U.S. patent number 3,645,267 [Application Number 04/872,150] was granted by the patent office on 1972-02-29 for medical-electronic stimulator, particularly a carotid sinus nerve stimulator with controlled turn-on amplitude rate.
This patent grant is currently assigned to Medtronic, Inc.. Invention is credited to Norman R. Hagfors.
United States Patent |
3,645,267 |
Hagfors |
February 29, 1972 |
**Please see images for:
( Certificate of Correction ) ** |
MEDICAL-ELECTRONIC STIMULATOR, PARTICULARLY A CAROTID SINUS NERVE
STIMULATOR WITH CONTROLLED TURN-ON AMPLITUDE RATE
Abstract
Electronic circuitry for providing electrical stimulation
signals to a selected portion of the body including circuitry for
automatically gradually increasing the amplitude of only the
initial output stimulating signals to a predetermined level which
is maintained until turnoff.
Inventors: |
Hagfors; Norman R.
(Minneapolis, MN) |
Assignee: |
Medtronic, Inc. (Minneapolis,
MN)
|
Family
ID: |
25358947 |
Appl.
No.: |
04/872,150 |
Filed: |
October 29, 1969 |
Current U.S.
Class: |
607/44; 607/63;
607/72; 327/261; 307/141.4; 331/113R; 331/185; 331/74 |
Current CPC
Class: |
A61N
1/36017 (20130101); A61N 1/36034 (20170801) |
Current International
Class: |
A61N
1/08 (20060101); A61N 1/36 (20060101); A61n
001/36 () |
Field of
Search: |
;128/419-422
;328/8,9,76,77,85,90 ;307/293,141,141.4 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Claims
What is claimed is:
1. In electronic circuitry for providing output electronic
stimulating signals to a selected portion of the body the signals
providing a plurality of pulses, the circuitry adapted to be
connected to a source of electrical energy, the improvement
comprising: means for gradually increasing the amplitude of the
initial pulses of the output stimulating signals to a predetermined
value; energy terminal means adapted to be connected to the source
of electrical energy; and further means for connecting said means
for gradually increasing the amplitude between said energy terminal
means and a selected portion of the electronic circuitry.
2. The improvement of claim 1 in which said means for gradually
increasing the amplitude includes: input and output terminals for
connection, respectively, to said energy terminal means and the
selected portion of the electronic circuitry; amplifier means
connected between said input and output terminals and having a
control terminal; electrical time constant means; and means
connecting said time constant means to said control terminal and
across said energy terminal means.
3. The improvement of claim 2 in which said electrical time
constant means comprises: resistance means and capacitance means;
means for connecting said resistance means between said control
terminal and one polarity of said energy terminal means; and means
for connecting said capacitance means between said control terminal
and another polarity of said energy terminal means.
4. The improvement of claim 3 in which said amplifier means
comprises: a transistor having input and output electrodes
connected to said input and output terminals, and having a control
electrode connected to said control terminal.
5. The improvement of claim 4 in which said transistor is connected
in emitter-follower configuration.
6. In electronic pulse stimulator apparatus for providing an output
train of pulses, the stimulator adapted to be connected to a source
of electrical energy and including pulse generator means and output
amplitude control means, the improvement comprising: energy
terminal means adapted to be connected to the source of electrical
energy; means for automatically gradually increasing the amplitude
of the initial pulses of the output train of pulses to a
predetermined value; and means for connecting said means for
gradually increasing the amplitude between said energy terminal
means and the output amplitude control means.
7. The improvement of claim 6 in which said means for gradually
increasing the amplitude includes: amplifier means connected
between said energy terminal means and the output amplitude control
means; electrical time constant means; means for connecting said
time constant means across said energy terminal means; and means
connecting said time constant means to said amplifier means for the
control thereof.
8. The improvement of claim 7 in which said electrical time
constant means comprises: resistance means and capacitance means
connected in series across said energy terminal means; and said
capacitance means connected to said amplifier means for controlling
the output thereof dependent on the electrical charge in said
capacitance means.
9. The improvement of claim 8 in which said amplifier means
comprises: a transistor having input, output and control
electrodes; said input and output electrodes connected to,
respectively, said energy terminal means and said output amplitude
control means; and said control electrode connected to said
capacitance means.
10. The improvement of claim 9 in which said transistor is
connected in emitter-follower configuration.
11. In a carotid sinus nerve stimulator for providing stimulating
signals to a selected nerve fiber between being turned on and
turned off, the improvement comprising: means automatically
responsive to the stimulator being turned on for gradually
increasing the amplitude of the initial stimulating signals to a
predetermined level maintained until the stimulator is turned off;
said means comprising time constant means connected to control the
initial current flow through at least a position of the nerve
stimulator; and including energy terminal means adapted to be
connected to a source of energy; and said time constant means
comprising an RC circuit connected between at least a position of
the nerve stimulator and said terminal means.
