Classifications

• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
  • A61B5/25—Bioelectric electrodes therefor
  • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
  • A61B5/296—Bioelectric electrodes therefor specially adapted for particular uses for electromyography [EMG]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
  • A61B5/316—Modalities, i.e. specific diagnostic methods
  • A61B5/389—Electromyography [EMG]
  • A61B5/395—Details of stimulation, e.g. nerve stimulation to elicit EMG response
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
  • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
  • A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
  • A61B5/686—Permanently implanted devices, e.g. pacemakers, other stimulators, biochips
• • 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
  • A61N1/36014—External stimulators, e.g. with patch electrodes
  • A61N1/36021—External stimulators, e.g. with patch electrodes for treatment of pain
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
  • A61B5/25—Bioelectric electrodes therefor
  • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
  • A61B5/294—Bioelectric electrodes therefor specially adapted for particular uses for nerve conduction study [NCS]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
  • A61B5/316—Modalities, i.e. specific diagnostic methods
  • A61B5/388—Nerve conduction study, e.g. detecting action potential of peripheral nerves
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/48—Other medical applications
  • A61B5/4836—Diagnosis combined with treatment in closed-loop systems or methods
• • 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
  • A61N1/36014—External stimulators, e.g. with patch electrodes
  • A61N1/36017—External stimulators, e.g. with patch electrodes with leads or electrodes penetrating the skin
• • 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
  • A61N1/36062—Spinal stimulation
• • 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
• • 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
  • A61N1/36167—Timing, e.g. stimulation onset
• • 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
  • A61N1/36167—Timing, e.g. stimulation onset
  • A61N1/36171—Frequency
• • 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
  • A61N1/372—Arrangements in connection with the implantation of stimulators
  • A61N1/37211—Means for communicating with stimulators
  • A61N1/37235—Aspects of the external programmer

