WO2007109497A2 - High efficiency neurostimulation lead - Google Patents

High efficiency neurostimulation lead Download PDF

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Publication number
WO2007109497A2
WO2007109497A2 PCT/US2007/064049 US2007064049W WO2007109497A2 WO 2007109497 A2 WO2007109497 A2 WO 2007109497A2 US 2007064049 W US2007064049 W US 2007064049W WO 2007109497 A2 WO2007109497 A2 WO 2007109497A2
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WO
WIPO (PCT)
Prior art keywords
lead
coating
disposed
electrode
electrodes
Prior art date
Application number
PCT/US2007/064049
Other languages
French (fr)
Other versions
WO2007109497A3 (en
Inventor
John M. Swoyer
Jeffrey S. Gagnon
Original Assignee
Swoyer John M
Gagnon Jeffrey S
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Swoyer John M, Gagnon Jeffrey S filed Critical Swoyer John M
Priority to CA002646079A priority Critical patent/CA2646079A1/en
Priority to EP07758588.3A priority patent/EP2004280B1/en
Publication of WO2007109497A2 publication Critical patent/WO2007109497A2/en
Publication of WO2007109497A3 publication Critical patent/WO2007109497A3/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0551—Spinal or peripheral nerve electrodes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0526—Head electrodes
    • A61N1/0529—Electrodes for brain stimulation
    • A61N1/0536—Preventing neurodegenerative response or inflammatory reaction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0526—Head electrodes
    • A61N1/0529—Electrodes for brain stimulation

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  • Health & Medical Sciences (AREA)
  • Neurology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurosurgery (AREA)
  • Veterinary Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Psychology (AREA)
  • Electrotherapy Devices (AREA)

Abstract

Devices and methods for stimulating nerves, such as peripheral nerves. Some devices can include small cross-section lead bodies having one or more electrodes in the distal portion, the electrodes having a substantially flat surface and being suitable for placement through a 12 gauge needle or smaller. Some lead electrodes are covered with a hydrophilic coating at least about 0.001 inch thick. The hydrophilic coating may include a steroid and/or a GABBA agonist which can elute or diffuse over time, away from the electrode.

