could allow
inferences of the state of the system.
[0223] The utility of such measurements includes the detection both
permanent and transitory abnormal conditions in the neural circuit
being measured; to provide assistance in the manual titration of
drugs prescribed to rectify such abnormal conditions; or to provide
closed loop control of neuromodulation therapies such as devices
designed to deliver such drugs (e.g., implantable drug pumps) or
devices which may stimulate the production of such chemicals in the
body (e.g., some neuro-stimulation therapies). Since the placement
of peripheral electrodes is commonly not very invasive, such
electrodes may be implanted for acute trials to determine if a
patient is likely to respond to an expensive neuromodulation
therapy.
[0224] An example of the kind of measurement that might be used to
infer information about the neural circuit and its environment is
the time between the stimulation of the input neurons to the
appearance of a response at the other end of the circuit (i.e., on
a output neuron) such as is done in the "h reflex" described
earlier. Another example is the threshold level of stimulation
required on the input neurons to evoke a response in the other end
of the circuit. A third measurement might be to compare the
difference in the average power of measured neural activity on the
output neurons when stimulation on input neurons is either present,
altered, or absent. According to one aspect of this invention
neural circuit processing may be used with temporary electrode as a
diagnostic aid to allow for particular conditions to be detected
and/or quantified.
[0225] According to another aspect of this invention neural circuit
processing may be used as part of a control loop to ensure or
confirm that the desired stimulation paradigm is being
appropriately delivered to the sensor nerve.
[0226] According to yet another aspect of this invention neural
circuit processing may be used as part of a "closed loop"
stimulation paradigm to detect particular physiological conditions
and customizes therapy delivery to meet that physiological
need.
[0227] It should be understood that making a measurement such as
the h-reflex is critically dependent on the ability to identify the
h-wave associated with a particular stimulus. In a clinical
setting, when the patient is at rest, this can be readily achieved
since circumstances can be arranged to ensure there is little or no
other activity on the nerve in question. Out of the clinic,
however, it can be expected that normal patient activity will
generate activity on the motor neurons that may make it difficult
to identify h-wave associated with a stimulus.
[0228] To manage this issue, the device measures the relationship
within a series of input stimuli and their corresponding output
responses. It is understood that if an appropriate input sequence
to a system is mathematically correlated with the corresponding
output sequence of that system, the cross correlation function
will, in many practical situations, have a peak when the two
sequences are most closely aligned, even in the presence of other
uncorrected output signals.
[0229] FIG. 30 is a diagrammatic illustration of a representative
cross-correlation signal processing technique to reliably measure
the influence of the interneurons element according to the
teachings of the present disclosure. If an input sequence is
correlated with itself (its auto-correlation), what is produced is
an auto-correlation which has the form of a single "spike" or delta
function. If the input sequence is repetitive in nature, then the
auto-correlation function shows multiple peaks, spaced equal to the
repetition period. If the input sequence has no repetition, then
the cross-correlation function will only show multiple peaks if the
system under examination introduces multiple responses to each
stimulus. An ideal input function is therefore one which closely
approximates a "white noise" sequence, though other sequences may
also be used. Referring to FIG. 30, an implanted electronics module
340 is configured to stimulate the sensory neurons with a pulse
train generated from a pseudo random binary noise (PRBN) generator.
The stimulation electrode 342 delivers a pattern of electrical
stimulation pulses controlled by the PRBN generator to the sensor
neurons. A measurement electrode 344 measures all electrical
activity occurring in the output neurons. A signal processing
circuitry then cross-correlates the PRBN sequence with the measured
activity on the measurement electrode 344. If at least some part of
the measured waveform or sequence is due to the PRBN controlled
stimulation sequence, then the cross-correlation of these two
signals produces a peak at the point where the PRBN sequence is
correlated with the neural activity evoked by that sequence.
Further, the height of that peak is proportional to the degree of
matching within the two sequences and the position of the peak
indicates the time delay within the input sequence and the
correlated output sequence.
