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WO2011072183A2 - Système de neurostimulation implantable - Google Patents

Système de neurostimulation implantable Download PDF

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Publication number
WO2011072183A2
WO2011072183A2 PCT/US2010/059789 US2010059789W WO2011072183A2 WO 2011072183 A2 WO2011072183 A2 WO 2011072183A2 US 2010059789 W US2010059789 W US 2010059789W WO 2011072183 A2 WO2011072183 A2 WO 2011072183A2
Authority
WO
WIPO (PCT)
Prior art keywords
patient
radio frequency
receiver
pulse generator
housing
Prior art date
Application number
PCT/US2010/059789
Other languages
English (en)
Other versions
WO2011072183A8 (fr
WO2011072183A3 (fr
Inventor
Charles V. Burton
Robert H. Lovett
Original Assignee
Pauncefore Technologies, Llc
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 Pauncefore Technologies, Llc filed Critical Pauncefore Technologies, Llc
Publication of WO2011072183A2 publication Critical patent/WO2011072183A2/fr
Publication of WO2011072183A8 publication Critical patent/WO2011072183A8/fr
Publication of WO2011072183A3 publication Critical patent/WO2011072183A3/fr

Links

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
    • 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
    • A61N1/37217—Means for communicating with stimulators characterised by the communication link, e.g. acoustic or tactile
    • A61N1/37223—Circuits for electromagnetic coupling
    • 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
    • A61N1/375—Constructional arrangements, e.g. casings
    • 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
    • A61N1/375—Constructional arrangements, e.g. casings
    • A61N1/37518—Anchoring of the implants, e.g. fixation
    • 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
    • A61N1/36082—Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
    • A61N1/36085—Eating disorders or obesity