Definitions

• the disclosure relates to medical devices and, more particularly, to programmable medical devices that deliver electrical stimulation therapy to a patient.
• Neurostimulation can include a therapy that may be delivered to a patient to treat a variety of conditions.
• Neurostimulation is typically delivered by an a device that can generate electrical stimulation, such as an implantable medical device (IMD) or an external neurostimulator.
• IMD implantable medical device
• An IMD delivers neurostimulation therapy via electrodes, which are coupled to the IMD by one or more leads, or carried by the IMD housing in the case of a leadless stimulator.
• the number and positions of the leads and electrodes can be dependent on the type or cause of the pain, and the type of neurostimulation delivered to treat the pain.
• an IMD may deliver neurostimulation therapy in the form of electrical stimulation signals such as pulses and continuous waveforms.
• the disclosure is directed to systems, devices and techniques for delivering electrical stimulation therapy to a patient.
• the electrical stimulation therapy may include ultra-low frequency (ULF) bi-phasic pulses configured to reduce or block transmission of neural activity along nerve fibers of the patient.
• ULF waveforms may thus be used to train a variety of symptoms, such as chronic pain, acute pain, and/or nociceptive pain.
• the ULF bi-phasic pulses may be delivered at a frequency from about 0.01 Hz to about 10 Hz.
• the amplitude of a first phase and/or second phase of the bi-phasic pulses may temporarily return to zero or near-zero (e.g., some amplitude value less than the phase amplitude) to create gaps in the respective phase.
• the system may deliver one or more stimulation pulses during these gaps from the same or different electrode combination.
• the ULF bi-phasic pulses may block nociceptive pain signals while other stimulation pulses may treat chronic pain.
• the system may be implantable or external from the patient. In this manner, the system may be used for chronic and/or temporary reduction in neural activity along the target nerve fibers.
• FIG. 7 is a flow diagram illustrating an example technique for controlling the delivery of stimulation to a patient in accordance with examples of the disclosure.
• FIG. 8 is an example timing diagram illustrating an example waveform comprising a low power mode and a high power mode.
• FIG. 9 is a flow diagram illustrating an example technique for controlling the delivery of stimulation to a patient in accordance with examples of the disclosure.
• FIGS. 10A, 10B, and 10C are conceptual diagrams of example electrode configurations to sense directional neural activity from nerve fibers.
• FIG. 11 is a timing diagram of low frequency and high frequency pulses delivered via different electrode combinations.
• FIGS. 12A and 12B are timing diagrams of low frequency and high frequency pulses delivered via different electrode combinations and a resulting waveform from the pulses.
• FIGS. 13 A and 13B are timing diagrams of low frequency and high frequency pulses delivered via different electrode combinations and a resulting waveform from the pulses.
• FIG. 14 is a timing diagram of delivered pulses and a charge bias applied to the patient.
• FIG. 16 is a flow diagram illustrating an example technique for adjusting gap widths in ULF waveforms for the delivery of stimulation to a patient in accordance with examples of the disclosure.
• the disclosure is directed to systems, devices and techniques for delivering electrical stimulation therapy to a patient.
• the therapy may include the delivery of ultra-low frequency (also referred to as “ULF”) waveforms to a patient for neural modulation.
• ULF waveforms are designed for application to complex neural structures. Examples may include peripheral nerves (which contain a mixture of fiber types such as A, B, and C fibers) of the patient, dorsal root ganglia and/or, and the spinal cord of the patient.
• the ULF waveforms may include a series of bi-phasic waveforms (referred to in some examples as “bi-phasic pulses”) configured to block neural activity from being conducted along the fibers (e.g., from one end of the fiber to the other).
• bi-phasic pulses a series of bi-phasic waveforms
• the individual bi-phasic waveforms may be substantially charge balanced and have relatively long pulse width (e.g., greater than 0.25 seconds).
• the phases of the bi-phasic pulses in the waveform may be approximately the same length and/or amplitude. In some examples, one phase (e.g., cathodic phase) can be longer than the other phase (e.g., anodic phase) but with lower amplitude than the other phase which may enable the biphasic pulse to be approximately charge balanced.
• ULF waveform may be less effective in blocking potentials during the transitions, e.g., between the phases
• higher frequency stimulation e.g., stimulation with bursts of pulses delivered at a frequency greater than 1 kHz
• the amplitude may be ramped up and ramped down for the respective phases of the ULF pulses, e.g., to prevent onset and offset activation of neural activity in the fibers that may otherwise result from the rapid increase or decrease in the stimulation amplitude.
• Each respective phase of the bi-phasic pulse may have a relatively long width (the length of time the phase is delivered) and amplitude that blocks neural activity, but the phase does not have a total charge that is at or above such a threshold that chemical reaction degrades a surface of electrode.
• one goal of the ULF stimulation may be to deliver stimulation that blocks activity from traveling along the nerve fibers and that is substantially charge balanced between the phases without degrading electrode material as described herein, e.g., due to undesired chemical reactions.
• Each program group may support an alternative therapy selectable by patient 12, and IMD 14 may deliver therapy according to the multiple programs.
• IMD 14 may rotate through the multiple programs of the group when delivering stimulation such that numerous conditions of patient 12 are treated.
• stimulation pulses formulated according to parameters defined by different programs may be delivered on a time-interleaved basis.
• a group may include a program directed to leg pain, a program directed to lower back pain, and a program directed to abdomen pain.
• multiple programs may contribute to an overall therapeutic effect with respect to a particular type or location of pain. In this manner, IMD 14 may treat different symptoms substantially simultaneously or contribute to relief of the same symptom.
• external medical device 15 may provide electrical stimulation therapy that can reduce neural activity, such as pain signal, resulting from surgical or other trauma.
• This electrical stimulation therapy may reduce the need for chemical pain control (e.g., opiates or other drugs) and/or may improve outcomes by improving patient movement and/or sleep that would otherwise be impacted due to temporary pain during recovery.
• temporary pain associated with surgical or traumatic events may, if left untreated, manifest as chronic pain for the patient. Therefore, by reducing or eliminating pain using external medical device 15 to deliver temporary electrical stimulation therapy described herein, the patient may be less likely to develop chronic pain.
