DE10143268A1 - Neurostimulator for medical use, e.g. for investigation of neuro-degenerative diseases has application electrode that allows different electrical stimuli to be applied as well as mechanical, thermal, magnetic or chemical stimuli - Google Patents

Abstract

Neurostimulator has an application device (2) with at least an application electrode and an electronic circuit (4). The application device is a cat whisker electrode that comprises a channel (40) and wires. The device is at least partially implantable in a patient. One end extends into the patient where a wire or wires can be extended from the channel to stimulate a nerve. The wires are insulated from each other within the channel so that a different electrical signal can be applied to each electrode. INDEPEPENDENT CLAIMS are made for a neurostimulator with magnetic, mechanical, chemical or thermal coupling for generation of a stimulus, a control device for a neurostimulator and a method for transferring data from a control unit to a neurostimulator.

Description

This invention relates to neurostimulators according to the preambles of Claims 1, 3, 7, 8, 9, 10, 11, 13, 20, 21 and 22. Furthermore, this relates to Invention a control device according to the preamble of claim 23 and 26. Finally, this invention relates to a data transmission method according to the preambles of claims 30 and 32.

Such a neurostimulator, such a control device and such Data transmission methods are known from US Pat. No. 5,683,422. This document describes a method and an apparatus for treating neurodegenerative diseases due to electrical stimulation of the brain.

Scientists are studying the phenomenon of excitotoxicity excitotoxicity), which means the poisoning of nerves due to excessive Excitation of nerve cells. Research focused on the Nerve cells that have glutamate neurotransmitter receptors and especially are susceptible to constant arousal (Rothman, S. M., Olney, J. W. (1987) Trends Neurosci. 10, 299-302). When nerve cells are excessively active - that is hyperactive - are, because they are exposed to many action potentials they are thought to have excessive glutamate or other transmitter substances (English: excitatory amino acids, EAA) release at their synapses. This leads to Poisoning of nerve cells that follow hyperactive nerve cells.

Benabid et al. (The Lancet, Vol. 337: Feb. 16, 1991, pp. 403-406) have shown that the stimulation of the vim nucleus of the thalamic tremor (tremor of the Patients, cf. Roche Medical Lexicon, 4th edition, published by the Hoffmann La Roche AG and Urban & Fischer, Urban & Fischer, Munich, 1998) suppressed. In this case, stimulation rates were from 100 to 185 Pulses per second for the same physiological response as an injury this brain area.

Parkinson's disease is the result of the degeneration of the substantia nigra Pars compactia. It has been shown that the nerve cells of the Subthalamus use glutamate as a neurotransmitter to provide information to transfer their target cells in the basal ganglia. The hyperexcitation that occurs at Parkinson's disease occurs, excess glutamate releases what theoretically leads to further degeneration.

US 5,683,422 suggests a through a lead implanted in the head Stimulate brain region. Preferably, a rod with four annular electrodes arranged one behind the other and insulated from one another used to target certain brain regions with electrical pulses stimulate. In addition, a "housing connection" to the conductive shaft of the Rods are provided, so that a total of five application electrodes are available stand. At least two of these electrodes may be from one implemented pulse generator controlled.

Furthermore, a sensor with two electrodes can be provided, which is also in the Subthalamus region, the substantia nigra or another brain region is implemented, whose electrical activity is the activity of the degenerate neurons reflected. The sensor electrodes can also be connected to the stimulating electrodes may be arranged. The sensor electrodes are over electrical lines connected to an analog-to-digital converter. alternative can the signals supplied by an external sensor via a telemetric Downlink are transmitted to the implemented pulse generator.

Alternatively, an electrochemical sensor can be provided which measures the amount of Glutamate, another neurotransmitter or a breakdown product thereof in the Substantia nigra measures. Such a sensor could consist of one with one ion-selective membrane coated electrode exist. An example of this Sensor type is in "Multichannel semiconductor-based electrodes for in vivo electrochemical and electrophysiological studies in rat CNS "by Craig G. von Home et al. (Neuroscience Letters, 120 (1990), pp. 249-252).

The output of the analog-to-digital converter is via a bus with one Microprocessor connected to the sensor signals depending on the type of evaluates the sensor used. If the sensor signal is from a doctor exceeds the programmed value, the stimulation is over the stimulating Electrodes increased.

The stimulation pulse rate is via a programmable via the bus Frequency generator generated. The amplitude of the stimulation pulse is over the Bus and a digital-to-analog converter programmed. Finally the Microprocessor also has a pulse width control module on the bus to the Set the pulse width of the stimulation pulses.

