JP5329089B2 - 持続される圧反射刺激のためのシステム - Google Patents
持続される圧反射刺激のためのシステム Download PDFInfo
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- 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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Description
本明細書では、参照により本明細書に組み込まれる、2004年10月12日に出願された米国特許出願第10/962,845号の優先権の利益が主張される。
高血圧症と圧受容器に関係する生理機能について簡単に説明し、読者が本開示を理解する助けとする。この簡単な説明では、高血圧症、自律神経系、圧反射を紹介する。
本主題の様々な実施形態は圧反射刺激装置システムに関する。このような圧反射刺激システムは、本明細書で、神経刺激装置(NS)機器または神経刺激装置コンポーネントとも呼ばれる。神経刺激装置の例としては、高血圧症を治療するために使用される抗高血圧(AHT)機器またはAHTコンポーネントがある。本主題の様々な実施形態は、スタンドアロンの埋め込み型圧反射刺激装置システムを含み、一体化型NSや心調律管理(CRM)コンポーネントを含み、無線で、または埋め込み型機器を接続するリード線を介して互いに通信することができる少なくとも1つの埋め込み型NS機器と埋め込み型CRM機器を備えるシステムを含む。埋め込み型システムが示され、説明されているが、本主題の様々な態様および実施形態は、外部NS機器で実装することができる。同じ機器または別の機器のいずれかで実行されるNSおよびCRM機能を統合し、NS治療と心臓治療のいくつかの態様を、それらの治療法をインテリジェント機能で連携させることにより改善する。
Claims (29)
- 被験者の圧反射を刺激するように適合されている刺激信号を発生する圧反射刺激装置と、
前記圧反射刺激装置を制御することにより、前記刺激された圧反射に対する所望の生理学的応答を提供するために効果的な強度において前記刺激信号を送るように構成されたコントローラであって、前記コントローラは、自然発生する血圧パルスの効果を模倣するプログラムされた刺激プロトコルを用いて、圧反射適応を弱めることにより、前記所望の生理学的応答を維持するようにさらに構成されており、前記コントローラは、前記所望の生理学的応答を維持するために、前記送られた刺激信号が、前記刺激された圧反射に対する前記所望の生理学的応答を引き起こす場合に、適応が発生する前に、前記プログラムされた刺激プロトコルを用いて、前記圧反射刺激の強度を変化させ、前記所望の生理学的応答に到達した場合に、前記圧反射刺激の強度を変化させ続けるように構成されている、コントローラと
を備える医療用機器。 - 前記コントローラは、前記圧反射刺激プロトコルを実行して、パルス発生率に対応する速度で前記圧反射刺激の強度を周期的に変調するように適合され、ここで、前記パルス発生率は前記被験者の脈拍数である、請求項1に記載の機器。
- 前記圧反射刺激装置は、約16Hzから約128Hzまでの範囲内の周波数を持つ刺激信号を発生するように適合される請求項1に記載の機器。
- 前記圧反射刺激プロトコルは、前記刺激信号の振幅を変化させて前記圧反射刺激の強度を変化させ圧反射適応を弱める振幅プロトコルを含む請求項1に記載の機器。
- 前記圧反射刺激プロトコルは、前記刺激信号の周波数を変化させて前記圧反射刺激の強度を変化させ圧反射適応を弱める周波数プロトコルを含む請求項1に記載の機器。
- 前記コントローラは、約8Hzから約256Hzまでの範囲内の刺激信号の周波数を変調する前記周波数プロトコルを実装するように適合される請求項5に記載の機器。
- 前記コントローラは、約16Hzから約128Hzまでの範囲内の刺激信号の周波数を変調する前記周波数プロトコルを実装するように適合される請求項6に記載の機器。
- 前記圧反射刺激プロトコルは、前記刺激信号のデューティ・サイクルを変化させて前記圧反射刺激の強度を変化させ圧反射適応を弱めるデューティ・サイクル変調プロトコルを含む請求項1に記載の機器。
- 前記圧反射刺激プロトコルは、
前記信号の振幅を周期的に変調し、前記圧反射刺激を周期的に変調する振幅変調プロトコルと、
前記信号の周波数を周期的に変調し、前記圧反射刺激を周期的に変調する周波数変調プロトコルと、
