JP2016511651A - 振戦を抑制する装置及び方法 - Google Patents
振戦を抑制する装置及び方法 Download PDFInfo
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- JP2016511651A JP2016511651A JP2015553901A JP2015553901A JP2016511651A JP 2016511651 A JP2016511651 A JP 2016511651A JP 2015553901 A JP2015553901 A JP 2015553901A JP 2015553901 A JP2015553901 A JP 2015553901A JP 2016511651 A JP2016511651 A JP 2016511651A
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Abstract
Description
本出願は、2013年1月21日に出願された米国特許仮出願第61/754,945号、2013年3月15日に出願された米国特許仮出願第61/786,549号、2013年4月25日に出願された米国特許仮出願第61/815,919号、2013年5月10日に出願された米国特許仮出願第61/822,215号、及び2013年7月23日に出願された米国特許仮出願第61/857,248号、の優先権を主張するものであり、これらのそれぞれは参照によってその全内容が本明細書に組み込まれている。
文献の引用
Claims (63)
- 患者の振戦を軽減する方法であって、
第1の末梢神経効果器を、第1の末梢神経に対して相対的な第1の場所に配置するステップと、
前記第1の末梢神経効果器から前記第1の末梢神経に第1の刺激を送達するステップと、
前記患者の神経回路網動態を修正することにより、前記振戦の振幅を低減するステップと、
を含む方法。 - 前記配置するステップは、前記第1の末梢神経効果器を前記患者の皮膚の上に配置するステップを含み、前記第1の刺激は、皮膚表面に印加される電気刺激である、請求項1に記載の方法。
- 前記第1の刺激は、振幅が約0.1mAから約10mAであり、周波数が約10Hzから約5000Hzである、請求項2に記載の方法。
- 前記配置するステップは、前記第1の末梢神経効果器を前記患者にインプラントするステップを含み、前記第1の刺激は電気刺激である、請求項1に記載の方法。
- 前記第1の刺激は、振幅が約3mA未満であり、周波数が約10Hzから約5000Hzである、請求項4に記載の方法。
- 測定部により前記患者の手足の動きを感知して、動きデータを生成するステップと、
前記動きデータから振戦情報を決定するステップと、
をさらに含む、請求項1に記載の方法。 - 前記送達するステップは、前記振戦情報に基づいて前記第1の刺激を送達するステップを含む、請求項6に記載の方法。
- 前記振戦情報は、前記患者の手足の休止位置からの最大偏移を含む、請求項7に記載の方法。
- 前記振戦情報は、前記患者の手足の休止位置を含む、請求項7に記載の方法。
- 前記振戦情報は、振戦の周波数、位相、及び振幅を含む、請求項6に記載の方法。
- 前記第1の刺激を送達する前記ステップは、複数の刺激バーストを送達するステップを含み、前記刺激バースト間には可変時間遅延がある、請求項1に記載の方法。
- 第2の末梢神経効果器を、第2の末梢神経に対して相対的な第2の場所に配置するステップと、
前記第2の末梢神経効果器から前記第2の末梢神経に第2の刺激を送達するステップと、
を更に含む、請求項1に記載の方法。 - 前記患者の振戦の周期を決定するステップを更に含み、前記第2の刺激を送達する前記ステップは、前記第2の刺激の送達を、前記第1の刺激の送達から、前記振戦の周期の所定の分数又は倍数だけオフセットするステップを含む、請求項12に記載の方法。
- 前記患者の脳内の神経回路網の共時性の位相を散逸させるステップを更に含む、請求項12に記載の方法。
- 前記第1の場所と前記第2の場所は、隣接する指に位置する、請求項12に記載の方法。
- 前記第1の末梢神経と前記第2の末梢神経は、隣接する神経である、請求項12に記載の方法。
- 前記第1の末梢神経は正中神経であり、前記第2の末梢神経は尺骨神経又は橈骨神経である、請求項12に記載の方法。