During the implantation, the doctor programs certain key parameters into one Memory of the stimulation device using telemetry. These parameters can be used for Need to be updated. The key parameters include the information whether nerve activity should be reduced or increased, whether an increase in Nerve activity at the sensor location an increase in nerve activity at the stimulation target here or vice versa, the pulse width, amplitude and frequency of the Stimulation pulses. The doctor can also set upper and lower limits for the Set key parameters. To increase the stimulation, the Pacing rate increased to its upper limit. Then the Pulse width increased up to its upper limit. Finally, the pulse amplitude is up to her Upper limit increased. Now there is an increase in stimulation within the predetermined limits are no longer possible and an error message is displayed Telemetry sent to the doctor.

An additional algorithm is superimposed on this algorithm in order to stimulate set as low as possible but as high as necessary to achieve a reasonable one Reach levels of nerve activity in the subthalamic nucleus. If the If the stimulation parameters are changed, a timer is started. If not stimulation is required before the time set in the timer expires increase, it may be possible to reduce the stimulation and still have one maintain adequate levels of nerve activity. Therefore the Trial stimulation reduced. If nerve activity remains high enough, the stimulation can be gradually reduced.

The following companies are active in the market for neurostimulation: Medtronic inc. (www.medtronic.co.uk) Cyberonics Inc. (www.cyberonics.com), Cochlear Inc. (www.cochlear.com) with the "Nucleus" system and EMPI Inc. (www.empi.com).

Various measuring methods are used in medicine to determine parameters of a patient's body. Here is electroencephalography (EEG) to name. Bioelectrical potential fluctuations in the brain, that is, brain electrical activity. The measurement is carried out routinely through surface electrodes, but can also be used in the Patients with fine needle electrodes can be tapped from the scalp. The Recording takes place using 12, 16 or 20 differential amplifiers ("channels") simultaneously.

Electromyography (EMG) is used to register the bioelectric activity of the Called muscles. With this method the electrical potentials tapped by the insertion of needle electrodes. The potentials can too be tapped from the body surface, but this leads to smaller signals.

A special form of EMG is the electrocardiogram (EKG), in which the at the spread of excitation and regression of the heart bioelectric potentials or potential differences are recorded. The The potentials are measured bipolar or unipolar by electrodes from the Body surface or directly from the heart, for example during heart operations.

Electrooculography (EOG) improves the resting potential of the eye based on the changes in the bioelectric potential difference between the anterior and posterior pole of the eye recorded. The eye forms one electrical dipole, with the cornea positively and the retina negatively charged. The potential changes are reflected in the voltage change in the environment which in turn can be derived using periocular electrodes (Roche Lexicon Medicine a. a. O.).

Through cochlear implants, the inner ear is stimulated with up to 32 channels Help deaf people to overcome their disabilities.

For wireless data transmission, the Bluetooth Standard set by the bluetooth website http: \ \ www.bluetooth.com can be downloaded. The Bluetooth standard works in most Countries with the exception of Spain and France in the frequency band from 2,400 to 2.4835 GHz. Bluetooth therefore works in the ISM band (ISM = Industrial Scientific Medicine). In this frequency band there are 79 channels on the frequencies 2'402 + n MHz (n = 0.1.2,..., 78). The transmission takes place digitally. As a type of modulation GSSK (Gaussian Frequency Shift Keying) is used. There are three Power classes that are determined depending on the maximum transmission power. The maximum output power for Class 1, 2 and 3100 mW, 2.5 mW or 1 mW. A power control is provided for devices of performance class 1, which limits the transmission power over 1 mW. The step size for the Power control should be between 8 and 2 dB.

To ensure user security and confidentiality, the Bluetooth System an application layer and a connection layer (link layer) available. Four different parameters are used to set the Maintaining link layer security: A public address (referred to as BD_ADDR), which is different for each Bluetooth unit, two secret key and a random number for each new transaction is different. The public address is 48 bits long. The one for authentication The private key used is 128 bits long, which is used for encryption private key has a configurable length of 8-128 bits, and the random number (RAND) is also 128 bits long.

It is the object of this invention, a neurostimulator, a control device as well as a data transmission method to indicate the therapy success of the To improve neurostimulators and thus expand its area of application.

This object is achieved by the teaching of claims 1, 3, 7, 8, 9, 10, 11, 13, 20, 21, 22, 23, 26, 30 and 32 solved.

Preferred embodiments of the invention are the subject of Dependent claims.