前記信号のデューティ・サイクルを周期的に変調し、前記圧反射刺激を周期的に変調するデューティ・サイクル変調プロトコルとからなる群から選択された2つまたはそれ以上のプロトコルの組合せを含む請求項1に記載の機器。 - さらに、前記圧反射刺激の効果を監視し、前記圧反射刺激の帰還を与える前記コントローラに動作可能なように接続された少なくとも1つの圧反射センサを備える請求項1に記載の機器。
- 前記少なくとも1つの圧反射センサは、血圧パラメータを監視し前記圧反射刺激の帰還を与える圧力トランスデューサを備える請求項10に記載の機器。
- 前記少なくとも1つの圧反射センサは、神経活動を監視し前記圧反射刺激の帰還を与える神経連絡センサを備える請求項10に記載の機器。
- 前記少なくとも1つの圧反射センサは、前記圧反射刺激の帰還を与える心拍数センサを備える請求項10に記載の機器。
- さらに、前記被験者のパルスを検出し、前記パルスの少なくとも1つのパラメータを示す信号を前記コントローラに供給するパルス検出器を備え、前記プログラムされた刺激プロトコルは、前記パルスに基づいて前記圧反射刺激を変化させるように適合されている請求項1に記載の機器。
- 前記パルス検出器は、パルス発生率を検出し、かつ前記パルス発生率を示す信号を前記コントローラに供給するように適合され、前記コントローラは、前記パルス発生率にほぼ等しい変調率で前記圧反射刺激を変調する前記圧反射刺激プロトコルを実装するように適合されており、ここで、前記パルス発生率は前記被験者の脈拍数である、請求項14に記載の機器。
- 前記パルス検出器は、さらに、前記被験者の前記パルスに対するパルス位相を検出し、前記パルス位相を示す信号を前記コントローラに供給するように適合され、
前記コントローラは、パルス周期における第1の脈動圧力が第1の圧反射刺激レベルに対応し、パルス周期における第2の脈動圧力が第2の圧反射刺激レベルに対応するように前記パルス位相で前記圧反射刺激を変調する前記圧反射刺激プロトコルを実装するように適合され、
第1の脈動圧力は前記第2の脈動圧力よりも高く、
前記第1の圧反射刺激レベルは前記第2の圧反射刺激レベルよりも高い請求項15に記載の機器。 - さらに、前記コントローラに動作可能なように接続された通信インターフェースと、前記圧反射刺激装置、前記コントローラ、前記通信インターフェースを収納した埋め込み型ハウジングとを備え、前記通信インターフェースは、プログラマと無線で通信するように適合される請求項1に記載の機器。
- さらに、前記圧反射刺激装置に接続され、前記刺激信号を頸動脈洞圧受容器部位の神経終末に送るように適合されたリードを備える請求項17に記載の機器。
- さらに、前記圧反射刺激装置に接続され、前記刺激信号を肺動脈圧受容器部位の神経終末に送るように適合されたリードを備える請求項17に記載の機器。
- さらに、前記圧反射刺激装置に接続され、前記刺激信号を求心性神経幹に送るように適合されたリードを備える請求項17に記載の機器。
- さらに、前記圧反射刺激装置に接続され、前記刺激信号を経脈管的に血管内から血管壁を通して血管の外側の神経終末に送るように適合されたリードを備える請求項17に記載の機器。
- さらに、前記圧反射刺激装置に接続され、前記刺激信号を経脈管的に血管内から血管壁を通して血管の外側の求心性神経幹に送るように適合されたリードを備える請求項17に記載の機器。
- 圧反射刺激信号を発生し、圧反射を刺激するための手段と、
前記圧反射刺激に対する所望の生理学的応答を引き起こすように前記圧反射刺激信号を制御し、そして、送られた刺激信号が、前記刺激された圧反射に対する所望の応答を引き起こす場合に、適応が発生する前に、前記圧反射刺激信号の強度を変化させることにより、連続刺激に対する圧反射適応を弱め、前記所望の生理学的応答に到達した場合に、前記圧反射刺激の強度を変化させ続ける手段であって、圧反射適応を弱めるように前記圧反射刺激を制御する前記手段は、前記送られた刺激信号が、前記所望の応答を引き起こす場合に、圧反射刺激が、第1の圧反射刺激レベルから第2の圧反射刺激レベルまでの範囲内にわたるように、前記圧反射刺激信号の少なくとも1つのパラメータを変更することにより、自然発生する血圧パルスの効果を模倣する手段を含む、手段と
を備える埋め込み型医療システム。 - 前記圧反射刺激信号の少なくとも1つのパラメータを変更する手段は、自然発生するパルス数に対応する速度で前記圧反射刺激信号を変調する手段を含む請求項23に記載のシステム。
- 前記圧反射刺激信号の少なくとも1つのパラメータを変更する手段は、前記圧反射刺激信号の周波数を変化させる手段を含む請求項23に記載のシステム。
