JP5032593B2 - 閉回路性能を含む選択的な神経刺激システム - Google Patents
閉回路性能を含む選択的な神経刺激システム Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/36128—Control systems
- A61N1/36135—Control systems using physiological parameters
- A61N1/36139—Control systems using physiological parameters with automatic adjustment
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/36114—Cardiac control, e.g. by vagal stimulation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/36128—Control systems
- A61N1/36146—Control systems specified by the stimulation parameters
- A61N1/36182—Direction of the electrical field, e.g. with sleeve around stimulating electrode
- A61N1/36185—Selection of the electrode configuration
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/36071—Pain
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Description
を示す信号の少なくとも一部は、電極列内の少なくとも2個の電極に電気的刺激を選択的に付与するために、移植医療装置のプログラム可能メモリで受信できるプログラミング信号を生成するように使用される。
れている。その他の移植技術として、神経刺激リード202、204、206は、外科的切開、内視鏡、皮下スティック、または他の標準的手段によって、血管系に到達した後で経血管的に位置決めされてよい。
すデータの抽出が含まれる。遠隔測定リンク460は、外部プログラマ408から移植医療装置402へのデータ伝送も提供する。これには、たとえば生理学的データを獲得するための移植医療装置402のプログラミング(ユーザインターフェース経由)、少なくとも1回の自己診断テスト(たとえば装置の動作状態のテスト)を実行するための移植医療装置402のプログラミング、または1回以上の治療を実施し、もしくは1回以上の治療を調節するための移植医療装置402のプログラミングが含まれる。
の組合せに応じて少なくとも1の利得(ゲイン)の増分または減分によって神経刺激を加減することによって、感知されたパラメータを目標レンジに近づける。種々の例は、目標レンジを上回るレンジ、目標レンジを下回るレンジ、または目標レンジ内のレンジ(すなわちサブレンジ)を提供する。レンジやサブレンジ等に応じて、種々の刺激調整プロトコル(たとえば利得)を使用できる。たとえば或る刺激パラメータ(たとえば周波数)を調整することによって大きい調整を行い、別の刺激パラメータ(たとえば振幅)を調整することによって比較的小さい調整を行うことができる。
とを感知、判定、その他導出できる。たとえば1つの実施形態は、咳が、付与された神経刺激に起因するか否か判定することを可能にする咳センサを含む。他の実施形態は、患者または医師の入力を用いて、いつ患者が神経刺激に起因する副作用を経験したか否か判定する。
Claims (15)
- 被選択神経ターゲットを刺激する神経刺激システムであって、前記神経刺激システムは:
2本以上の神経刺激リードと;
前記2本以上の神経刺激リード上に少なくとも一部が配置される電極列であって、前記電極列の電極は単一末梢神経幹に隣接して移植可能に位置決めされ、前記電極列は第1神経刺激リードに配置される第1電極と、第2神経刺激リードに配置される第2電極とを有すること;
プログラム可能メモリを含む移植医療装置と
を有し、
前記プログラム可能メモリは、1個以上の生理学的パラメータの状態を示すように生理学的センサによって生成される生理学的信号に少なくとも部分的に基づき、少なくとも2個の前記電極の刺激ベクトル組合せに電気的刺激を選択的に付与するためのプログラミング信号を受信するように構成され、
前記2本以上の神経刺激リードは、前記神経刺激リードが前記単一末梢神経幹に隣接して移植されることを許容するように構成された1個以上のリード位置決め部材を有するか、前記リード位置決め部材に取着される
ことを特徴とする、神経刺激システム。 - 前記1個以上のリード位置決め部材は、前記単一末梢神経幹の近くでの前記2本以上の神経刺激リードの部分間を接続することによってこれら部分間の幾何学的関係を維持するように構成され、
前記1個以上のリード位置決め部材は、前記リード位置決め部材と前記神経刺激リードとの間の接続点では、前記神経刺激リードの軸線とは異なる方向に延びる、
請求項1記載の神経刺激システム。 - 前記リード位置決め部材の寸法と形状は、前記神経刺激リードを前記単一末梢神経幹に隣接して位置決めし、前記リード位置決め部材の上に少なくとも一つの前記電極を配置するように設定された、
請求項2記載の神経刺激システム。 - 前記神経刺激システムは更に、1以上の遠隔生成された入力を受信することによって、遠隔測定リンク経由で前記入力を前記移植医療装置に送るように構成された外部プログラマを含む、
請求項1〜3何れか一項記載の神経刺激システム。 - 前記神経刺激システムは更に、前記電極を載せた心臓刺激リードを含み、前記心臓刺激リードは心臓の内部、上部、または周囲に移植可能に位置決めされる、
請求項1〜4何れか一項記載の神経刺激システム。 - それぞれ前記電極は、電気的刺激が付与される際に刺激域を創出する目的で正極性または負極性を確認するために、前記移植医療装置によってプログラム可能であり、