The following section deals with the diseases associated with Neurostimulators can be treated. Here is the particular one Parkinson's disease with the symptoms tremor (trembling of the limbs), Rigor (increased basic tension of the skeletal muscles) and akinesia To mention (sedentary lifestyle). It should by deep, possibly multi-channel Brain stimulation of the subthalamus can be treated. The deep possibly multi-channel Hind stimulation of the subthalamus is also used to treat essential tremors (dominant hereditary resting tremor), dystonia (disturbance of the natural Muscle tension), dyskinesias (disorder or painful Malfunction of the movement) and epilepsy. pain patients can be stimulated by the spinal system, especially the spinal cord, be helped. Epilepsy is treated by stimulating the left vagus nerve. Furthermore, functional electrical stimulation, ie the stimulation of efferents Lanes or muscle tissue, for example in paraplegia become. By stimulating the vestibular system with bipolar carbon electrodes, that are placed behind the ears can cause balance problems are treated, for example, on cerebellar diseases or disorders of the vestibular system (organ of balance).

The advantage of using a brush electrode is that a high Electrode density for tissue stimulation is achieved.

It is an advantage of a mesh electrode that the Network electrode can be structured very finely and they like the pin electrode enables a high electrode density to be achieved. By hanging one Network electrode on the cortex or thalamus is the risk of destruction of nerve tissue less than when inserting rod-shaped electrodes.

The integration of the electronic circuit on the network electrode offers the Advantage that the connecting wires between the electronic circuit and the individual electrodes can be kept optimally short and thus space in the Body of the patient is saved, no unnecessary electrosmog in the body is generated and the implantation is simplified.

Because a network electrode compared with the large number of individual electrodes other neurostimulators have a relatively high energy requirement the implanted electronic circuit wires from the body of the Patients led out so that batteries serving as energy sources are easy can be changed.

The transmission of data over the wires to the energy source reduces the Exposure of the patient to electromagnetic radiation compared to a wireless interface.

The control of electrical stimulation depending on different Sensor signals provides the ability to keep stimulation as low as possible but set as high as necessary to achieve a certain therapeutic success to reach. EMG and EEG signals can be easily through implanted electrodes, needle electrodes or glued on the skin Surface electrodes are tapped from the patient's body. The Using a microphone offers the possibility of both body noise as well as ambient noise when selecting and intensity of To consider stimulation signals. For example, the microphone Noises of the blood, i.e. flow noise and the pulse rate as well Breathing noises of the patient when choosing the stimulation impulses and their Take intensity into account. In addition, a microphone Provide additional information about the patient's environment. Finally, the Give the patient acoustic commands via the microphone to the neurostimulator.

The tapping of electrical signals at the balance organ and the Stimulating the right nerves or muscles can help treat the Balance sense can be used. With a different clinical picture can improves the sense of balance by stimulating the balance organ to prevent the patient from falling.

The advantage of using the Bluetooth standard is that the Transmitting power over 1 mW is regulated to the lowest possible values and so the Patient with only a weak electromagnetic connection despite the wireless connection Exposed to radiation.

The implantation of an antenna as close as possible under the skin enables the Use a low transmission power and thus reduce the impact of electrosmog on the patient.

An optical, in particular an infrared, interface has the advantage that the patient is spared radio frequencies. An infrared interface can to be implanted under the skin (subcutaneously) because of the absorption of infrared Radiation through tissue is relatively low. Is the neurostimulator able to measured sensor data via a transmitter to a control unit transmitted, they can advantageously be evaluated there more precisely because there is more computing power available in the control unit.

The use of some of the application electrodes as sensor electrodes leads to a more flexible use of the neurostimulator. That way after implantation, it can still be determined which electrode is used as the stimulation or used as a sensor electrode.

Advantage of the possibility of a periodic signal curve with more than Entering one pulse per period is flexible Experimenting with multiple impulses is possible. Advantageous in one Storage of the various pulses in a linked list of Data structures, each of which is a reference to another data structure may include the flexible programming of the impulses in one period without limitation to a certain number of pulses. Advantage of that the pulse width and pulse height of the first pulse as Standard pulse width or height is interpreted is that the input that Storage in the control unit and the transfer of control unit to one Neurostimulator requires fewer values if further pulses are the same width and / or have the same height as the first pulse. especially the less complex and therefore more ergonomic input is advantageous.

The advantage of using an aperiodic signal curve is that the signals naturally generated by the nerve cells only are approximately periodic and thus an aperiodic waveform comes particularly close to natural conditions.

Advantageous in using any pulse shape instead of one simple rectangular pulse is that this creates natural pulse shapes can be used.

Advantageous in using the same data structures for the transmission of Control unit to a neurostimulator, such as that used to store a Pulse period used in the control unit is that these data structures Store pulse trains efficiently. The fact that the reference in a data packet or a data structure to another data packet or another data structure indicates the amount of data that passes between the Beginning of the reference and the further data packet are transferred an adaptation of the reference to a data transmission process.