• Memory 24 may include any volatile, non-volatile, magnetic, optical, or electrical media, such as a random access memory (RAM), read-only memory (ROM), non-volatile RAM (NVRAM), electrically-erasable programmable ROM (EEPROM), flash memory, or any other digital media.
• Memory 24 may store instructions for execution by processing circuitry 26, stimulation therapy data, information regarding evoked signals sensed at one or more locations on the dorsal columns, and any other information regarding therapy or patient 12. Therapy information may be recorded for long-term storage and retrieval by a user, and the therapy information may include any data created by or stored in IMD 14.
• Memory 24 may include separate memories for storing instructions, sensed signal information, program histories, and any other data that may benefit from separate physical memory modules.
• An electrode configuration e.g., electrode combination and associated electrode polarities, may be represented by data stored in a memory location, e.g., in memory 24, of IMD 14.
• Processing circuitry 26 may access the memory location to determine the electrode combination and control stimulation generator 30 to deliver electrical stimulation via the indicated electrode combination.
• processing circuitry 26 may command stimulation generator 30 to make the appropriate changes to therapy according to instructions within memory 24 and rewrite the memory location to indicate the changed therapy. In other examples, rather than rewriting a single memory location, processing circuitry 26 may make use of two or more memory locations.
• processing circuitry 26 may access not only the memory location specifying the electrode combination but also other memory locations specifying various stimulation parameters such as voltage or current amplitude, pulse width and pulse rate (frequency).
• IMD 14 may deliver stimulation including bi-phasic (e.g., symmetric bi-phasic or asymmetric bi-phasic) pulses at an ultralow frequency (e.g., from about 0.01 Hz to about 10 Hz, such as about 4 Hz or lower, such as 2 Hz or lower or 1 Hz or lower).
• ultra-low frequency waveforms may have a pulse frequency of greater than zero, and less than or equal to 4 Hz, less than or equal to 2 Hz, or less than or equal to 1 Hz.
• the ultra-low frequency may be from 0.05 Hz to 1 Hz, or about 0.1 Hz in one example.
• frequencies above 10 Hz may begin to generate EMG responses.
• fast transitions from one phase of the ULF waveform to the second phase may also elicit EMG signals or other nerve actions. Therefore, ramping amplitudes up and/or down for ULF waveforms may help to prevent or reduce undesired nerve activity.
• Higher frequencies of ULF waveforms may reduce time for gradual transitions.
• the ULF stimulation may be delivered alone, i.e., without non-ULF stimulation, or in combination with non-ULF stimulation such as higher frequency stimulation to treat one or more patient disorders.
• the higher frequency stimulation may include discrete periods of time in which a plurality of pulses are delivered at a frequency of at least about 1 kHz in combination with the ULF stimulation pulses.
• IMD 14 may deliver stimulation in accordance with the examples described with regard to FIGS. 4A-7.
• the electrical stimulation delivered by IMD 14 to patient 12 may be configured to block nerve activity of patient 12, e.g., at or near the target site of the stimulation.
• the electrical stimulation may be delivered to at least partially (e.g., substantially fully) block nerve activity of patient 12 at or near the target site of the stimulation.
• partial block while the response in each individual nerve fiber to the stimulation may be binary (blocked/unblocked), the stimulation may not block every nerve fiber (e.g., of a bundle or group of nerve fibers) so that the nerve activity of a bundle/group of fibers is only partially blocked.
• Processing circuitry 26 accesses stimulation parameters in memory 24, e.g., as programs and groups of programs. Upon selection of a particular program group, processing circuitry 26 may control stimulation generator 30 to generate and deliver stimulation according to the programs in the groups, e.g., simultaneously or on a time- interleaved basis.
• a group may include a single program or multiple programs.
• each program may specify a set of stimulation parameters, such as amplitude, pulse width and pulse rate.
• each program may specify a particular electrode combination for delivery of stimulation. Again, the electrode combination may specify particular electrodes in a single array or multiple arrays, e.g., on a single lead or among multiple leads.
• Processing circuitry 26 also may control telemetry circuit 28 to send and receive information to and from external programmer 20.
• Sensing module 32 may be configured to monitor, with sensing circuitry, one or more signals from one or more electrodes on lead 16 in order to monitor electrical activity at one more locations in patient 12, e.g., via electrogram (EGM) signals, electromyogram (EMG), or evoked compound action potential (ECAP) signals.
• ECM electrogram
• EMG electromyogram
• ECAP evoked compound action potential
• sensing module 32 may be configured to, using sensing circuitry, monitor one or more electrical signals from electrode(s) on lead 16 at nerve site locations.
• Such electrical signals may be intrinsic or evoked by delivery of stimulation by IMD 14. Signals sensed via a particular electrode may be made with reference to another electrode on a lead or an electrode on the housing of IMD 14.
• Sensing module 32 may also include a switch module to select which of the available electrodes, or which pairs or combinations of electrodes, are used to sense intrinsic activity or activity evoked, e.g., by PNS.
• IMD 14 may determine a characteristic value of the sensed signals, such as an EGM, EMG, or ECAP signals.
• one or more characteristics of ECAP signals may be monitored from a target nerve (e.g., a peripheral nerve) in order to determine if a ULF waveform is reducing or blocking nerve propagation.
• a characteristic value of the ECAP signal include an amplitude of one or more peaks, a magnitude of the difference between two peaks, the area under the curve of one or more peaks, a derivative of the ECAP signal, a difference between two or more derivatives of the ECAP signal, or any other values.
• the characteristic value of the ECAP signal may indicate which fibers are being reduced or blocked.
• IMD 14 may use the ECAP characteristic value as a feedback variable to adjust one or more parameter values of the ULF waveform. For example, IMD 14 may monitor if ECAP signals are propagating from peripheral nerves back to the spinal cord when such signals should be reduced or blocked. In some examples, IMD 14 may also, or alternatively, adjust parameter values of stimulation pulses being delivered in addition to the ULF waveform based on the ECAP characteristic values.
• Signals produced by the sense amplifiers may be converted from analog signals to digital signals by analog-to-digital converters (ADCs) provided by sensing module 32.