Description
BACKGROUND OF THE INVENTION
This invention is concerned with medical-electronic pulse
stimulators, and more particularly with an improvement to
automatically provide for the gradual increase of the amplitude of
the initial output signals from the pulse stimulating circuitry.
Electrical stimulation of nerves, muscles, or other tissue, for
medical purposes, is well known in the art. Some examples of
well-known circuitry are heart pacers and carotid sinus nerve
stimulators. The electrical stimulation of nerves, muscles or other
tissue is often accompanied by undesirable side effects caused by
stimulation of adjacent nerve fibers, for example. It has been
discovered that in many cases these side effects are transitory in
nature and persist for only a short period of time after stimulus
by means of electrical signals is first applied. It is theorized
that the stimulating signals, when turned on at full stimulating
amplitude, cause the afferent nerve fibers to fire giving a
sensation of electrical shock. It appears that these afferent
fibers then accommodate to the stimulus signal, and will no longer
fire.
The apparatus of this invention overcomes the above-mentioned
undesirable side effects by providing circuitry for gradually
increasing the amplitude of the initial stimulating signals to a
predetermined stimulus level. It has been found that if the
stimulus is turned on gradually, the afferent nerve fibers
accommodate to the stimulus signal without depolarizing and provide
little or no sensation of electrical shock, and that the
stimulating signals may thereafter be maintained at the
predetermined level without adverse reaction. Therefore, the
apparatus of this invention has been designed for implantable,
transcutaneous, and external stimulators to provide pulse or other
stimulus turn-on characteristics which will be accommodated by the
afferent nerve fibers to prevent a transitory response.
SUMMARY OF THE INVENTION
Briefly described, the apparatus of this invention comprises
amplifier means connected between a selected portion or all of the
circuitry for providing stimulating signals and the source of
energy which provides the electrical power to the circuitry. The
amplifier means is controlled by electrical time constant circuitry
which is connected by switch means across the source of electrical
energy. In the preferred embodiment of the drawings, the time
constant means is shown as a serial RC circuit, that is, a resistor
and a capacitor connected in series. When the switch is closed, the
time constant causes a gradual buildup of charge in the capacitor.
The charge on the capacitor is used to control the initial output
of the amplifier which in turn controls the current reaching the
circuitry for providing stimulating signals, in this circuit a
train of pulses. By gradually increasing the initial output of the
amplifier, the initial amplitude of the train of output pulses will
also be gradually increased to its maximum or predetermined level.
As described above, this gradual increase of the initial amplitude
of the signals which provide stimulus will reduce or remove the
transitory response that causes an uncomfortable feeling in the
patient receiving the stimulation.
IN THE DRAWINGS
FIG. 1 is a combination schematic and block diagram showing an
embodiment using the apparatus of this invention;
FIG. 2 is a schematic diagram of electronic pulse stimulating
circuitry using another embodiment of the apparatus of this
invention;
FIG. 3 is a graph indicating a typical envelope for a train of
prior art stimulating pulses; and
FIG. 4 is a graph indicating the envelope of a train of stimulating
pulses provided by the apparatus of this invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
In FIG. 1 there is shown in block diagram an electronic stimulator
10. Stimulator 10 has a pair of input terminals 11 and 12 adapted
to be connected to a source of electrical energy, and a pair of
output terminals 13 and 14 across which the stimulator provides a
train of output pulses. A source of electrical energy, here shown
as batteries 15, is connected between input terminal 11 and one
side of a switch 16. The apparatus of this invention for gradually
increasing the initial output amplitude of the stimulating signals
is shown enclosed within dotted lines and indicated generally as
20. Apparatus 20 comprises a capacitor 17 and resistor 18 serially
connected across source 15 and switch 16. Apparatus 20 also
includes a transistor 19, having an emitter connected to input
terminal 12, a collector connected to the other side of switch 16,
and a base connected to a junction between capacitor 17 and
resistor 18.
To best understand the operation of the apparatus of FIG. 1, assume
first that switch 16 is open. Therefore, there will be no charge on
capacitor 17 and no output signals from stimulator 10. When output
signals are desired, switch 16 is closed. This will connect the
electrical time constant apparatus, comprising the serial RC
circuit of capacitor 17 and resistor 18, across source 15. As
capacitor 17 cannot charge instantaneously, there will be no
current flow through the amplifier comprising transistor 19, and
therefore no power to stimulator 10, instantaneously.