Preferred embodiments of the invention are described below Reference to the accompanying drawings explained in more detail. Show:

Fig. 1 is a neurostimulator according to the invention with various sensors transmitting devices and application electrodes,

A neurostimulator according to the invention, which is supplied via a supply and communication line with electric power, whereby data can be exchanged with the neurostimulator Fig. 2 via this line,

Fig. 3 shows an inventive control unit with a radio and infrared interface,

Fig. 4 is a brush electrode,

Fig. 5 is a stimulation device according to the invention with the mesh electrode,

FIG. 6 a representation of a pulse sequence in the display of a control unit,

Fig. 7 different data structures for storage and transmission of periodic and aperiodic pulse sequences,

Fig. 8 an input dialog for programming of another pulse in a pulse train, and

Fig. 9 is a menu bar with a folded down, drop-down menu for selecting a pulse shape.

Fig. 1 shows a neurostimulator 1 of the invention. The housing of the neurostimulator encapsulates an electronic circuit. The outside of the housing can be tissue-compatible, so that it can be implanted in the human body. In another embodiment, however, the housing is housed outside the body, so that the battery 23 serving as an energy supply can be easily replaced. Application or stimulation electrodes 3 are provided for the stimulation of nerve tissue.

As will be explained further below with reference to FIG. 4, the application electrodes can be designed as insulated wires which are stripped at the end and thus make an electrically conductive contact with the nerve tissue to be stimulated. In a preferred embodiment, the feed lines to the application electrodes 3 are mechanically gripped by a cannula 40 and electrically shielded. Therefore, the cannula 40 is preferably made of an electrically conductive material and can therefore be used as an additional electrode. In one embodiment, the application or stimulation device 2 comprises application electrodes 3 and cannula 40 .

In another embodiment, the application electrodes can be designed as mutually insulated rings on a rod similar to a jack plug, as is the case with the device Itrel II mentioned in US Pat. No. 5,683,422. In the preferred embodiment, 20 rings are used. In addition, the rings can be divided into sectors that are isolated from one another. In this way, the area of a single electrode becomes smaller, so that nerve cells can be stimulated more precisely. In a further embodiment, the application electrodes can be designed as network electrodes. This is described in connection with FIG. 5. An advantage of using ring electrodes or sector electrodes is that other rings and / or sectors can be addressed when the rod-shaped carrier slips or rotates, so that the slipping or rotating is compensated for.

In addition, surface electrodes can also be used as application electrodes be used. Especially for the therapy of the balance organ carbon electrodes are attached behind the ears.

In further embodiments, the electrodes can be compared to the tissue to be stimulated so that the stimulation takes place capacitively. In Another embodiment can stimulate nerve cells done magnetically.

With electrical, capacitive or magnetic coupling, the stimulation of nerve cells mainly by increasing the pulse frequency, a Increase the pulse width or increase the pulse height. The Pulse height is preferably specified as a voltage in volts. she can but also as current in amperes, charge in Coulomb or magnetic field in Tesla be specified.

In yet another embodiment, tissue can mechanically Pressure be stimulated. Piezo elements can be used for this, alternatively, the use of components that have the effect of magnetostriction use, possible. In a further embodiment, the stimulation can chemical way. Through micromechanically manufactured valves Neurotransmitters are released in nerve tissue, causing synapses be stimulated.

Finally, thermal stimulation is in some embodiments of the Invention provided. A thermal stimulation device can thereby be realized that metallic strips on a flexible plastic film be applied. The structuring is preferably carried out by photolithographic processes through which very fine structures can be etched. On In certain places, the thickness and / or width of the metal strips is reduced.

This creates an increase in the electrical resistance locally, thereby when the current flows, the area reduced in width and / or thickness is heated.

Instead of reducing the thickness and / or width of the metal layer another, less conductive material can be used. It can a metal with a higher specific resistance or also act amorphous or polycrystalline silicon, its specific resistance can be adjusted by doping.

The metal tracks are either isolated by a layer of lacquer or another film, so that electrical excitation of the tissue is prevented. As explained in connection with FIG. 5 below, an electronic circuit integrated on a silicon chip is preferably integrated on the plastic film. The electronic circuit preferably realizes a multiplexer, but can also comprise a central processing device and a memory.

Various cordless interfaces can be provided in preferred embodiments of this invention. This is particularly advantageous when the housing of the neurostimulator 1 is implanted in the patient's body so that it is difficult to access. In one embodiment, an antenna 10 is provided, via which the electrical circuit 4 can send and receive data.