• ADCs analog-to-digital converters
• the digital signals may be stored in memory for analysis on-board the IMD 14 or remote analysis by a programmer 20 or other device.
• Sensing module 32 may include a digital signal processor (DSP) that implements any of a variety of digital signal processing features such as digital amplifiers, digital filters, and the like.
• DSP digital signal processor
• IMD 14 wirelessly communicates with external programmer 20, e.g., a patient programmer or a clinician programmer, or another device by radio frequency (RF) communication or proximal inductive interaction of IMD 14 with external programmer 20.
• Telemetry circuit 28 may send information to and receive information from external programmer 20 on a continuous basis, at periodic intervals, at non-periodic intervals, or upon request from the stimulator or programmer.
• telemetry circuit 28 may include appropriate electronic components, such as one or more antennas, amplifiers, filters, mixers, encoders, decoders, and the like.
• misbalanced stimulation e.g. 1 microampere (pA), 10 pA, or 100 pA
• the respective phases have the same charges so that phases 54 and 52 are charged balanced.
• ULF stimulation may be delivered to the pudendal nerve trunk and HF stimulation may be delivered to nerve sites on two or more pudendal branches, e.g., dorsal genital nerve, perineal nerve, inferior rectal nerve.
• the HF stimulation could be delivered to each branch at the same time or individually, e.g., based on pain being experienced by a patient.
• FIG. 8 is an example timing diagram illustrating an example waveform comprising a low power mode and a high power mode.
• ULF waveform 100 includes bi-phasic pulses delivered during different power modes, such as a low power mode of bi-phasic pulses 102 and 110 and a high power mode including bi-phasic pulses 106.
• the low power modes are separated from the high power mode by intervals 104 and 108 during no pulses are delivered as part of the ULF waveform 100.
• Processing circuitry 26 of IMD 14, for example, may be configured to switch between the two or more power modes, such as the low power mode and the high power mode.
• the high power mode or a turbo mode, may be configured to achieve a neural block or reduction in neural activity quickly.
• relatively high amplitude and/or pulse widths of the first and/or second phases of each bi-phasic pulse in ULF waveform 100 may cause neural activity to be quickly blocked or reduced.
• the system Once the high power mode has effectively reduced or blocked neural activity, the system may still be able to maintain the reduced or blocked neural activity at a reduced power.
• This low power mode may include bi-phasic pulses having a lower amplitude and/or shorter pulse width and/or lower frequency than the biphasic pulses of the high power mode. In this manner, the overall energy required by IMD 14 to generate the bi-phasic pulses of the low power mode is less than the energy required to deliver the bi-phasic pulses of the high power mode.
• Processing circuitry 26 may switch between the high power mode and the low power mode (or more modes) in response to any trigger events, which may include an elapse of a predetermine period of time (e.g., a timer), a neural sensed event (e.g., detecting signal propagation or no longer sensing propagation), patient input, or any other event. Processing circuitry 26 may then cycle between the different power modes in order to reduce overall power usage while maintaining effective therapy.
• trigger events may include an elapse of a predetermine period of time (e.g., a timer), a neural sensed event (e.g., detecting signal propagation or no longer sensing propagation), patient input, or any other event.
• Processing circuitry 26 may then cycle between the different power modes in order to reduce overall power usage while maintaining effective therapy.
• FIG. 9 is a flow diagram illustrating an example technique for controlling the delivery of stimulation to a patient in accordance with examples of the disclosure.
• the example of FIG. 9 will be described with respect to processing circuity 26 and IMD 14, but any processing circuitry or medical device, such as external medical device 15 may perform this technique.
• processing circuitry 26 may control stimulation generator 30 to deliver ULF electrical stimulation to patient 12 via one or more electrodes located on lead 16, where the ULF electrical stimulation includes a plurality of bi-phasic pulses delivered at a relatively low frequency (120).
• IMD 14 under the control of processing circuitry 26 and using electrode(s) on lead 16, may deliver ULF electrical stimulation including any bi-phasic pulses or modified bi-phasic pulses described herein.
• the target nerve site may be a peripheral nerve site.
• the ULF stimulation may be configured to block nerve activity of patient 12 at or near the target site.
• pulses 102, 106, and 110 may block neural activity, (e.g., electrical neuropotentials), from being conducted along nerve fibers (e.g., from one end of the fiber to the other).
• the block may include one or more of A, B, or C fibers.
• IMD 14 using sensing module 32 and one or more electrodes on lead 16, may monitor one or more feedback variables that may be indicative of the nerve activity of patient 12, e.g., at or near the target site.
• the one or more feedback variables may be indicative of whether the ULF electrical stimulation successfully reduces or blocks the nerve activity of patient 12.
• IMD 14 may monitor the nerve activity using any suitable technique including techniques for sensing electrical nerve activity of patient 12.
• the feedback variable may include at least one of a neural activity, a patient input (e.g., patient feedback on the therapy efficacy and/or side effects), a posture state (e.g., via an accelerometer), an activity level (e.g., via an accelerometer and/or other movement sensors), a sleeping state (e.g., via movement and/or brain activity, etc.), an electrode impedance, an electrode characteristic, or a biological marker of the patient.
• a neural activity e.g., a patient input (e.g., patient feedback on the therapy efficacy and/or side effects), a posture state (e.g., via an accelerometer), an activity level (e.g., via an accelerometer and/or other movement sensors), a sleeping state (e.g., via movement and/or brain activity, etc.), an electrode impedance, an electrode characteristic, or a biological marker of the patient.
• processing circuitry 26 of IMD 14 determines that the continuous delivery of the ULF stimulation successfully reduces or blocks the targeted nerve activity, e.g., based on the periodic sensing of nerve activity occurring during the transition between respective pulses and/or respective phases within a pulse (“NO” branch of block 124), then processing circuitry 26 may continue to deliver the ULF stimulation pulses (120). Conversely, if processing circuitry 26 determines that the continuous delivery of the ULF stimulation including pulses is not successfully blocking the targeted nerve activity (e.g. based on the monitoring of the feedback variable) (“YES” branch of block 124), then processing circuitry 26 may update or adjust the value of one or more stimulation pulses that at least partially defines the bi-phasic pulses of the ULF waveform (126).