Definitions

  • the present invention relates to a neurostimulation system that includes an implantable electronic device.
  • This system is particularly useful for the purpose of appetite control, as well as for pain control of visceral and somatic origin.
  • Transcutaneous electrical nerve stimulation is described in U.S. Patent No. 7,200,443 to reduce eating and for gastrointestinal disorders.
  • This approach utilizes a small electrical device to deliver electrical impulses through the skin via electrode pads affixed externally to the skin in the thoracic region of the spine at the level of T6-T10.
  • Wire leads have been used as a means of reducing somatic pain or appetite suppression but there is a high risk of associated device lead wire failure rate due to the hostile environment of the human body. While this is true for all neurologic targets, it is particularly true in regard to the remote location of the celiac plexus.
  • Radio frequency coupled neurostimulators have been in use for various applications for over 30 years. In all such cases, the transmitting antenna is placed on the skin and the radio frequency receiver is placed subcutaneously close to the transmitting device in order to couple with it.
  • the present invention relates to a radio frequency based system for stimulating a target structure in a patient.
  • the device includes an implantable electronic device comprising a housing, wherein the housing comprises a radio frequency signal receiver, an amplifier and a stimulating electrode.
  • the receiver can receive signals in a three-dimensional manner when implanted in the target structure of the patient's body.
  • the system also includes a transmitting coil placed on the exterior surface of the patient' s body for transmitting a signal to the receiver of the implantable electronic device.
  • the housing of the device can include a geodesic shaped dome.
  • the present invention includes an implantable electronic device comprising a housing, wherein the housing comprises a radio frequency receiver, an amplifier and a stimulating electrode.
  • the device also includes a means for attaching the housing to a target structure within a patient.
  • the present invention includes a method of stimulating a patient's neurologic structure.
  • the method includes implanting an electronic device comprising a housing, wherein the housing comprises a radio frequency signal receiver, an amplifier and a stimulating electrode, wherein the receiver can receive signals in a three-dimensional manner when implanted in the target structure of the patient's body.
  • the method also includes positioning a transmitting coil on the exterior side of the patient's body for controlling the stimulating electrode of the electronic device.
  • the method further includes initiating radio frequency waves from a pulse generator to the transmitting coil, wherein the transmitting coil transmits radio frequency waves to the electronic device to stimulate the neurologic structure.
  • the present invention includes a method of controlling pain in a patient.
  • the method includes implanting an electronic device comprising a housing, wherein the housing comprises a radio frequency signal receiver, an amplifier and a stimulating electrode, wherein the receiver can receive signals in a three-dimensional manner when implanted on the celiac plexus of the patient.
  • the method also includes positioning a transmitting coil on the exterior side of the patient's body for controlling the stimulating electrode of the electronic device.
  • the method further includes initiating radio frequency waves from a pulse generator to the transmitting coil, wherein the transmitting coil transmits radio frequency waves to the electronic device to stimulate the celiac plexus.
  • the present invention includes a method of controlling appetite in a patient.
  • the method includes implanting an electronic device comprising a housing, wherein the housing comprises a radio frequency signal receiver, an amplifier and a stimulating electrode, wherein the receiver can receive signals in a three-dimensional manner when implanted on the celiac plexus of the patient.
  • the method includes positioning a transmitting coil on the exterior side of the patient's body for controlling the stimulating electrode of the electronic device.
  • the method further includes initiating radio frequency waves from a pulse generator to the transmitting coil, wherein the transmitting coil transmits radio frequency waves to the electronic device to stimulate the celiac plexus.
  • Figure la is a schematic diagram of the implantable electronic device.
  • Figure, lb is a representation of the implantable electronic device.
  • Figure 2 shows the implantation of the device by an endoscope.
  • Figure 3 shows the internally placed device affixed to the surface of the celiac plexus.
  • Figure 4 is a representation of the external pulse generator controlled by the patient.
  • the present invention relates to a radio frequency based stimulation system that can be used to stimulate target structures in a patient, particularly neurological targets.
  • This neurostimulation system includes an implantable electronic device, an external transmitting coil and a pulse generator.
  • the implantable electronic device houses multiple components including a radio frequency receiver, an amplifier and a stimulating electrode and, in addition, the device is structured to receive signals in a three-dimensional manner.
  • the components of the implantable device are housed in a geodesic shaped dome structure.
  • the geodesic shaped dome can be implanted in a patient at a desired target neurologic area or structure.
  • the neurostimulation system also includes a transmitting coil that is placed externally on the patient.
  • the transmitting coil receives a signal from a pulse generator that is external to the patient's body.
  • the transmitting coil can transmit radio frequency waves to the receiver in the implantable device.
  • the receiver can capture the signal and ultimately activate the stimulating electrode within the implantable device.
  • the activated stimulating electrode stimulates the structure on which it is located.
  • a geodesic shaped dome is a spherical or partial-spherical shell structure or lattice shell based on a network of great circles (geodesies) lying on the surface of a sphere.
  • the geodesies intersect to form triangular elements that have local triangular rigidity and also distribute the stress across the entire structure.
  • Geodesic shaped dome as used herein can refer to the implantable electronic device and include, for example, the multiple components described herein. However, housing structures of other shapes may also be used and are also within the scope of the invention.
  • the present invention also includes a method for using the neuro stimulation system to stimulate neurological structures such as the celiac plexus.
  • a minimally invasive endoscopic surgical procedure is used for implanting the geodesic shaped dome housing that includes the receiver, amplifier, and stimulating electrode.