The antenna 10 can for example be designed as a dipole antenna, the wires forming the dipole being implanted as close as possible under the skin in order to keep the patient's exposure to radio frequency as low as possible. An implantation just under the skin means that the radio frequency is only weakly absorbed by the body, so that low-power transmission and good reception are guaranteed.

In a further embodiment, the antenna 10 can be designed as a ring antenna. The near field of a ring antenna mainly consists of a magnetic field. This affects nerves less than an electrical near field, since the information transfer in nerve cells is mainly due to electrical potential differences.

In another embodiment, the electronic circuit 4 can transmit data via light-emitting diode (LED) 8 and receive it via photodiode 9 . If only the sending or receiving of data is required, only the light-emitting diode or the photodiode can be provided. Human skin and human muscle tissue only weakly absorb red and especially infrared light, so that both the light-emitting diode and the photodiode can be implanted under the skin (subcutaneously). Instead of a light-emitting diode 8 , a laser diode can also be used. A laser diode has the advantage that it provides a higher light intensity, so that the reception of the light signals is easier.

Furthermore, the data exchange between circuit 4 and the environment can take place capacitively or acoustically.

One or more sensors can also be connected to the neurostimulator. One or more sensor electrodes 11 can serve as sensors. In Fig. 1, two sensing electrodes 11 are shown as an example, similar to the application electrodes 3 out mechanically through a cannula 40 and electrically shielded. With the sensor electrodes, electrical signals can be tapped at different parts of the body. In particular, EEG and EMG signals can be measured. It is also possible to measure EOG and EKG signals via sensor electrodes 11 . Finally, electrical signals can be tapped from the equilibrium organ by sensor electrodes 11 and / or the equilibrium organ can preferably be stimulated by application electrodes 3, for example from carbon electrodes arranged behind the ears. This enables therapy if the part of the brain responsible for the equilibrium organ has been damaged, for example, by a stroke.

Furthermore, a microphone 12 can be connected to the neurostimulator 1 as a further sensor. The microphone can be used, for example, to evaluate noises from the patient's body. This includes blood flow noises such as the rustling or pulsing of the blood and breathing noises. In another embodiment, the microphone 12 can pick up external noise that provides additional information about the patient's surroundings. In a further embodiment, the patient can transmit commands to the neurostimulator 1 by voice. This can be particularly advantageous for functional stimulation, i.e. the stimulation of muscles or nerves that lead directly to muscles, because the patient can verbally explain what he wants to do and the stimulator ensures that the patient's body behaves accordingly ,

In addition, electrochemical sensors can be provided which Measure blood or lymphatic composition. In particular with diabetes Patients' blood sugar levels can be determined.

Furthermore, initial sensors, that is to say acceleration sensors (accelerometers) 14 or rotation rate sensors, such as a gyroscope 15 , can be provided. These sensors can monitor the movement of the patient, including the movement of his limbs. If the initial sensors detect the movement of the trunk and limbs of the patient with sufficient accuracy, it is possible to filter out signals about the tremor of the patient or a fall of the patient from the signals of the initial sensors. However, the difficulty arises here in distinguishing desired accelerations and rotations, which arise, for example, when the patient is walking, from tremor or a fall. For this purpose, frequency analysis of the sensor signals can be used, for example. In order to avoid a fall, functional electro-stimulation of muscles is recommended.

The detection of body movements can not only be done with initial sensors, but in addition to or instead of initial sensors with goniometers respectively. A goniometer is a device used to measure connected angles. So can, for example, use a goniometer to measure the angle between the right Upper arm and upper body of the patient are measured. By Frequency filtering and other analyzer methods can also be used Goniometer signals of the tremor or a rowing or support movement or after a fall of the patient. Furthermore, at functional stimulation are monitored to what extent the stimulation of a Muscle causes movement, and stimulation over it Feedback can be controlled.

In a further embodiment, the pressure of at least one foot of the Patients measured against the floor. This can be done, for example, by Piezoelectric or piezoresistive shoe inserts are made. It has turned out that the signals of such shoe insoles are particularly special well suited to measure the equilibrium state of Parkinson's Identify patients. Furthermore, the rigidity of Parkinson's patients can be determined by evaluating such signals.

Piezoelectric or resistive shoe inserts help to distribute the pressure measured over one or both soles of the feet depending on the location. In a Embodiment, such an insert can consist of four piezo sensors, above which a fixed platform is attached, on which the patient can rest with a Foot supports.