• Processing circuity may then continue to control stimulation generator 30 to deliver the ULF stimulation waveform according to the updated parameter values.
• Example stimulation parameters that may be adjusted include an amplitude, a frequency, a slope, a gap width, a number of gaps within a single phase, a symmetry parameter of each bi-phasic pulse, or a power mode for the plurality of bi-phasic pulses.
• FIGS. 10A, 10B, and 10C are conceptual diagrams of example electrode configurations to sense directional neural activity from nerve fibers.
• a system may utilize different combinations of electrodes to sense electrical signals and identify the anatomical location of breakthrough conduction as a feedback variable the system can use to adjust subsequent bi-phasic pulses of the ULF waveform.
• action potentials or evoked compound action potentials ECAPs
• processing circuitry 26 may adjust a parameter, such as amplitude, the number of gaps, etc. of subsequent bi-phasic pulses in order to reduce the breakthrough action potentials.
• the location of the electrodes can be leveraged to determine where the conduction is happening within the nerves, such as along the length or the circumference of the nerve.
• the electrodes can also be used for bipolar sensing in some examples.
• the example configuration of FIG. 10A includes multiple electrodes 132A, 132B, 132C, and 132D disposed around the circumference of nerve 130. Although four electrodes 132 are shown, fewer or greater number of electrodes may be used. Electrodes 132 may be configured to sense directionality of action potentials across the cross-section of the nerve.
• the example configuration of FIG. 10B includes multiple electrodes 132A, 132B, 132C, and 132D disposed at different circumferential and longitudinal directions of nerve 130. Although four electrodes 132 are shown, fewer or greater number of electrodes may be used. Electrodes 132 may be configured to sense directionality of action potentials along the length, or longitude, of the nerve.
• lead 140 includes an electrode support structure configured to wrap around a perimeter (e.g., circumference similar to a cuff) of nerve 130 and contain electrodes 142 A, 142B, 142C, and 142D disposed at different circumferential positions adjacent nerve 130 and electrodes 144A, 144B, and 144C configured to penetrate a portion of nerve 130.
• a combination of penetrating electrodes 144 and surface electrodes 142 may enable processing circuitry 26 to identify the conduction location as well as the integration of fiber types (via single fiber recording-penetrating electrodes 144) and ECAPs (via surface electrodes 142). Using this sensed information from these electrodes as feedback variables may enable processing circuitry 26 to more precisely control of ULF waveforms by adjusting one or more parameter values.
• processing circuitry 26 may be configured to monitor neural activity at one or more of the nerve fibers, compare the neural activity to a threshold (e.g., indicating the neural block is not effective or is effective), and responsive to determining that the neural activity exceeds the threshold, adjust a value of one or more stimulation parameters to reduce the detected neural activity.
• the system may sense the neural activity via two or more electrodes (e.g., electrodes 132) disposed at least one of adjacent to the one or more nerve fibers or at least partially within the one or more nerve fibers.
• FIG. 11 is a timing diagram of low frequency and high frequency pulses delivered via different electrode combinations.
• the top waveform 150 may be a ULF waveform that includes multiple bi-phasic pulses (e.g., repeating pulses), such as the bi-phasic pulse that includes first phase 152 and second phase 156.
• the system may deliver waveform 150 such that there are a plurality of gaps (e.g., amplitude returning to zero or close to zero) within each phase, such as gaps 154 in first phase 152 and gaps 158 in second phase 156.
• the number of gaps within each phase may be the same or different.
• the frequency and/or width of the gaps 154 and gaps 158 may be the same or different.
• gaps 154 and/or gaps 158 may be scheduled to occur at a frequency from 5 Hz to 80 Hz, or in some examples at a frequency from 40 Hz to 50 Hz. Although gaps 154 and gaps 158 are shown as occurring in the between the ramp up and ramp down sections, gaps could also, or alternatively, be positioned in one or more ramps of waveform 150.
• first phase 152 may be asymmetrical from second phase 156 (e.g., the amplitude and/or duration of each phase are different). Example asymmetrical phases are also shown in FIGS. 4A and 4B.
• the bottom waveform 160 indicates that pulses 162 may be delivered within respective gaps of waveform 150. As shown, pulses 162 may be delivered during respective gaps in waveform 150 and also during other portions of the pi-phasic pulses in order to maintain the pulse frequency of pulses 162. In this manner, processing circuitry 26 may “synchronize” the delivery of pulses 162 to line up with respective gaps in waveform 150. Although only one pulse 162 (e.g., a bi-phasic square wave pulse as shown or a pulse with passive recharge), multiple pulses may be delivered within one, some, or all of the gaps in waveform 150. In addition, as shown in FIG. 11, the beginning polarity of first phase 152 of waveform 150 is opposite of the beginning polarity of the first pulse 162. This opposite polarity of the first phases may cause the ULF waveform 150 to block nerve conduction in one direction while allowing nerve propagation in the opposite direction from pulses 162.
• processing circuitry 26 is configured to control the stimulation generator 30 to deliver the plurality of bi-phasic pulses of waveform 150 via a first electrode combination and control stimulation generator 30 to deliver the one or more pulses 162 via a second electrode combination different than the first electrode combination.
• processing circuitry 26 may be configured to control the stimulation generator 30 to deliver the plurality of bi-phasic pulses (such as ULF waveform 150) to reduce or block the transmission of the neural activity along a first direction of the nerve fibers and control stimulation generator 30 to deliver the one or more pulses (e.g., pulses 162) to elicit neural signal propagation along a second direction of the nerve fibers opposite the first direction.
• the stimulation generator 30 may be configured to control the stimulation generator 30 to deliver the plurality of bi-phasic pulses (such as ULF waveform 150) to reduce or block the transmission of the neural activity along a first direction of the nerve fibers and control stimulation generator 30 to deliver the one or more pulses (e.g., pulses 162) to elicit neural signal propagation
• FIGS. 12A and 12B are timing diagrams of low frequency and high frequency pulses delivered via different electrode combinations and a resulting waveform from the pulses.