  • the geodesic shaped dome housing may be placed upon or within the celiac plexus or other target neurologic structures. Electrical stimulation of the celiac plexus can be effective both for visceral pain control as well as for appetite control, depending on the stimulation parameters.
  • the celiac plexus can be stimulated by the internal device when communicating with an external radio frequency wave transmitting coil to control the patient symptoms. This novel type of neurostimulator has been specifically designed to be used for these purposes, as well as a new means of controlling visceral as well as somatic pain.
  • the neurostimulator system described herein advantageously avoids the pitfalls of previous direct and indirect neurostimulator systems.
  • Prior art radio frequency stimulators have used a two dimensional system for receiving signals.
  • the present invention receives signals in a three-dimensional or multi-directional manner leading to a more effective means of stimulating structures.
  • the remote system described herein the user has complete external control of the system.
  • the implanted device itself is inert until activated by the external radio frequency pulse generator.
  • the present system can also allow stimulation of structures deep within the body as opposed to structures immediately beneath the skin surface.
  • the neurostimulator system described herein can also minimize side effects through providing the most direct, discrete and local stimulation.
  • the system and the methods can provide treatment of obesity and control of visceral pain and somatic pain in a user-friendly manner.
  • Implantable device 10 includes radio frequency receiver 20, amplifier 30 and stimulating electrode 40. Generally, receiver 20 is electrically connected to amplifier 30 which in turn is electrically connected to electrode 40.
  • the device 10 preferably also includes a power source 50 that is connected to receiver 20, amplifier 30 and electrode 40.
  • Power source 50 can be, for example, a battery encased in a substance such as titanium. Other power sources are also within the scope of this invention.
  • Housing 60 contains all of the components of device 10. Housing 60 of the implantable device is designed to capture radio frequency pulses in a three- dimensional manner directed toward it by an external radio frequency power source. A variety of types and shapes of housing are within the scope of this invention.
  • Fig. lb shows geodesic shaped dome 100 which is one preferred embodiment for housing of an implantable device.
  • Geodesic shaped dome can be made from a variety of materials, preferably biocompatible materials.
  • One exemplary embodiment includes geodesic shaped dome made from non-metallic, ceramic material.
  • Geodesic shaped dome 100 houses, for example, the components shown in Fig. la and can receive pulses 114 in a three-dimensional manner.
  • Geodesic shaped dome 100 includes dome 110 and suture skirt 120.
  • Suture skirt 120 preferably includes apertures 130 such that suture 140 can pass through the apertures.
  • the diameter of suture skirt 120 can vary but generally is approximately similar to the diameter of dome 100.
  • Suture skirts are well known in the art and can be made from a variety of materials including natural and/or synthetic materials that are biocompatible.
  • the device can be affixed with an adhesive or a crimping device.
  • Fig. 2 shows patient 200 with two small incisions, 210a and 210b.
  • endoscope 220 is used to implant geodesic shaped dome 100 into patient 200 via incisions 210a and 210b.
  • Geodesic shaped dome 100 is sized appropriately to fit within endoscope 220 to enable insertion into patient 200. The insertion is preferably in the patient's flanks.
  • Fig. 3 illustrates the placement of geodesic shaped dome 100 in celiac plexus 240 of patient 200.
  • Geodesic shaped dome 100 is oriented toward the outside of the patient's body.
  • the present invention also includes an external transmitting coil and a pulse generator.
  • the external transmitting coil is generally placed on the exterior of the patient, preferably on the backside or the frontside of the patient's thoraco-lumbar spine.
  • the transmitting coil may be placed, for example, as an applique.
  • the pulse generator is external to the patient's body, i.e. not attached to the body.
  • Fig. 4 schematically illustrate the placement of transmitting coil 300 on either the front side 310a or backside 310b of patient 200. More than one transmitting coil 300 may be placed on a patient. In embodiments containing more than one transmitting coil, the coils are constructed to provide different stimulation parameters so that there is no interference or cancellation of the signal.
  • pulse generator 320 is a small device that includes keypad 330 with keys 340.
  • the pulse generator optionally includes display screen 350.
  • the pulse generator can be handheld or placed on a table and can be operated by the patient, another operator or computer controlled.
  • the geodesic shaped dome can be surgically placed through an endoscope and affixed directly to neurologic targets such as the celiac plexus.
  • the use of an endoscope is advantageous because it is minimally invasive and allows quick recovery of the patient with fewer complications.
  • Other techniques such as regular surgical procedures may be used and are within the scope of the invention.
  • the geodesic shaped dome can be held in place by sutures through the suture skirt that preferably is attached to the dome.
  • Other attachment means such as using adhesives or claw like crimping structures at the bottom of the dome that hold the geodesic shaped dome in place are also within the scope of the invention.
  • the orientation of the transmitting coil can vary and the geodesic shaped dome housing the receiver can facilitate a number of different transmitting coil designs.
  • the transmitting coil may send signals to the geodesic shaped dome in a continuous manner, periodic manner and/or in a defined manner that is determined by the patient, physician or another operator.
  • a variety of parameters can be manipulated and can determine the type of response a patient exhibits. These parameters include the length or duration of the signal, the amplitude or intensity of the signal, and the periodicity at which the radio waves are emitted.
  • the pulse generator may be controlled manually. When a signal is desired, the operator can for example, set the intensity, periodicity and duration of the signal on the pulse generator and manually operate the pulse generator so the desired radio frequency waves are emitted to the transmitting coil which in turn transmits the signal to the geodesic shaped dome.
  • the pulse generator may also be a programmable device that is programmed for future transmissions based on historical data recorded in the pulse generator.
  • the pulse generator can also be adaptable to be connected to a computer that can then be used to download information into the pulse generator for determining the transmission parameters and/or schedule. Some pulse generators may have a combination or all of these features.
  • the pulse generator includes both a manual and a programmable mode.
  • the pulse generator In the manual mode, the pulse generator is controlled manually as the patient begins to notice hunger pains.