The electrical circuit 4 essentially consists of one or more analog-digital converters 7 , which digitize the signal or signals supplied by one or more sensors, a central processing unit 5 and one or more digital-analog converters 6 , which apply the application electrodes 3 float. The central processing unit 5 comprises a processor and a storage unit. It evaluates the available transmission signals, for example by frequency filtering, and determines, for example, a tremor signal. If the tremor signal is too high, the central processing unit 5 varies the stimulation of one or more application electrodes or application devices accordingly. Depending on the region of the brain in which an application electrode or device has been implanted, the stimulation must be increased or decreased, for example in order to reduce the tremor of the patient. For example, it is known that the neurons of the basal ganglia have an inhibitory effect, so that excitation of the basal ganglia leads to less activity of the thalamus and the motor cortex fields. If an application electrode were implanted in one of the basal ganglia, it can be expected that the stimulation of this electrode must be increased in order to reduce the tremor.

In a further embodiment of the invention, the central processing unit 5 can filter out various tremor signals from the sensor signals. In this way, application electrodes 3 implanted in different brain regions can be controlled in accordance with the different tremor signals, and specific brain regions can thus be selectively more or less stimulated. Thereby a more targeted therapy is possible.

In addition, changeover switches can be provided in the electronic circuit 4 in order to read out a larger number of sensors with a small number of analog-digital converters. If the sensor signal of a sensor changes slowly compared to a possible switching frequency, which is usually the case with electrochemical sensors, then several sensors can be read out in a multiplex process. Furthermore, different operating modes of the central processing unit can be defined, each operating mode determining the reading out of certain sensors. Each operating mode can be assigned to a patient's condition. For example, a first operating mode can be set when the patient is awake and a second operating mode can be set when the patient is sleeping. In other embodiments, this rough classification can be refined further.

The patient's condition can be determined on the basis of a suitable analysis of the sensor signals. A microphone can be used to distinguish between the two patient states. In a similar manner, a switchover device can be provided between the digital-to-analog converters 6 and the electrical lines to the application electrodes 3 . Since, in a preferred embodiment, an application electrode is excited with pulses, between which there is no excitation for a relatively long time compared to the pulse width, a digital-to-analog converter can control a plurality of application electrodes in a time-division multiplex process, that is to say one after the other. If a large number of electrodes are present, for example in the case of a network electrode 50 , the electrodes can be selected by means of such a switching device, which electrodes have a great therapeutic effect due to their particularly intimate coupling to important nerve cells.

Sensor signals and / or trend data of the sensor signals (cf. 101 16 361.4) can also be stored in the memory unit of the central processing unit 5 . Trend data is data determined from the sensor signals, the information content of which has been reduced by 2 to 5 orders of magnitude compared to the sensor signals themselves. In addition, times of occurrence of symptoms or abnormalities could be saved. For diagnosis, they can be transmitted to a control unit, which is described below.

If the neurostimulator 1 is equipped with antenna 10 and can receive data via antenna 10 , sensor data can also be transmitted wirelessly via antenna 10 to the neurostimulator. For therapy monitoring, the existing sensors can therefore be supplemented by further sensors, as described in the German patent application with the official file number 101 16 361.4.

The use of the Bluetooth standard for such an application is Particularly advantageous because each radio module has a unique number here is assigned, so that the interaction of several devices simplified, as described in Application No. 101 16 361.4.

Battery 23 serves as the energy source for electronic circuit 4 . A lithium battery is predestined for this due to its long service life. In another embodiment, however, electrical energy can also be generated on the basis of substances present in the body, so that a battery is not required. Alternatively, a rechargeable battery, such as a lithium ion battery, can be used. Charging can take place via a coil which is preferably implanted in the body close to the skin. A ring antenna described above can also be used for energy transmission. Due to the low absorption of the skin in the red and especially in the infrared spectral range, a suitable solar cell can also be implanted to charge the battery.

In principle, all parts shown in FIG. 1 can be implanted in the patient's body. Instead of the piezoelectric shoe inserts, smaller piezoelectric or resistive sensors can be implanted in the soles of the patient's feet. However, it is only necessary for the stimulation devices, in particular the application electrodes, to be implanted in the correct parts of the nerve tissue, in particular the brain. For all other parts, practicality considerations can be made for or against an implantation.

Piezo buzzers and LEDs are used to control the operation of the neurostimulator and to warn the patient of critical conditions. If the neurostimulator 1 is not implanted in the patient's body, it can consist, for example, of a transparent housing in which various LEDs, including a red and a piezo buzzer, are accommodated. Furthermore, controls such. B. an on-off switch may be provided.