• the top waveform 170 may be a ULF waveform that includes multiple bi-phasic pulses (e.g., repeating pulses), such as the bi-phasic pulse that includes first phase 172 and 174.
• the bottom waveform 180 indicates that pulses 182 having a single polarity opposite the polarity of first phase 172 and temporally aligned with first phase 172.
• bottom waveform 180 includes pulses 184 having a single polarity opposite the polarity of second phase 174 and temporally aligned with second phase 174.
• Waveform 170 may be delivered with a first electrode combination different from the second electrode combination delivering waveform 180.
• the first and second electrode combination may have zero common electrodes or have one or more common electrodes.
• the resulting waveform 186 experienced by the tissue e.g., the overall charge delivered to the target tissue from both electrode combinations delivering waveforms 170 and 180, may include a bi-phasic pulse that includes first phase 187A with gaps 188 A and second phase 187B with gaps 188B. In this manner, the gaps may be created using electrical pulses of opposing polarity delivered via different electrodes.
• processing circuitry 26 may be configured to control the stimulation generator 30 to deliver the plurality of bi-phasic pulses via a first electrode combination, where the bi-phasic pulses comprising a first phase of a first polarity and a second phase of a second polarity opposite the first polarity.
• Processing circuity 26 may also be configured to control the stimulation generator 30 to deliver, via a second electrode combination different than the first electrode combination, one or more pulses having the second polarity during the first phase and one or more pulses having the first polarity during the second phase.
• the resulting charge seen by the nerve fibers may be similar to waveform 186 (or waveform 150).
• the amplitude of the first phase is approximately equal to an amplitude of the one or more pulses having the second polarity
• an amplitude of the second phase is approximately equal to an amplitude of the one or more pulses having the first polarity
• FIGS. 13 A and 13B are timing diagrams of low frequency and high frequency pulses delivered via different electrode combinations and a resulting waveform from the pulses.
• the top waveform 170 may be a ULF waveform that includes multiple bi-phasic pulses (e.g., repeating pulses), such as the bi-phasic pulse that includes first phase 172 and 174.
• the bottom waveform 190 indicates that pulses 192 having a single polarity opposite the polarity of first phase 172 and temporally aligned with first phase 172.
• bottom waveform 190 includes pulses 194 having a single polarity opposite the polarity of second phase 174 and temporally aligned with second phase 174.
• Waveform 170 may be delivered with a first electrode combination different from the second electrode combination delivering waveform 190.
• the first and second electrode combination may have zero common electrodes or have one or more common electrodes.
• the resulting waveform 200 experienced by the tissue e.g., the overall charge delivered to the target tissue from both electrode combinations delivering waveforms 170 and 190, may include a bi-phasic pulse that includes first phase 200 with gaps 204 and second phase 206 with gaps 208. In this manner, the gaps may be created using electrical pulses of opposing polarity delivered via different electrodes.
• FIG. 14 is a timing diagram 220 of delivered pulses 222 and a charge bias applied to the patient.
• the channel delivering pulses 22 may experience a drift or bias in charge that may be the result of a non-linearity oxidation region or other issue at the electrodes, for example. This drift may result in less than desired charge at the nerves.
• processing circuitry 26 may provide a bias charge 224 to the channel in order to correct the drift in pulses 222.
• the bias charge 224 may include pulses such as pulse 226 which is delivered to provide a corrective bias to reduce the charge offset from the drift in charge of pulses 22.
• FIG. 15 is a timing diagram of an example bi-phasic pulse comprising different gaps in the first phase and second phase.
• waveform 240 may be a ULF waveform that includes multiple bi-phasic pulses (e.g., repeating pulses), such as the bi-phasic pulse that includes first phase 242 and 246.
• the system may deliver waveform 240 such that there are a plurality of gaps (e.g., amplitude returning to zero or close to zero) within each phase, such as gaps 244 in first phase 242 and gaps 248 in second phase 246.
• the number of gaps 244 in first phase 242 may be different from the number of gaps 248 in second phase 246 in order to adjust the charge from each phase to be unequal to each other.
• This unequal charge may be created to, for example, account for a drift or bias in charge at the electrodes. Therefore, on method of providing a corrective bias to the ULF waveform may be to adjust the gaps within one or more phase of a bi-phasic pulse within the ULF waveform.
• processing circuitry 26 may adjust stimulation parameters to provide any number of gaps (e.g., zero up to any number of gaps that fit within set guidelines) in any phase of the bi-phasic pulse.
• FIG. 16 is a flow diagram illustrating an example technique for adjusting gap widths in ULF waveforms for the delivery of stimulation to a patient in accordance with examples of the disclosure.
• the example of FIG. 16 will be described with respect to processing circuity 26 and IMD 14, but any processing circuitry or medical device, such as external medical device 15 may perform this technique.
• the width of the gaps in ULF waveforms can alter the types of fibers that remain blocked by the ULF waveform and the different types of fibers that are unblocked by the presence of the gaps in the waveform.
• the change in gap width in the ULF waveform and/or ULF waveform amplitude can change ECAP signals detected from those nerve subjected to the ULF waveform.
• processing circuitry 26 may control stimulation generator 30 to deliver ULF electrical stimulation to patient 12 via one or more electrodes located on lead 16, where the ULF electrical stimulation includes a plurality of bi-phasic pulses delivered at a relatively low frequency with gaps in at least one phase of the biphasic pulses (300).
• IMD 14 under the control of processing circuitry 26 and using electrode(s) on lead 16, may deliver ULF electrical stimulation including any bi-phasic pulses or modified bi-phasic pulses described herein that provide one or more gaps in the phase(s) of the ULF waveform.
• the target nerve site may be a peripheral nerve site in some examples.
• Example 1 A system comprising: a stimulation generator configured to deliver electrical stimulation therapy to a patient; and processing circuitry configured to control the stimulation generator to deliver the electrical stimulation to the patient such that the electrical stimulation therapy includes a plurality of bi-phasic pulses, each pulse of the bi-phasic pulses including a first phase followed by a second phase, and wherein the plurality of bi-phasic pulses are configured to reduce or block transmission of neural activity along nerve fibers of the patient.