Description

HIGH EFFiCiENCY NEUROSTiMULATSON LEAD
TECHNICAL FiELD
The present invention is reiated generalSy to medical devices. More specifically, the present invention is related to neurostimuiation leads.
BACKGROUND
Implantable leads, typically having externally exposed ring or band electrodes can be used to deiiver electrical stimulation to surrounding tissue and/or to sense electrical energy produced by the surrounding tissue. Such leads are often implanted, for example, within the epidural or intrathecal spaces of the spina! column, along peripheral nerves, within the brain, and about the heart. Electrical stimulation of the spinal cord has been shown to be effective in relieving intractable pain in some patients. Such electrical stimulation can reduce or eliminate the use of pain relieving drugs. Examples of some leads may be found in U.S. Patent Nos.: 8,721 ,604; 6,981,314; 6,216:045, and 5,483.022.
One such lead is formed of polymeπc materia!, for example, polyurethane or silicone. The lead can be nominally 1 mm in outer diameter and about 20 cm in length. A typical lead may have a series of electrodes formed as bands or rings disposed in a spaced apart relationship in a iead distal region. The distal region of the lead can be introduced, for example, into the epidural region for use in stimulation of the spinal column. The lead proximal region may have a corresponding set of band or ππg connectors or terminals, one for each corresponding electrode in the distal region. Each proximal region terminal can thus be connected to one distal electrode in a typical configuration.
The terminals can be used to couple the proximai end of the iead to a lead extension, which can in turn be coupled to an implantable pulse generator (IPG). The lead extension can provide added length to extend the reach of the iead to a more distantiy placed IPG, In some embodiments, the iead extension is between about 20 and 50 cm in length. The lead typically has a lumen extending from the proximal end through to the distal region, with the lumen being dimensioned to accept a stiffening member or stylet. The lead, commonly formed of a polymeric material and being very smail in cross section, is typically very floppy and not pushable. With a styiet or stiffening member inserted, the lead gains the needed pushabiiify, and can be advanced into and up the spinal column to the desired location.
Current neurostimuSation leads often use poiished platinum electrodes having relatively large surface areas. Leads are described in U.S. Patent Nos 5,103.837; 5,324,324; 5.345;933, 4,044,774; and 5,265,608 Typical percutaneously inserted leads can use ring electrodes that wrap around 360 degrees. This is often wasteful as energy is delivered to tissue that is not intended to be stimulated. Such wasted energy may lead to shortened battery iife. This can also lead to side effects such as pain in those tissues.
What would be desirable are leads that can be percutaneously inserted and provide directional stimulation.
SUMMARY
Some embodiments of the present invention include the use of directional electrodes that can be percutaneously delivered. Sn some embodiments, the lead has a flat face at the distal end that predominately or only stimulates in one direction. Optionally, the electrodes can be coated with a hydrophiiic polymer film, layer, or coating. The poiymer absorbs body fluid, which allows the electrical charge to pass through the poiymer from the metal substrate Io the stimuiatabSe tissue. This minimizes polarization of the electrodes. It may also present a more biocompatible surface to the tissue, minimizing the foreign body response to the implanted electrode.
Minimizing the response may limit the amount of fibrosis, or scar tissue that forms at the electrode surface. This type of tissue essentially acts as an insulator and increases the energy requirements of the system. Additionally, pharmaceutical agents can be included in the poiymer These agents can eiute out of the poiymer matrix over time and modify the tissue response to the lead. Pharmaceuticals agents in some embodiments may include steroids, for example, be amethasone, dexamethosone, etc and their derivatives. These agents minimize the inflammatory response to the implanted foreign body.
A different class of drug that can be included in some embodiments are GABBA agonists, for example, baclofen. These drugs enhance the ability of the stimulation to generate action potentials in the target nerves.
The present invention provides an implantable medical electrical lead including: an elongate body having a proximal portion, a distai portion, and at least one electrical conductor extending between the proximal portion and the distal portion; and a first electrode disposed in the distal portion, the first electrode having a substantially fiat, planar surface and being eiectricaily coupled to the conductor. The lead elongate body and electrode may be sized smali enough in cross-sectional profile to be iπsertable through a 12 gauge needle. Some leads also include a hydrophilϊc coating over the fiat electrode surface, the coating having a thickness of at least about 0.001 inch or 0.0005 inch, or between about 0.0001 and 0.01 inch, in various embodiments. The hydrophiiic coating is swellable in water, in some embodiments. Some coatings include a steroid substance disposed within the hydrophiitc coating for diffusion out of the hydrophiϋc coating, in some embodiments, the steroid is selected from the group consisting of beciamethason, dexamethosone, and their derivatives, and combinations thereof.