Fig. 2 shows an embodiment of a neurostimulator which is supplied via supply and communication line 16 with power. A supply of electrical energy via electrical lines is particularly advantageous when the electronic circuit 4 controls a relatively large number of application electrodes 3 , which leads to high energy consumption. The electronic circuit 4 in Fig. 2 includes, as the electronic circuit 4 in Fig. 1 is preferably analog-to-digital converter 7, a central processing unit 5 as well as digital-to-analog converter 6.

In this embodiment, the stimulation device and the electronic circuit 4 together with the housing are preferably implanted in the patient's body. In such an embodiment, the supply line 16 can also be used for communication. The energy supply takes place in the low-frequency part of the signal on line 16 and the data communication in the higher-frequency part.

Coil 21 and capacitor 22 are provided in electronic circuit 4 in order to screen out the high-frequency AC voltage component from the voltage supplied by line 16 in order to supply DC circuit 4 with a DC voltage that is as constant as possible. The data coded by the drive 19 are modulated onto the voltage on line 16 via capacitor 20 . The driver acts as a transmitter. The AC voltage component, which contains the data sent to the neurostimulator, is filtered out with capacitor 18 and digitized by the analog-digital converter 17 . The analog-digital converter acts as a receiver.

Data can be sent and received using time division multiplexing, so that data can either be sent or received at one point in time. On the other hand, the data sent are known in the electronic circuit, so that they can be calculated out of the signal received by the analog-digital converter. In this way, simultaneous sending and receiving is possible. In another embodiment, the data to be sent and received can be modulated by the electronic circuit 4 or a remote station to different carrier frequencies and thus differentiated on the basis of the different carrier frequencies. In this embodiment, capacitors 18 and 20 are replaced by bandpass filters.

In a further embodiment, the coil 21 can be replaced by a resistor, which usually has a smaller design. If the data is coded in binary form so that a zero corresponds to a somewhat lower and one to a somewhat higher voltage, the analog-digital converter 17 can also be replaced by a comparator. At the open drawn in Fig. 2 the end of the line 16, a similar circuit is provided, as shown schematically in the electronic circuit 4 in Fig. 2. However, the capacitor 22 is replaced by a battery as an energy source.

In a further embodiment, the supply and communication line 16 can comprise more than two conductors. If the supply and communication line comprises three conductors, two conductors are preferably used for energy supply and the third conductor for data communication. The transmission and reception of data is preferably carried out using time division multiplexing. In this embodiment, coil 21 and capacitors 18 and 20 can be omitted. The capacitor 22 can either be omitted or - if it is necessary for filtering interference on the supply voltage generated by the central processing unit 5 or by the DA converter 6 - can be at least reduced in capacity and thus in size.

The supply and communication line 16 can also comprise four conductors, in which case two conductors are used for the energy supply, one conductor for transmitting data and one conductor for receiving data through the electronic circuit 4 . Additional conductors can be provided for the transmission of synchronization signals.

In a further preferred embodiment, the electronic circuit 4 can contain only a multiplexer instead of a central processing unit 5 and analog-digital converters 7 . In this embodiment, the supply and communication line preferably contains three conductors, namely two for energy transmission and one for data transmission to the multiplexer. In this embodiment, a large number of 20 to 50 or more electrodes, in the vicinity of which the electronic circuit 4 including the housing is implanted, can be controlled by a handy, ie thin and flexible line 16 . A CAN bus (CAN: Controller Area Network) can also be used advantageously for data transmission via line 16 . The CAN bus was developed for the automotive industry and is used there. Due to the large numbers, CAN bus controllers are relatively cheap to buy.

Fig. 3 shows the preferred embodiment of a control device according to the invention for the inventive neurostimulators 24th In the preferred embodiment, the heart of the control unit is a computer, preferably a laptop. The laptop is equipped with a suitable interface for data communication with one or more neurostimulators.

This can be a radio module for the Bluetooth standard, for example, which is indicated by antenna 25 . The interface can also be formed by communication line 16 . A suitable software runs on the laptop, the essential properties of which are explained with reference to FIGS. 6 to 9. When using the Bluetooth standard for communication between neurostimulators and control devices, several control devices can monitor one neurostimulator or one control device can also monitor several neurostimulators, as described in application no. 101 16 361.4 in connection with CPAP devices. This application is incorporated by reference for all purposes.

The control unit can also be used to monitor the patient in his home be used. In this case, it is preferably connected via a modem connected to a hospital or medical supply store, so that the control unit can automatically make an emergency call (see 101 16 361.4).

The control unit can also be equipped with software for diagnosis his. This diagnostic software can either only evaluate the data from the Stimulator can currently be measured or that in the stimulator Include recorded data, if available. in the the latter case, the diagnosis quality is improved because the doctor makes his diagnosis due to a much larger database. The stimulator can monitor the patient around the clock.