• Example 14 The system of any of examples 12 and 13, wherein the one or more pulses are bi-phasic pulses having a total width less than a width each gap of the one or more gaps.
• Example 21 The system of example 19, wherein an amplitude of the first phase is less than an amplitude of the one or more pulses having the second polarity, and wherein an amplitude of the second phase is less than an amplitude of the one or more pulses having the first polarity.
• Example 22 The system of any of examples 1 through 21, wherein the processing circuitry is configured to: determine a charge offset in the electrical stimulation therapy; and responsive to determining the charge offset, applying a corrective bias to reduce the charge offset.
• Example 23 The system of any of examples 1 through 22, wherein the processing circuitry is configured to control the stimulation generator to deliver of the electrical stimulation therapy such that an amplitude of the delivered first and second phases begins with a ramp up and ends with a ramp down.
• Example 24 The system of any of examples 1 through 23, wherein the plurality of bi-phasic pulses are delivered at a frequency from about 0.01 Hz to about 10 Hz.
• Example 25 The system of any of examples 1 through 24, wherein the biphasic pulses are asymmetric with the first phase having a longer duration and a lower amplitude compared to the second phase.
• Example 26 The system of any of examples 1 through 25, wherein the first phase is a cathodic phase and the second phase is an anodic phase.
• Example 27 The system of any of examples 1 through 26, wherein respective pulses of the bi-phasic pulses are substantially charge balanced.
• Example 28 The system of any of examples 1 through 27, further comprising an implantable medical device comprising the stimulation generator and the processing circuitry.
• Example 29 The system of any of examples 1 through 27, further comprising an external medical device comprising the stimulation generator and the processing circuitry, wherein the external medical device is configured to be coupled to at least one percutaneous lead via which the electrical stimulation therapy is delivered to the patient.
• Example 30 A method comprising: delivering, by a stimulation generator, electrical stimulation therapy to a patient; and controlling, by processing circuitry, the stimulation generator to deliver the electrical stimulation to the patient such that the electrical stimulation therapy includes a plurality of bi-phasic pulses, each pulse of the biphasic pulses including a first phase followed by a second phase, and wherein the plurality of bi-phasic pulses are configured to reduce or block transmission of neural activity along nerve fibers of the patient.
• Example 31 The method of example 30, wherein the plurality of bi-phasic pulses is a first plurality of bi-phasic pulses, wherein the delivering the electrical stimulation therapy comprises switching between a high power mode comprising the first plurality of bi-phasic pulses and a low power mode comprising a second plurality of biphasic pulses configured to reduce or block transmission of neural activity along the nerve fibers of the patient, and wherein the first plurality of bi-phasic pulses comprise at least one of an amplitude or a pulse width greater than an amplitude or a pulse width of the second plurality of pulses.
• Example 32 The method of example 31, further comprising delivering the electrical stimulation therapy with the high power mode and subsequently switch to the low power mode in response to a first trigger event.
• Example 33 The method of example 31, further comprising switching to the high power mode from the low power mode in response to a second trigger event.
• Example 34 The method of any of examples 31 through 33, further comprising: monitoring a feedback variable associated with the electrical stimulation therapy; adjusting, based on the feedback variable, a value of at least one stimulation parameter that at least partially defines the plurality of bi-phasic pulses; and controlling, according to the adjusted value, subsequent stimulation therapy comprising the plurality of bi-phasic pulses.
• Example 35 The method of example 34, further comprising: sensing sense at least one of an evoked compound action potential (ECAP) signal, an electromyogram (EMG) signal, or a compound muscle action potential (CMAP) signal; and determining a characteristic value of the ECAP signal, EMG signal, or CMAP signal, wherein the feedback variable comprises the characteristic value.
• ECAP evoked compound action potential
• EMG electromyogram
• CMAP compound muscle action potential
• Example 36 The method of example 34, wherein the feedback variable comprises at least one of a neural activity, a patient input, a posture state, an activity level, a sleeping state, an electrode impedance, an electrode characteristic, an electrode potential, or a biological marker of the patient.
• Example 37 The method of example 36, wherein the at least one stimulation parameter comprises an amplitude, a frequency, a ramp up, a ramp down, a slope, a gap width, a number of gaps within a single phase, a gap ramp up, a gap ramp down, a symmetry parameter of each bi-phasic pulse, or a power mode for the plurality of biphasic pulses.
• Example 38 The method of any of examples 30 through 37, further comprising: monitoring neural activity at one or more of the nerve fibers; comparing the neural activity to a threshold; and responsive to determining that the neural activity exceeds the threshold, adjusting a value of one or more stimulation parameters to reduce the detected neural activity.
• Example 39 The method of example 38, further comprising sensing the neural activity via two or more electrodes disposed at least one of adjacent to the one or more nerve fibers or at least partially within the one or more nerve fibers.
• Example 40 The method of any of examples 30 through 39, wherein controlling the stimulation generator to deliver the electrical stimulation therapy comprises controlling delivery such that at least one of the first phase or the second phase of at least some of the plurality of bi-phasic pulses comprises one or more gaps, and wherein an amplitude during the one or more gaps is approximately zero.
• Example 41 The method of example 40, further comprising controlling the stimulation generator to deliver one or more pulses within at least one of the one or more gaps.
• Example 43 The method of any of examples 41 and 42, wherein the one or more pulses are bi-phasic pulses having a total width less than a width each gap of the one or more gaps.
• Example 44 The method of any of examples 41 through 43, further comprising: controlling the stimulation generator to deliver the plurality of bi-phasic pulses via a first electrode combination; and controlling the stimulation generator to deliver the one or more pulses via a second electrode combination different than the first electrode combination.
• Example 45 The method of any of examples 41 through 44, further comprising: controlling the stimulation generator to deliver the plurality of bi-phasic pulses to reduce or block the transmission of the neural activity along a first direction of the nerve fibers; and controlling the stimulation generator to deliver the one or more pulses to elicit neural signal propagation along a second direction of the nerve fibers opposite the first direction.