[0230] The PRBN generator can be designed with arbitrarily long
pseudo-random pulse trains. The need to ensure there is no sequence
repetition in the time periods of interest (in general less than 40
msec.) arbitrates in favor of longer sequence lengths, but longer
sequences require longer cross-correlation windows to ensure the
function is properly computed. In the preferred embodiment, the
PRBN sequence length is chosen to appropriately balance these two
issues. It should be understood that other stimulation patterns may
also have desirable properties and can be used herein as the
stimulation waveform.
[0231] According to one aspect of this disclosure, the effect that
a stimulation pattern applied to the input of a neural circuit has
on the average signal power measured on the output of the neural
circuit may be used for closed loop control.
[0232] FIG. 31 is a diagrammatic representation of a sum of squares
circuit/processor according to the teachings of the present
disclosure. The input signal, x(t), is first multiplied by itself
(x(t)2) and the resulting signal is then summed or integrated over
a fixed period (.SIGMA.x(t)2/T). Since the power in a signal is
proportional to the square of its amplitude, the resulting output
of the integrator stage is proportional to the power in the
received signal over the integration period (P(x(t)). It should be
understood by those skilled in the art that other methods of
measuring the power and other properties in a signal are also
contemplated herein. For example, the measured output may be
transmitted to a computing device that is configured to analyze the
output signal and modify or generate a control parameter of the
neuro-stimulating device or modifying a parameter or characteristic
of the input signal, thus forming a feedback loop.
[0233] FIG. 32 is a diagrammatic illustration of using a sum or
squares signal processing technique to measure the performance of a
neural circuit. This method is of particular utility when higher
stimulation frequencies are used, but may be used in any situation.
The signal measured at the output neurons is a composite of
"normal" neural activity (i.e., the signal that is present
regardless of any stimulation on the sensor neuron) and activity
that is a result of stimulating the sensor neurons. The implanted
electronics module is configured to control the higher frequency
stimulation signal to be sometimes present and sometimes absent.
The measurement electrode detects all the activity on the output
neurons, both the naturally occurring activity as well as the
activity in response to the stimulation patterns. When the measured
signal passes through the sum of squares power detection function,
the output of that function is a waveform of which the amplitude is
proportional to the power in the measured signal on the output
neuron. This measured waveform has some regions where the computed
power represents the power in the natural activity of the neurons
only (when no stimulation is applied) and other regions where the
computed power represents the sum of the natural activity and the
activity evoked in the neurons by the stimulation pattern. Over
short periods it is very likely to be valid to assume the natural
level of neural activity is constant so any difference within the
stimulation absent and stimulation present measurements may be
interpreted as being due to the applied stimulation. The difference
within these two measurements is proportional to both the intensity
of the stimulation pattern and the performance of the neural
circuit being measured. It may be appreciated by those skilled in
the art that this method may also be used to determine the
effectiveness of a high frequency stimulation pattern on a neural
circuit where no synapse is included.
[0234] In many cases, effective neural circuit processing requires
information about the performance of the receptor nerve. For
example, if the sensitivity of the CNS synapsing functions needs to
be estimated, it is desirable to have estimates of the sensor and
effector nerves as well. At least the sensitivity of the sensor
nerve may be estimated by analyzing the Compound Action Potential
(i.e. the sum of individual neural action potentials) evoked by a
stimulation pulse. This signal is called the Evoked Compound Action
Potential or ECAP. Such information may include threshold
stimulation level (the minimum stimulation level at which at least
some neurons in the nerve are stimulated), neural conduction
velocity (the speed with which the ECAP travels along the nerve) or
the spread of individual neural velocities (ECAP shape). Measuring
ECAPs is known to be complicated by the presence of the stimulation
artefact. This artefact is a result, at least in large part, of
capacitance in the stimulation circuit path.
[0235] In many cases the effect of the stimulation artifact can be
minimized by physically separating the stimulation and measurement
electrodes. In some cases, however, this is impractical.
[0236] FIG. 33 is a schematic diagram representation of an
equivalent circuit 350 of an electrode tissue interface according
to the teachings of the present disclosure. The circuit 350
includes a capacitive element 352 coupled in parallel with a
resistive element 354. The capacitive element 352 arises from the
double layer of ionized electrolyte on the electrode surface.