  • the patient controls the frequency and temporal occurrences of the transmissions as well as the parameters of the transmissions to the receiver using the keyboard built into the pulse generator.
  • the pulse generator can record and display the time and date and parameters of the previous doses for reference by the patient to assist in the decision making and to avoid under or over dosing.
  • the pulse generator may also include a pre- settable alarm that can be heard audibly or vibrate, in the manner of a cell phone to remind the patient to administer a dose. This alarm can also remind the patient in the event a dose has not been taken within the time set by the patient.
  • the alarm can sound prior to a programmed dose, so as to permit the patient to override the programming and return to the manual mode.
  • the programming may take place on a connected desktop or laptop computer or using the keyboard.
  • the pulse generator can communicate with a desktop or laptop computer via a USB port. Over time, when the patient becomes aware of the ideal frequency, timing, and strength, the patient may elect to replay a course of treatment from a previous period of time with such modifications as the patient wishes to program.
  • the pulse generator may contain a USB port to communicate with the patient's home computer, permitting the patient to view prior history and set future programs. When plugged in with the USB cable, the pulse generator's re-chargeable battery may recharge.
  • the device may also include a battery re-charger for use while the patient is sleeping.
  • the keyboard may also permit the manual recordation by the patient of the estimated caloric intake using the keyboard built into the pulse generator. This information can be displayed along with the information relating the frequency, timing, and parameters of the transmissions to the internal receiver. All of this information allows the patient and/or healthcare professional to fine-tune the stimulation regimen.
  • the present invention includes a method of stimulating structures, preferably neurological structures in a patient using the neuro stimulatory systems described herein.
  • the patient can be human or animal.
  • a variety of neurological structures can be stimulated including for example, cervical plexus, celiac plexus, brachial plexus, sacral plexus, lumbar plexus and the like.
  • the celiac plexus is stimulated.
  • the method includes placing the implantable device in, on or within a neurologic structure of the patient.
  • the device may be placed using a variety of techniques including by the use of an endoscope.
  • the device is secured in the target structure by any of the attachment means described above.
  • a transmitting coil can be attached to the patient who has the implantable device in place.
  • the transmitting coil can be, for example, in the form of an applique patch.
  • the transmitting coil can be attached to or within another structure such as an ace bandage and the like.
  • a pulse can be initiated from the pulse generator.
  • the pulse generator can be handheld or on a tabletop but it is close enough to the patient that the pulse generator can send the signal to the transmitting coil to emit the radio frequency waves to the device within the patient.
  • the periodic or continual stimulation of the receiver provides impulses to the target area.
  • the pulse generator that initiates the pulses that ultimately lead to stimulation of the target structure may be operated manually or programmed as described above to administer a desired stimulation regimen to the patient.
  • the present invention preferably relates to stimulating the celiac plexus in a patient. Stimulation of the celiac plexus can lead to appetite suppression and/or pain control depending on the specific stimulation parameters used.
  • the celiac plexus is stimulated by low level electric pulses which in turn can control appetite by inducing low grade nausea but not at the expense of undue comfort to the patient.
  • the low grade nausea can suppress the patient's appetite and lead to weight loss.
  • the celiac plexus when stimulated with different stimulation parameters or intensities of electric pulses can control visceral and/or somatic pain.
  • the level of the transmission can be initially adjusted by the healthcare professional and the frequency of the doses can be monitored and optimized during an initial course of treatment, but with the goal of essentially achieving self-control by the patient of the device.
  • Stimulation parameters used for a patient can vary based on the goal of the therapy, i.e. appetite suppression, pain relief and/or pain control. Stimulation parameters can also vary from patient to patient. Stimulation parameters that may produce pain control in one patient may produce pain relief in another patient. Generally, the stimulation parameters are optimized for each individual patient. A patient's body habitus can play an important role in the stimulation parameters used for a particular desired result. A patient's innate pain tolerance can also be seminal to the stimulation parameters selected.
  • the neurologic structure can be stimulated at a variety of intensities.
  • the neurological structure is generally stimulated between about 20 Hz and aboutl,000 Hz.
  • the neurological structure is stimulated at between about 50 Hz and about 200 Hz. Stimulation with intensities outside of these ranges are also within the scope of this invention.
  • the neurologic structure can be stimulated for varying lengths of time at varying periodicities.
  • the neurologic structure may be continually stimulated at a very low grade intensity.
  • the neurologic structure may be stimulated for an hour and off for a few hours.
  • the neurologic structure may be stimulated prior to mealtimes. Duration and periodicity other than those specifically described herein are also within the scope of this invention.
  • the present invention can also include a method of controlling pain in a patient.
  • the pain can be a visceral pain as experienced, for example, by patients suffering from pancreatic cancers and the like.
  • the pain can also be somatic pain.
  • the method includes stimulating the celiac plexus of the patient using the neurostimulatory devices described herein.
  • the stimulation regimen for controlling pain in a patient can vary depending on the patient's age, size, health status, the stage of the disease causing the pain, the amount of pain and the like.
  • the present invention can also include a method of controlling appetite in a patient.
  • the method can result in appetite suppression that results in weight loss for a patient.
  • the method includes stimulating the celiac plexus of the patient using the neurostimulatory devices described herein.
  • the stimulation regimen for controlling appetite in a patient can vary depending on the patient's weight, gender, age, health status and the like.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Radiology & Medical Imaging (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Physics & Mathematics (AREA)
  • Pain & Pain Management (AREA)
  • Neurology (AREA)
  • Neurosurgery (AREA)
  • Electromagnetism (AREA)
  • Acoustics & Sound (AREA)
  • Electrotherapy Devices (AREA)