• any of examples 41 through 47 further comprising: controlling the stimulation generator to deliver the plurality of bi-phasic pulses via a first electrode combination, the bi-phasic pulses comprising a first phase of a first polarity and a second phase of a second polarity opposite the first polarity; and controlling the stimulation generator to deliver, via a second electrode combination different than the first electrode combination, one or more pulses having the second polarity during the first phase and one or more pulses having the first polarity during the second phase.
• Example 49 The method of example 48, wherein an amplitude of the first phase is approximately equal to an amplitude of the one or more pulses having the second polarity, and wherein an amplitude of the second phase is approximately equal to an amplitude of the one or more pulses having the first polarity.
• Example 50 The method of example 48, wherein an amplitude of the first phase is less than an amplitude of the one or more pulses having the second polarity, and wherein an amplitude of the second phase is less than an amplitude of the one or more pulses having the first polarity.
• Example 51 The method of any of examples 31 through 50, further comprising: determining a charge offset in the electrical stimulation therapy; and responsive to determining the charge offset, applying a corrective bias to reduce the charge offset.
• Example 52 The method of any of examples 31 through 51, further comprising controlling the stimulation generator to deliver of the electrical stimulation therapy such that an amplitude of the delivered first and second phases begins with a ramp up and ends with a ramp down.
• Example 53 The method of any of examples 31 through 52, wherein the plurality of bi-phasic pulses are delivered at a frequency from about 0.01 Hz to about 10 Hz.
• Example 56 The method of any of examples 31 through 55, wherein respective pulses of the bi-phasic pulses are substantially charge balanced.
• Example 57 The method of any of examples 31 through 56, wherein an implantable medical device comprises the stimulation generator and the processing circuitry.
• Example 58 The method of any of examples 31 through 56, wherein an external medical device comprises the stimulation generator and the processing circuitry, wherein the external medical device is configured to be coupled to at least one percutaneous lead via which the electrical stimulation therapy is delivered to the patient.
• Example 59 The method of any of examples 31 through 56, wherein an external medical device comprises the stimulation generator and the processing circuitry, wherein the external medical device is configured to be coupled to at least one percutaneous lead via which the electrical stimulation therapy is delivered to the patient.
• a computer-readable medium comprising instructions that, when executed, cause processing circuitry to: control a stimulation generator to deliver electrical stimulation therapy to a patient such that the electrical stimulation therapy includes a plurality of bi-phasic pulses, each pulse of the bi-phasic pulses including a first phase followed by a second phase, and wherein the plurality of bi-phasic pulses are configured to reduce or block transmission of neural activity along nerve fibers of the patient.
• the techniques described in this disclosure may be implemented, at least in part, in hardware, software, firmware or any combination thereof.
• various aspects of the techniques may be implemented within one or more microprocessors, DSPs, ASICs, FPGAs, or any other equivalent integrated or discrete logic circuitry, as well as any combinations of such components, embodied in programmers, such as physician or patient programmers, stimulators, or other devices.
• the term “processor” or “processing circuitry” may generally refer to any of the foregoing logic circuitry, alone or in combination with other logic circuitry, or any other equivalent circuitry.
• the functionality ascribed to the systems and devices described in this disclosure may be embodied as instructions on a computer- readable medium such as RAM, ROM, NVRAM, EEPROM, FLASH memory, magnetic media, optical media, or the like.
• the instructions may be executed to support one or more aspects of the functionality described in this disclosure.
• Computer-readable media may include non-transitory computer storage media or communication media including any medium that facilitates transfer of a computer program from one place to another.
• Data storage media may be any available media that can be accessed by one or more computers or one or more processors to retrieve instructions, code and/or data structures for implementation of the techniques described in this disclosure.
• such data storage media can comprise RAM, ROM, EEPROM, CD-ROM or other optical disk storage, magnetic disk storage, or other magnetic storage devices, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer.
• any connection is properly termed a computer- readable medium.
• the software is transmitted from a website, server, or other remote source using a coaxial cable, fiber optic cable, twisted pair, digital subscriber line (DSL), or wireless technologies such as infrared, radio, and microwave, then the coaxial cable, fiber optic cable, twisted pair, DSL, or wireless technologies such as infrared, radio, and microwave are included in the definition of medium.
• DSL digital subscriber line
• Disk and disc includes compact disc (CD), laser disc, optical disc, digital versatile disc (DVD), floppy disk and blu-ray disc where disks usually reproduce data magnetically, while discs reproduce data optically with lasers. Combinations of the above should also be included within the scope of computer-readable media.
• systems described herein may not be limited to treatment of a human patient.
• these systems may be implemented in non-human patients, e.g., primates, canines, equines, pigs, birds, and felines. These animals may undergo clinical or research therapies that my benefit from the subject matter of this disclosure.

Landscapes

• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• Veterinary Medicine (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Public Health (AREA)
• General Health & Medical Sciences (AREA)
• Biophysics (AREA)
• Heart & Thoracic Surgery (AREA)
• Surgery (AREA)
• Physics & Mathematics (AREA)
• Molecular Biology (AREA)
• Medical Informatics (AREA)
• Pathology (AREA)
• Pain & Pain Management (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Radiology & Medical Imaging (AREA)
• Neurology (AREA)
• Neurosurgery (AREA)
• Electrotherapy Devices (AREA)

Applications Claiming Priority (3)

Publications (1)

Family

ID=88098000

Family Applications (1)

Country Status (2)

Families Citing this family (1)

Family Cites Families (3)

• 2023
  • 2023-08-24 EP EP23773013.0A patent/EP4577295A1/de active Pending
  • 2023-08-24 WO PCT/US2023/031064 patent/WO2024044326A1/en not_active Ceased

Also Published As

Similar Documents

Legal Events