前記移植医療装置のプロセッサ回路は、少なくとも2個の前記電極に前記電気的刺激を選択的に付与するように構成されている、
請求項1〜5何れか一項記載の神経刺激システム。 - 前記神経刺激リードは、神経刺激カフリード、神経刺激血管内リード、および神経刺激皮下リードのうちの少なくとも1つを含む、
請求項1〜6何れか一項記載の神経刺激システム。 - 前記生理学的パラメータは、心拍パラメータ、心拍変動パラメータ、PRインターバルパラメータ、T波速度パラメータ、および活動電位持続時間パラメータのうちの少なくとも1つを含む、
請求項1〜7何れか一項記載の神経刺激システム。 - 前記生理学的パラメータは、心収縮性パラメータ、心臓リモデリングパラメータ、1回拍出量パラメータ、心拍出量パラメータ、および血圧パラメータのうちの少なくとも1つを含む、
請求項1〜8何れか一項記載の神経刺激システム。 - 前記生理学的パラメータは、分時換気量パラメータと1回換気量パラメータのうちの少なくとも1つを含む、
請求項1〜9何れか一項記載の神経刺激システム。 - 前記生理学的パラメータは、心臓有害事象パラメータ、活動性パラメータ、腹痛パラメータ、食欲パラメータ、感情パラメータ、人格性パラメータ、筋緊張パラメータ、睡眠パラメータ、アレルギーパラメータ、および姿勢パラメータのうちの少なくとも1つを含む、
請求項1〜10何れか一項記載の神経刺激システム。 - 前記神経刺激システムは、前記1個以上の生理学的パラメータの状態を示す前記生理学的信号を生成すべく、前記1個以上の生理学的センサを有する、
請求項1〜11何れか一項記載の神経刺激システム。 - 神経ターゲットを刺激する神経刺激システムであって、前記神経刺激システムは:
2本以上の神経刺激リードと;
前記2本以上の神経刺激リード上に少なくとも一部が配置される電極列であって、前記電極列の電極は単一神経ターゲットに隣接して移植可能に位置決めされ、前記電極列は第1神経刺激リードに配置される第1電極と、第2神経刺激リードに配置される第2電極とを有することと;
プログラム可能メモリと加減装置を有する移植医療装置と
を含み、
前記プログラム可能メモリは、少なくとも2個の前記電極の刺激電極ベクトル組合せに電気的刺激を選択的に付与するためのプログラミング信号を受信するように構成され、前記プログラミング信号は、1個以上の生理学的パラメータの状態を示すように生理学的センサによって生成される生理学的信号に少なくとも部分的に基づき、
前記加減装置は、前記電気的刺激の1以上のパラメータを加減し、
前記2本以上の神経刺激リードは、前記単一神経ターゲットの近くでの互いの幾何学的関係を維持すべく、バイアス部分とカフと経血管的大きさと形状とを有するか、あるいはリード位置決め部材に取着する、
神経刺激システム。 - 前記神経刺激システムは更に、前記電気的刺激を選択的付与するために少なくとも2個の前記電極を選択する選択装置を、前記移植医療装置の内部に含む、
請求項13記載の神経刺激システム。 - 前記神経刺激システムは更に、前記電気的刺激を選択的付与するために少なくとも2個の前記電極を選択する選択装置を、前記移植医療装置の外部に含む、
請求項13記載の神経刺激システム。
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Application Number | Priority Date | Filing Date | Title |
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US11/687,809 | 2007-03-19 | ||
US11/687,809 US8406877B2 (en) | 2007-03-19 | 2007-03-19 | Selective nerve stimulation with optionally closed-loop capabilities |
PCT/US2008/003574 WO2008115507A1 (en) | 2007-03-19 | 2008-03-19 | Selective nerve stimulation including closed-loop capabilities |
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JP2010519960A JP2010519960A (ja) | 2010-06-10 |
JP5032593B2 true JP5032593B2 (ja) | 2012-09-26 |
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EP (1) | EP2131917A1 (ja) |
JP (1) | JP5032593B2 (ja) |
WO (1) | WO2008115507A1 (ja) |
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- 2008-03-19 JP JP2009551759A patent/JP5032593B2/ja not_active Expired - Fee Related
- 2008-03-19 EP EP08726958A patent/EP2131917A1/en not_active Ceased
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EP2131917A1 (en) | 2009-12-16 |
US20080234780A1 (en) | 2008-09-25 |
WO2008115507A1 (en) | 2008-09-25 |
JP2010519960A (ja) | 2010-06-10 |
US8406877B2 (en) | 2013-03-26 |
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