Some embodiment leads include a GABBA agonist substance disposed within the hydrophiitc coating for diffusion out of the hydrophiiic coating, for example, baclofen.
In various embodiments, the iead conductor has surface area of less than about 3 square mm, the iead has a thickness of less than about 1 mm, and the lead distai region has a width of less than about 2 mm or less than about 1.5 mm.
The present invention a!so provides a method for implanting a medical electrical lead, the method including advancing an implantabie medical electrical lead through a needle smaller than about 12 gauge to a target site. The Sead can include an elongate body having a proximal portion, a distal portion, and at least one electrical conductor extending between the proximal portion and the dista! portion. The lead may also include a first electrode disposed in the distal portion, the first electrode having a substantially flat, planar surface and being electrically coupled to the at least one conductor, where the lead elongate body and electrode are sized smaii enough in cross- sectiona! profile to be insertabie through a 12 gauge needle.
In some methods, the target site is selected for peripheral nerve stimulation. The nerve stimulation target site may be selected from the group consisting of occipital, supra orbital sub orbital, and pudendal nerve stimulation, and combinations thereof. The target site may also include the spinal cord, stimulated from a lead advanced in the epidural or intrathecal space, depending on the embodiment.
DESCRIPTION OF THE DRAWINGS
FIG 1 is a fragmentary, perspective view of a lead distal region in one embodiment having substantially planar, nominally square shaped electrodes.
FIG 2 is a fragmentary, front view of a lead distal region in one embodiment, having substantially planar, nominally rectangular electrodes.
FIG 3 is a fragmentary, side, cross-sectional view of the lead distal region of FIG 2, having a polymeric, hydrophilic layer over the electrode metal surface.
FIG 4 is a perspective view of one electrode of FIG 3, having the polymeric hydrophilic layer disposed over the metallic electrode surface. FIG 5 is a fragmentary, bottom view of a lead according to the present invention having a distal region with four electrodes and a proximal region with four conductor rings.
DETAILED DESCRIPTION
The present invention provides leads; sized in some embodiments such that it can be delivered via a percυtaneousiy placed needle, for example, smaller than 12 gauge, typically between 13 and 28 gauge. The lead distai end or distal portion can have at least one flat face Electrodes may be disposed on at least one of the flat faces and can have a flat surface in some embodiments of the invention. The electrode metal substrate can be a corrosion resistant, biocompatible and biostable material, such as platinum, platinum alloys, titanium or titanium alloy, gold, etc.
The lead can have 1 or more electrodes (preferably 1-32 and more preferably 4-8 electrodes), with eiectrica! conductors connecting the distal and proximal regions and/or ends, with the proximal region and/or end containing the corresponding number of contacts and configured to be compatible to an implanted pulse generator, or other power source. The electrode dimensions are optimized for battery life by minimizing current loss into undesirable tissue.
The insulation of the lead body, and distal and proximal ends, can be a biocompatible and biostable polymer, such as polyυrβthanβ, silicone, poiyurethane-silicone hybrid, peek, polyimide, etc,
FIG 1 shows one lead 20 according to the present invention, having a polymeric distal region 24 including a housing 40 having four flat surface planar electrodes 30, 32, 24, and 36 disposed within a substantially flat housing region 28. Electrical conductors 42 may be seen in a cutout view, extending proximally. Lead 20 terminates in this embodiment in a somewhat rounded distal end 26. FIG- 2 illustrates another iead embodiment 120 having a width of less than 2 mm, here about 1.3 m, indicated at 144 and having electrodes 130, 132, and 134 with a surface area of less than about 3 square mm, here about 2 square mm. Lead 120 terminates in a dista! tip 126.
FIG 3 illustrates lead 120 of FIG. 2 in cross section, having a thickness of less than about 1 mm, here about 0.75 mm, indicated at 146. Housing 148 houses a first electrode 130 having a conductor layer and a surface coating or layer 152, which can include a hydrophilic material, steroid, and/or a GABA agonist A second electrode 132 having a conductor layer 154 with a coating 156 is also shown.