Abstract

La présente invention concerne un dispositif électronique implantable qui comprend un dôme de forme géodésique (100), un boîtier (60) et des moyens de fixation du dôme (110) à une structure neurologique cible. Ledit dôme (110) comprend un récepteur radiofréquence (20), un amplificateur (30), et une électrode de stimulation (40). Un système de neurostimulation basé sur la radiofréquence comprend en outre une bobine de transmission (300) positionnée à l'extérieur du corps d'un patient (200) destinée à transmettre des impulsions (114) au récepteur et à activer l'électrode de stimulation (40) dans le dispositif électronique implantable. Le système de neurostimulation peut être utilisé pour soulager une douleur viscérale et une douleur somatique ainsi que pour contrôler l'appétit de patients.
PCT/US2010/059789 2009-12-10 2010-12-10 Système de neurostimulation implantable WO2011072183A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US12/635,266 2009-12-10
US12/635,266 US20110144717A1 (en) 2009-12-10 2009-12-10 Implantable neurostimulation system and methods of using the system for appetite control and pain control

Publications (3)

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WO2011072183A2 true WO2011072183A2 (fr) 2011-06-16
WO2011072183A8 WO2011072183A8 (fr) 2011-09-22
WO2011072183A3 WO2011072183A3 (fr) 2011-11-10

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US (1) US20110144717A1 (fr)
WO (1) WO2011072183A2 (fr)

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