- 前記第1の末梢神経と前記第2の末梢神経は、体部位局在的に隣接している、請求項12に記載の方法。
- 前記第1の刺激は、振幅が感覚閾値を下回る、請求項1に記載の方法。
- 前記第1の刺激は15Hz超である、請求項1に記載の方法。
- 前記第1の末梢神経は、前記患者の手足から固有受容情報を運搬する、請求項1に記載の方法。
- 前記振戦の振幅を低減することに対する前記第1の刺激の有効性の持続時間を調べるステップと、
前記有効性の持続時間が切れる前に第2の刺激を送達するステップと、
を含む、請求項1に記載の方法。 - 前記有効性の持続時間を調べる前記ステップは、所定の期間にわたって行われた複数の刺激印加を分析するステップを含む、請求項1に記載の方法。
- 前記有効性の持続時間を調べる前記ステップは、前記患者の活動プロファイルを決定するステップを更に含む、請求項23に記載の方法。
- 前記有効性の持続時間を調べる前記ステップは、前記振戦のプロファイルを決定するステップを更に含む、請求項23に記載の方法。
- 前記活動プロファイルは、カフェイン及びアルコールの消費量に関するデータを含む、請求項24に記載の方法。
- 前記第1の末梢神経の上に導電経路エンハンサを配置するステップを更に含む、請求項1に記載の方法。
- 前記導電経路エンハンサは導電性タトゥである、請求項27に記載の方法。
- 前記導電経路エンハンサは、1つ以上の導電性ストリップを含む、請求項27に記載の方法。
- 第1の場所は、手首、前腕、手根管、指、及び上腕からなる群から選択される、請求項1に記載の方法。
- 患者の振戦を治療するシステムであって、
決定部と、
末梢神経に電気刺激を送達するように適合された面接触部であって、前記面接触部は、前記決定部と通信する第1の末梢神経効果器を備え、前記第1の末梢神経効果器は少なくとも1つの電極を備える、前記面接触部と、を備え、
前記決定部は、処理部と、命令を記憶するメモリと、を備え、前記命令は、前記処理部によって実行されると、
前記第1の末梢神経効果器から第1の末梢神経に第1の電気刺激を送達することを前記決定部に行わせ、前記電気刺激は、前記患者の神経回路網動態を修正することによって前記患者の手足の振戦を軽減するように、前記制御部によって構成される、
システム。 - 前記第1の電気刺激は、振幅が約10mA未満であり、周波数が約10Hzから約5000Hzである、請求項31に記載の方法。
- 前記接触面部は更に、前記決定部と通信する第2の末梢神経効果器を備え、前記第2の末梢神経効果器は少なくとも1つの電極を備え、前記メモリは命令を記憶し、前記命令は、前記処理部によって実行されると、前記第2の末梢神経効果器から前記患者の手足の第2の末梢神経に第2の電気刺激を送達することを前記決定部に更に行わせる、請求項31に記載のシステム。
- 前記命令は、前記処理部によって実行されると、前記第1の電気刺激から、前記振戦の周期の所定の分数又は倍数だけ時間オフセットされた前記第2の電気刺激を送達することを前記決定部に行わせる、請求項30に記載のシステム。
- 前記第1の末梢神経効果器は第1の指に配置されるように適合され、前記第2の末梢神経効果器は第2の指に配置されるように適合されている、請求項30に記載のシステム。
- 前記第1の末梢神経効果器は、直線アレイとして並べられた複数の電極を備える、請求項31に記載のシステム。
- 前記複数の電極は、約1mmから約100mmの間隔を置いて配置されている、請求項31に記載のシステム。
- 前記第1の末梢神経効果器は、2次元アレイとして並べられた複数の電極を備える、請求項31に記載のシステム。
- 前記メモリは命令を記憶し、前記命令は、前記処理部によって実行されると、前記患者の手足上の第1の末梢神経効果器の位置に基づいて前記複数の電極のうちのサブセットを選択することを前記決定部に更に行わせ、前記複数の電極のうちの前記サブセットの前記選択は、前記第1の末梢神経効果器が前記手足上で配置又は再配置されるたびに行われる、請求項38に記載のシステム。
- 前記複数の電極は、第1の軸に沿って約1mmから約100mmの間隔を置いて配置され、前記第1の軸に垂直な第2の軸に沿って約1mmから約100mmの間隔を置いて配置される、請求項38に記載のシステム。
- 測定部を更に備え、前記メモリは命令を記憶し、前記命令は、前記処理部によって実行されると、
前記測定部を使用して前記患者の手足の動きを測定して動きデータを生成することと、