As the electrical time constant apparatus remains connected across
source 15, a charge will buildup in capacitor 17 and the resulting
voltage change at the junction between capacitor 17 and resistor 18
will be felt on the base of the amplifier comprising transistor 19
to turn it on and provide a current flow through terminals 11 and
12 to stimulator 10. This current flow will allow operation of the
electronic stimulator 10 which will in turn provide the desired
train of output signals. As the charge across capacitor 17
continues to gradually increase, the current flow through
transistor emitter-follower connected 19 will also gradually
increase until the maximum current flow from source 15 is reached.
During this time the resulting gradual increase of current flow to
stimulator 10 will cause a corresponding gradual increase in the
output amplitude of the initial signals. This gradual increase of
the amplitude of only the initial output signals to a maximum or
predetermined amplitude is the desired result to alleviate the
undesirable feelings caused in the patient receiving the train of
pulses, which undesirable feeling is present when the initial
turn-on of the train of pulses is at full amplitude and is
apparently caused by stimulation of adjacent nerve fibers.
Referring now to FIG. 2 there is shown another embodiment of the
apparatus of this invention. In FIG. 2 the disclosed schematic is
that of a radiofrequency pulse transmitter of a type presently in
use in the art, for transmitting a train of stimulating pulses via
RF to an implanted receiver which is connected to the tissue that
is to be stimulated.
In FIG. 2, output terminals 13 and 14, source 15 and switch 16 bear
the same numbers as for FIG. 1. Also, the improvement comprising
the apparatus of this invention is again enclosed in dotted lines
and denoted as 20. Source 15 has one terminal connected to a
positive bus 21, and another terminal connected through switch 16
to a negative bus 22. A capacitor 23, for voltage stabilization
purposes, is connected between buses 21 and 22. A transistor 24 has
its emitter connected to bus 21. The base of transistor 24 is
connected through a pair of diodes 25 and 26 to bus 21, and through
a resistor 27 and a variable resistor 28 to bus 22. A transistor 30
has its emitter connected to bus 22. The base of transistor 30 is
connected through a resistor 33 to the collector of transistor 24,
and through a resistor 34 to bus 22. The collector of transistor 30
is connected through a resistor 32 and a capacitor 31 to the base
of transistor 24. A transistor 35 has its emitter connected to bus
21. The base of transistor 35 is connected through a resistor 36 to
the collector of transistor 30, and through a resistor 37 to bus
21. The collector of transistor 35 is connected through a serial
combination of a resistor 38 and a Zener diode 39 to bus 22. A
junction between resistor 38 and diode 39 is connected to bus 22
through a serial combination of a potentiometer 40 and a resistor
41. A transistor 42 has its base connected to the wiper arm of
potentiometer 40, and its emitter connected through a resistor 43
to a junction 44. Junction 44 is connected through a capacitor 45
to bus 22, and directly to output terminal 13. A pair of serially
connected resistors 46 and 47 are connected between junction 44 and
bus 22. A transistor 50 has its base connected to a junction
between resistors 46 and 47, and its collector connected directly
to output terminal 14. A capacitor 51 is connected between the
collector and emitter of transistor 50. The emitter of transistor
50 is connected through an RF tank circuit 53 to bus 22. Tank
circuit 53 comprises a parallel combination of a variable
inductance 54, a capacitor 55 and a capacitor 56.
The apparatus of this invention 20 is connected as follows: a
transistor 60 has its emitter connected to the collector of
transistor 42. The collector of transistor 60 is connected to bus
21. The base of transistor 60 is connected through a resistor 61 to
bus 21, and through a capacitor 62 to bus 22. A capacitor 63 is
connected between the emitter of transistor 60 and bus 22 to
provide lower circuit impedance in a manner well known in the
art.
In reviewing the operation of the apparatus of FIG. 2, it will be
apparent to one of normal skill in the art that transistors 24 and
30 and their associated electrical components comprise a pulse
generator that will act to provide output pulses as long as switch
16 is closed. When switch 16 is closed the voltage from source 15
will be felt between buses 21 and 22. There will be a current flow
through diodes 25 and 26, resistor 27 and variable resistor 28.
Capacitor 31 will not be charged, and the drop across diodes 25 and
26 will forward bias the emitter-base junction of transistor 24 to
turn it on. The turn-on of transistor 24 will cause a current flow
through resistors 33 and 34 thus causing a forward bias at the
emitter-base junction of transistor 30 to turn it on. When
transistor 30 turns on a charging path will be provided for
capacitor 31, and when the charge on capacitor 31 has reached a
sufficient level it will bias off transistor 24, which will in turn
bias off transistor 30. The charge on capacitor 31 will then
discharge through the path comprising resistor 37, resistor 36,
resistor 32, capacitor 31, resistor 27 and resistor 28. When a
sufficient lowering of the charge on capacitor 31 has been
accomplished transistor 24 will again turn on and the cycle will
repeat. Thus there is an output train of pulses generated as long
as switch 16 is closed.