[0237] FIG. 34 is a schematic diagram of an equivalent circuit 360
for a stimulation pulse passing through two electrodes with
impedance Ze, through the tissue impedance Zt, through two sensing
electrodes Zi, then into a measurement amplifier 362 according to
the teachings of the present disclosure. There are several energy
storage elements in the signal path that can give rise to the
electrode artifact shown at the output of the amplifier 362. When
the stimulation level generates a field that exceeds the activation
function of the nerve being stimulated, then the signal at the
output of the measurement amplifier 362 is the sum of the artifact,
the Evoked Compound Action Potential (ECAP), and any other
electrical noise. For any practical stimulation signal, the
artifact may have an amplitude of tens to thousands of milli-volts
compared to the ECAP signal of micro-volts or tens of micro-volts.
An amplifier capable of measuring the ECAP without being overloaded
by the artifact would need a dynamic range in the order of 120 dB,
for example. Since this is hard to achieve in a device suitable for
implantation, the measurement amplifier has a time-varying gain
such that the gain of the amplifier increases over time, inversely
with the expected level of the artifact. In this way, the
measurement amplifier does not overload, and the true value of the
measurement signal can be digitally reconstructed by multiplying
the measured signal with the gain function. In many cases the
artifact signal is either effectively constant or can be modeled as
a function of a small number of parameters. These parameters may
include stimulation voltage or current, stimulation duration, and
other parameters. The measurement device has the capacity to
generate an artifact model based on suitable input parameters and
to appropriately combine this model with the measurement signal to
generate a good estimate of the ECAP signal.
[0238] Where it is desirable to estimate the amplitude of the ECAP
signal there are several methods known in the art that may be
applied. Methods which are computationally efficient, such as
simple amplitude detection, are often susceptible to noise. More
sophisticated methods such as matched filters, correlation
techniques methods and even wavelet processing techniques are less
susceptible to corruption by noise, but in every case these methods
can sometimes produce an estimate of an ECAP, even when one is not
present. Where this estimate is used by a control algorithm such
behavior will cause the algorithm to behave unpredictably.
[0239] FIG. 35 is a block diagram of a system for enhancing
detection performance with a signal present estimator according to
the teachings of the present disclosure. The amplitude detection
algorithm is managed or "gated" by a separate algorithm used to
estimate the presence or absence of an ECAP in the measured signal.
In this apparatus, the signal is passed through a conditioning
stage 380 that may provide, for example, low input capacitance,
level shifting, amplification or other suitable condition steps.
The signal is then presented to a "signal detection" device 382
that includes an amplitude detecting element 384 that estimates the
power in the signal, and a "presence detection" element 386 that is
configured to recognize the presence of the desired signal. The
output of both these elements 384 and 386 is then passed to the
control unit 388. The control unit 388 applies a suitable control
strategy when reliable signal measurement can be made, and a
potentially different control strategy when no reliable measurement
can be made. It should be understood by those skilled in the art
that this structure allows for each detection algorithm to be
optimized for their particular purpose and improves the overall
performance of the control algorithm. When the "presence detector"
386 estimates that no signal is present, the control algorithm can
ignore the amplitude or power estimate from the amplitude detecting
element 384 and behave according to predefined rules to ensure the
safety and efficacy of the device.
[0240] According to another aspect of this disclosure, one method
for detecting ECAP presence is achieved by examining the phase
behavior of the Fourier transform of the measured signal. FIGS.
36-43 are amplitude and phase spectra of estimates of ECAP and
Artifact signals according to the teachings of the present
disclosure.
[0241] The features of the present invention which are believed to
be novel are set forth below with particularity in the appended
claims. However, modifications, variations, and changes to the
exemplary embodiments described above will be apparent to those
skilled in the art, and the system and method described herein thus
encompass such modifications, variations, and changes and are not
limited to the specific embodiments described herein.
[0242] While preferred embodiments of the present invention have
been shown and described herein, it will be obvious to those
skilled in the art that such embodiments are provided by way of
example only. Numerous variations, changes, and substitutions will
now occur to those skilled in the art without departing from the
invention. It should be understood that various alternatives to the
embodiments of the invention described herein may be employed in
practicing the invention. It is intended that the following claims
define the scope of the invention and that methods and structures
within the scope of these claims and their equivalents be covered
thereby.
* * * * *