前記動きデータの分析に基づいて振戦の周波数及び大きさを決定することと、
を前記決定部に更に行わせる、請求項31に記載のシステム。 - 前記動きデータの前記分析は、前記動きデータのスペクトル電力の周波数分析を含む、請求項41に記載のシステム。
- 前記周波数分析は、約4Hzから約12Hzの間に制限される、請求項42に記載のシステム。
- 前記動きデータの前記分析は、所定の時間長の前記動きデータに対して行われる、請求項41に記載のシステム。
- 前記決定部は、前記動きデータに基づいて振戦位相情報を決定することと、前記振戦位相情報に基づいて前記第1の電気刺激を送達することと、を行うように更に適合されている、請求項41に記載のシステム。
- 前記振戦位相情報はピーク振戦偏移を含み、前記決定部は、前記ピーク振戦偏移に対応する時刻に前記第1の電気刺激を送達するように更に適合されている、請求項45に記載のシステム。
- 前記メモリは命令を記憶し、前記命令は、前記処理部によって実行されると、前記第1の電気刺激を複数の電気刺激バーストとして送達することを前記決定部に更に行わせ、前記電気刺激バースト間には可変時間遅延がある、請求項41に記載のシステム。
- 前記メモリは命令を記憶し、前記命令は、前記処理部によって実行されると、前記決定された振戦の周波数に基づいて前記第1の電気刺激のパラメータを設定することを前記決定部に更に行わせる、請求項41に記載のシステム。
- 前記メモリは命令を記憶し、前記命令は、前記処理部によって実行されると、前記決定された振戦の大きさに基づいて前記第1の電気刺激のパラメータを設定することを前記決定部に更に行わせる、請求項41に記載のシステム。
- 前記メモリは命令を記憶し、前記命令は、前記処理部によって実行されると、前記決定された振戦の大きさを所定閾値と比較することを前記決定部に更に行わせ、前記第1の電気刺激は、前記決定された振戦の大きさが所定閾値を超えた場合に送達される、請求項41に記載のシステム。
- 前記電極は、前記患者の皮膚を貫通して前記第1の電気刺激を送達するように適合されている、請求項31に記載のシステム。
- 前記電極は、インプラントされて前記神経に前記電気刺激を送達するように適合されている、請求項31に記載のシステム。
- 前記決定部は、前記第1の電気刺激のパラメータを調節する為の入力をユーザから受け入れるように適合されたユーザインタフェースを含む、請求項31に記載のシステム。
- 前記メモリは更に、1つ以上の所定の刺激プロトコルのライブラリを記憶する、請求項31に記載のシステム。
- 前記面接触部は前記決定部と一体化されている、請求項31に記載のシステム。
- 前記面接触部と前記決定部は互いに別々であり、個別のハウジングを有する、請求項31に記載のシステム。
- 前記決定部は、前記面接触部に電力を無線で供給するか、前記面接触部と通信するように構成されている、請求項56に記載のシステム。
- 前記決定部内に位置する測定部を更に備える、請求項56に記載のシステム。
- 前記面接触部内に位置する測定部を更に備える、請求項56に記載のシステム。
- 前記決定部は、スマートフォン、タブレット、及びラップトップからなる群から選択されるコンピューティング装置である、請求項56に記載のシステム。
- 前記コンピューティング装置と通信するサーバを更に備え、前記サーバは、動きデータを、前記患者に送達された前記電気刺激の履歴とともに前記コンピューティング装置から受信するように構成されている、請求項60に記載のシステム。
- 前記サーバは、
前記受信された動きデータと、前記患者に送達された前記電気刺激の前記履歴とを、複数の患者からのデータを記憶しているデータベースに追加するようにプログラムされている、
請求項61に記載のシステム。 - 前記サーバは、
前記受信された動きデータ、及び前記患者に送達された前記電気刺激の前記履歴を、前記データベースに記憶されているデータと比較することと、
前記受信された動きデータ、及び前記患者に送達された前記電気刺激の前記履歴を、前記データベースに記憶されているデータと比較した結果に基づいて、修正された電気刺激プロトコルを決定することと、
前記修正された電気刺激プロトコルを前記コンピューティング装置に送信することと、
を行うようにプログラムされている、請求項62に記載のシステム。
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