It will also be apparent to one of normal skill in the art that
transistor 35 and Zener diode 39, along with their associated
electrical components, comprise a voltage regulator. Operating in a
manner apparent to one of normal skill in the art, the output pulse
from the pulse generator causes a current flow through resistors 36
and 37 to forward bias the emitter-base junction of transistor 35
thus causing a current flow through resistor 38, potentiometer 40
and resistor 41. Diode 39 acts to regulate the voltage of this
portion of the circuit.
Transistor 42 in combination with potentiometer 40 operate as an
output amplitude adjustment, with the capability of varying the
amplitude of the output according to the positioning of the wiper
arm of potentiometer 40. Assuming first that the apparatus 20 is
not present, and that, as in the prior art, the collector of
transistor 42 is connected directly to bus 21, then the current
flow through transistor 40 will cause the forward biasing of the
emitter-base junction of transistor 42, causing a current flow
through resistor 43 to junction 44. This will charge transistor 45
and be felt across the serial combination of resistors 46 and 47.
Transistor 50 will then be turned on to provide energy to the tank
circuit 53 and the RF oscillator interconnection of these
components will cause a train of RF output pulses at terminals 13
and 14, the amplitude of which is controlled by the setting of
potentiometer 40.
Returning now to the apparatus of FIG. 2, in which the apparatus 20
is present, it can be seen that the output of transistor 42 will
not be provided to the RF oscillator until the amplifier comprising
transistor 60 has been turned on. It can also be seen that the time
constant apparatus, comprising the serial combination of resistor
61 and capacitor 62 across the power supply, controls the turn-on
of transistor emitter-follower connected 60. That is, when switch
16 is closed there will have been no charge on capacitor 62 and
there will therefore not be an instantaneous forward biasing of the
emitter-base junction of transistor 60. As capacitor 62 gradually
charges through resistor 61, the forward bias of the emitter-base
junction of transistor 60 will gradually increase, and the current
flow therethrough to the collector of transistor 42 will
correspondingly gradually increase. When capacitor 62 is fully
charged then the maximum current flow will be available through
transistor 60 and transistor 42.
It thus becomes apparent that the amplitude of the initial pulses
available through transistor 42 to the RF oscillator is gradually
increased, and that only the initial pulses of the resulting train
of RF pulses will be correspondingly gradually increased. Thus the
RF receiver which is connected to the tissue of the patient will
receive a train of pulses of which the initial pulses gradually
increase in amplitude to a predetermined value, and the possibility
of an unpleasant feeling due to the transitory side effects caused
by the immediate full amplitude turn-on of the train of pulses will
be alleviated.
In testing the apparatus of FIGS. 1 and 2, it has been determined,
for the RF pulse transmitter of FIG. 2, that the connection of
apparatus 20 at the position in the circuitry as shown in FIG. 2 is
preferable to that of FIG. 1 for purposes of conservation of
energy. The connection possibility suggested in the embodiment of
FIG. 1, that is, where the apparatus 20 is placed between the
source of energy 15 and all of circuitry 10, is believed to be the
preferred embodiment for purposes of stability. Other embodiments
than those shown in the drawings have been used, for example the
placement of apparatus 20 so as to provide gradual increase of
power supply voltage to both the voltage regulator and output
amplitude adjustment apparatus of FIG. 2, and it will be apparent
that the placement of apparatus 20 to select gradual control of any
selected portion of the pulse stimulator circuitry is in any case
within the scope of this invention.
FIGS. 3 and 4 are graphs of the pulse train amplitude versus time
for representing the difference between the prior art output pulse
trains and the pulse trains from apparatus utilizing this
invention. FIG. 3 is a prior art output pulse train where it can be
seen that almost instantaneously the train of pulses reaches its
full amplitude. It is this sudden rise to full amplitude which is
believed to cause the side effects and unpleasant feelings in the
patient, probably due to stimulation of adjacent tissue to the
tissue it is desired to stimulate. FIG. 4, a graph on the same
scale as FIG. 3, depicts the gradual rise to full amplitude of the
initial pulses of the output pulse train of stimulators including
the invention disclosed herein. It is believed that with this
gradual turn-on of only the initial portion of the stimulating
signals, the adjacent fibers will accommodate to the stimulus
signals without depolarizing and will provide little or no
sensation to the patient.
* * * * *