FIG 4 illustrates lead electrode 130, having a fiat metal substrate 150 coated with a hydrophilic layer 162.
FIG 5 illustrates a neurological stimulation lead 220 according to the present invention. Lead 220 can incorporate a multi-conductor cable. Lead 220 has a distal region 224, a proximal region 226; and an intermediate region 228 disposed between the distal and proximal regions. In a preferred embodiment, the intermediate region is defined to lie between the innermost distal and proximal electrical contacts described below. Lead 220 can be formed of a body or shaft 234 extending between a distal end 230 and a proximal end 232. Lead body 234 has an exterior surface or side wall 236. In some embodiments, the lead body proximal of the dista! region has a substantially round cross section, while in other embodiments the lead regions proximal of the distal region are flat on at least one side, similar to the shape of the dista! region bearing the electrodes. Lead body 234 is preferably formed of a polymeric material, for example, poiyurethane or silicone.
Lead dista! region 224 may include a number of electrodes 238, which may, for example, be cathodes disposed aiong the bottom of iead body 234 in a spaced-apart configuration. Electrodes 238 may also be described as electrical contacts or contacts. Electrodes 238 are normally adapted to be inserted into the human body, are externally exposed, and can be used for neurological stimulation. One exemplary use of electrodes 328 is the stimulation of the nerves within the spinal cord. Proximal region 226 can include a number of connector bands or connector rings 240 disposed in a spaced-apart configuration. Connectors 240 may also be described as electrical contacts or terminals, and are preferabiy also externally exposed. Connectors may be circumferential or fiat, and may be made from platinum, platinum alloys, stainless steel, nickel alloys, etc. Electrodes 238 and connectors 240 may be formed of Piatinum and/or Indium. Connectors 240 can be used for connecting lead 220 to a lead extension to extend the effective length of the lead. In some uses, connectors 240 may also be used to directly couple lead 222 to an implantable pulse generator.
Electrodes 238 and connectors 240 can be coupled to each other in a one-to- one arrangement. In some leads, the distal-most electrode is coupled to the distal-most connector, the second-to-distai-most electrode coupied to the second-to-distal-most connector, and so forth. The electrodes and connectors can be coupled through conductors extending between the two. in some leads, the conductors are embedded within the lead while in other leads, the conductors ite within lumens extending the length of the lead, in some leads, the conductors are disposed within lumens that are later backfiiSed to substantially fill the lumens with a polymeric materia! Some leads have stylet iumens for receiving a stiffening stylet member.
Lead 220 can be varied in outer diameter and length to suit the application for which it is intended, in some embodiments, lead 220 has a total length of between about 5 cm and about 100 cm. in other embodiments, iead 220 has an outer diameter of less than about 1 mm and a total length of between about 10 cm and 150 cm.
Uses for the present invention include, but are not limited to: spinal cord stimulation; brain stimulation; any central nervous system stimulation: any peripheral nerve stimulation, including but not limited to occipital, orbital, cranial sacrai, pudendal, vagus, and/or radia! nerves; cardiac pacing and/or defibrination: smooth mυscie stimulation (stomach, Siver, etc); and skeletal muscle stimulation.
Leads according to the present invention can be introduced into the epidural space and used to stimulate the spinal cord. In another use, a lead can be introduced into the intrathecal space for spinal cord stimulation. While not wishing to be bound by theory, applicants believe that intrathecal stimulation is not currently used because circumferential electrodes would dump too much current into the highly conductive cerebral spinal fluid. Highly directional electrodes of some embodiments of the present invention, placed in close proximity to the spinal cord, may require much lower current. In some embodiment methods, a GABBA agonist coating or layer on the lead distal region, for example, on the electrode, can be piaced much closer to the spinal cord when the lead is placed in the intrathecal space This close proximity to the nerves may increase the effectiveness of the GABBA agonist The GABA agontst coating or coating may aiso be used in peripheral nerve stimulation. Applicants beiieve peripherai nerve stimulation may also benefit from the close proximity of the electrode and drug to the nerve.
Various examples and embodiments of the present invention have been presented above, and are intended to illustrate some aspects of the present invention. The scope of the present invention is to be defined by the claims which follow.