- 前記圧反射刺激信号の少なくとも1つのパラメータを変更する手段は、前記圧反射刺激信号の振幅を変化させる手段を含む請求項23に記載のシステム。
- 前記圧反射刺激信号の少なくとも1つのパラメータを変更する手段は、前記圧反射刺激信号のデューティ・サイクルを変化させる手段を含む請求項23に記載のシステム。
- さらに、圧反射刺激信号を発生する手段と、圧反射適応を弱める手段とを備える単一の埋め込み型機器を備える請求項23に記載のシステム。
- さらに、埋め込み型神経刺激装置(NS)機器と埋め込み型心調律管理(CRM)機器を備え、
前記NS機器と前記CRM機器は、互いに通信するように適合され、
前記CRM機器は、パルス情報を検出するように適合された分析装置を備え、
前記NS機器は、圧反射刺激信号を発生する手段と、前記圧反射刺激信号の少なくとも1つのパラメータを変更する手段とを備え、
前記圧反射刺激信号の少なくとも1つのパラメータを周期的に変化させる手段は、前記パルス情報に基づき前記少なくとも1つのパラメータを変化させる手段を備える請求項23に記載のシステム。
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Application Number | Priority Date | Filing Date | Title |
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US10/962,845 | 2004-10-12 | ||
US10/962,845 US8175705B2 (en) | 2004-10-12 | 2004-10-12 | System and method for sustained baroreflex stimulation |
PCT/US2005/029540 WO2006044025A1 (en) | 2004-10-12 | 2005-08-19 | System for sustained baroreflex stimulation |
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JP2008515591A JP2008515591A (ja) | 2008-05-15 |
JP5329089B2 true JP5329089B2 (ja) | 2013-10-30 |
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US (4) | US8175705B2 (ja) |
EP (1) | EP1804901B1 (ja) |
JP (1) | JP5329089B2 (ja) |
WO (1) | WO2006044025A1 (ja) |
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2004
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2005
- 2005-08-19 EP EP05789106.1A patent/EP1804901B1/en not_active Not-in-force
- 2005-08-19 JP JP2007536687A patent/JP5329089B2/ja not_active Expired - Fee Related
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2017
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US20060079945A1 (en) | 2006-04-13 |
US11724109B2 (en) | 2023-08-15 |
EP1804901A1 (en) | 2007-07-11 |
US20120215279A1 (en) | 2012-08-23 |
US20170189682A1 (en) | 2017-07-06 |
US20200139128A1 (en) | 2020-05-07 |
WO2006044025A1 (en) | 2006-04-27 |
US8175705B2 (en) | 2012-05-08 |
JP2008515591A (ja) | 2008-05-15 |
EP1804901B1 (en) | 2018-05-02 |
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