Claims

CLAIMSWhat is claimed is:
1. An implantable medical electrical lead comprising- an elongate body having a proximal portion, a distal portion, and at least one electrical conductor extending between the proximal portion and the dtstal portion; a first electrode disposed in the distal portion, the first electrode having a substantially fiat, pianar surface and being electrically coupled to the at least one conductor, where the lead elongate body and electrode are sized small enough in cross-sectiona! profile to be insertabSe through a 12 gauge needle.
2. The lead of claim 1 , further comprising a hydrophilic coating over the flat electrode surface, the coating having a thickness of at least about 0.001 inch.
3. The lead of claim 2r further comprising a substance disposed within the hydrophilic coating for diffusion out of the hydrophiiic coating, where the substance is a steroid.
4. The lead of claim 3, in which the steroid is selected from the group consisting of beclametnason, dexamethosone, and their derivatives, and combinations thereof,
5. The lead of claim 2. further comprising a substance disposed within the hydrophiiic coating for diffusion out of the hydrophilic coating, where the substance is a GA8BA agonist.
6. The lead of claim 5, in which the GABBA agonist includes baclofen.
7. The lead of claim 2, further comprising a steroid disposed within the hydrophiiic coating for diffusion out of the hydrophilic coating
8. The lead of claim 2, further comprising a GABBA agonist disposed within the hydrophiSic coating for diffusion out of the hydrophilic coating.
9. The lead of claim 2. further comprising a steroid and a GABBA agonist disposed within the hydrophilic coating for diffusion out of the hydrophilic coating.
10. The lead of claim 2, in which the hydrophilic coating is sweϋable in water.
11. The lead of claim 2. in which the coating has a thickness of at least about 0.005 inch.
12. The lead of claim 2, in which the coating has a thickness of between about 0.001 and 0.01 inch.
13. The lead of claim 1 : in which the lead conductor has surface area of less than about 3 square mm.
14. The lead of claim 1 , in which the lead distal region has a width of iess than about 2 mm.
15. The lead of claim 1 , in which the lead distal region has a width of iess than about 1,5 mm,
16. The lead of claim 1 , in which the Sead distal portion has a thickness substantially perpendicular to the conductor flat surface, where the thickness is less than about 1 mm.
17. A method for implanting a medical electrical lead, the method comprising: advancing an implantable medical electrical lead through a needle smaller than about 12 gauge to a target site, the lead including an elongate body having a proximal portion, a distal portion, and at least one electrical conductor extending between the proximal portion and the distal portion, and a first electrode disposed in the distal portion, the first electrode having a substantially flat, planar surface and being electrically coupled to the at least one conductor, where the lead elongate body and electrode are sized small enough in cross-sectionai profile to be insertabSe through a 12 gauge needie.
18. The method of claim 17, in which the target site is selected for peripheral nerve stimulation.
19. The method of claim 18, in which the nerve stimulation target is selected from the group consisting of occipitaϊ, supra orbitai, sub orbital, and pudendal nerve stimulation, and combinations thereof.
20. The method of claim 17, further comprising eiuting a steroid from a hydrophiSic coating disposed over the lead conductor.
21. The method of claim 17, further comprising eluting a GABBA agonist from a hydrophiisc coating disposed over the ϊead conductor.
22. The method of ciaim 21 , in which the GABA agonist eiuiing includes eiuting baclofen.
23. The method of claim 17, in which the target site is the epidural space.
24. The method of claim 17, in which the target site is the intrathecal space,
25. The method of claim 24, further including eluting a GABA agonist within the intrathecal space,
26. An implantable medical electrical lead comprising.
Page 1 i of 13 an elongate body having a proximal portion, a distal portion, and at least four eiectricaS conductors extending between the proximal portion and the distal portion; at least four electrodes disposed in the distal portion, the at least four electrodes each having a substantially flat, planar surface and being electrically coupled to at least one of the at least four conductors, where the tead elongate body and electrodes are sized small enough in cross-sectionai profile to be insertabSe through a 12 gauge needle; and a hydrophiiic coating over the flat electrode surfaces, the coating having a thickness of at ieast about 0 001 inch.
27. The implantable lead of claim 26, in which the electrodes have a substance disposed within the hydrophilic coating for diffusion out of the hydrophtSic coating, where the substance is a steroid selected from the group consisting of beclametnason, dexamethosone, and their derivatives, and combinations thereof.
28. The implantable lead of claim 26, in which the electrodes have a substance disposed within the hydrophilic coating for diffusion out of the hydrophilic coating, where the substance is a GABBA agonist.
PCT/US2007/064049 2006-03-16 2007-03-15 High efficiency neurostimulation lead WO2007109497A2 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
CA002646079A CA2646079A1 (en) 2006-03-16 2007-03-15 High efficiency neurostimulation lead
EP07758588.3A EP2004280B1 (en) 2006-03-16 2007-03-15 High efficiency neurostimulation lead

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US78281906P 2006-03-16 2006-03-16
US60/782,819 2006-03-16
US11/686,322 US7729781B2 (en) 2006-03-16 2007-03-14 High efficiency neurostimulation lead
US11/686,322 2007-03-14

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WO2007109497A2 true WO2007109497A2 (en) 2007-09-27
WO2007109497A3 WO2007109497A3 (en) 2008-04-03

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CA (1) CA2646079A1 (en)
WO (1) WO2007109497A2 (en)

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EP2004280B1 (en) 2014-06-04
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US7729781B2 (en) 2010-06-01
EP2004280A4 (en) 2010-12-15
CA2646079A1 (en) 2007-09-27
EP2004280A2 (en) 2008-12-24

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