In a further embodiment, the interface between the neurostimulator and the control device can be an optical interface, in particular an infrared interface. For this reason, light-emitting diode 26 and photodiode 27 are shown schematically in FIG. 3. Nowadays most laptops are equipped with infrared interfaces. However, the light generated by the light emitting diode 26 must at least partially strike the photodiode 9 . The same applies to light emitting diode 8 and photo diode 27 . Therefore, light emitting diode 8 and photodiode 27 as well as light emitting diode 26 and photodiode 9 must be arranged in spatial proximity and aligned with one another. It is therefore advantageous if the LED 26 and the photodiode 27 are mounted in an external housing and are connected to the laptop, for example, via cables. The external housing can thus be optimally arranged in relation to the patient-side light-emitting diode 8 and the patient-side photodiode 9 independently of the laptop. The laptop can be placed where it can be conveniently operated.

As mentioned above, data transmission can also be magnetic or acoustic coupling.

Fig. 4 discloses a brush electrode as an embodiment of an application device 2. Here, a cannula 40 is implanted in the patient's body so that the end 46 of the cannula to be implanted is in or in the vicinity of nerve tissue to be stimulated. In most cases, the aim is to stimulate certain brain regions. Therefore, the skull 44 and scalp 45 were drawn in for illustration purposes. Insulated wires are pushed through the cannula 40 into the nerve tissue to be stimulated. The wires 41 are insulated from one another, but have stripped ends that form the application electrodes 44 .

In order to achieve a capacitive coupling, the application electrodes 44 can also be covered with thin insulation. In particular, this insulation should be thinner than the insulation of the wires in the cannula 40 , so that on the one hand a locally limited area of the nerve tissue is excited and on the other hand the crosstalk between the individual wires is kept acceptably low.

Since the application electrodes are insulated from one another, they can be controlled individually as electrodes by the electronic circuit 4 of a neurostimulator 1 . In a preferred embodiment, the cannula 40 is made of metal, that is to say an electrically conductive material. Therefore, it can also be controlled by the electronic circuit 4 and preferably used as a ground electrode. The leading end 47 of the cannula 40 can actually lead out of the scalp or lead in the scalp to an implanted neurostimulator, to the electronic circuit 4 of which the wires 41 are connected. In a further embodiment, the cannula 40 and wires 41 can be guided along a distance in the scalp in order to be led out of the scalp at a location that is not subjected to a great deal of mechanical stress and to be connected to a neurostimulator worn on the body.

Furthermore, the wires 41 can be combined at any point, preferably close to the application electrodes 44 or close to the cranial bone 44 , with a multiplexer to form a supply and communication line 16 .

The sensor electrodes 11 can also be designed as a brush electrode. Here, however, the wires 41 are connected to analog-to-digital converters 7 instead of to digital-to-analog converters 6 .

A further embodiment of the stimulation device 2 is represented by the network electrode 50 shown in FIG. 5. Here, a large number of electrodes 51 are arranged on an electrically non-conductive support 52 , which is preferably made of a plastic that is compatible with tissue. Carrier 52 also includes wires for connection between the individual electrodes and an integrated circuit 52 .

In order to keep the connecting wires between the individual electrodes 51 and the integrated circuit 52 as short as possible, the integrated circuit is integrated into the network electrode. This means that the integrated circuit is arranged in the immediate vicinity of the network electrode. The integrated circuit has bond points for contacting the integrated circuit with the network electrode. Corresponding bond points are provided on the carrier 52 of the network electrode. In a preferred embodiment, the bond points on the integrated circuit and the corresponding bond points on the carrier 52 are connected by electrically conductive epoxy resin adhesives. In another embodiment, the corresponding bond points are soldered.

The mesh electrode is placed directly on the cortex (the Brain). Alternatively, it can also affect the thalamus or parts of the Basal ganglia are placed, insofar as these are made operationally accessible can.

The carrier of the mesh electrode is elastic and has approximately the shape of the brain part to which it is to contact. Due to the large number of individual electrodes, a network electrode ensures relatively high power consumption. Therefore, the integrated circuit is preferably connected via a supply and communication line to an energy source located outside the body, as was explained in connection with FIG. 2. The integrated circuit thus works as a multiplexer. However, it can also have a central processing unit 5 , so that it can also perform logically more complicated processes than multiplexing.

In order to expand the field of application of the neurostimulators according to the invention, it is advantageous to create the possibility of experimenting with different pulse sequences. For this purpose, the central processing unit 5 of the electrical circuit of the neurostimulator must be suitably programmed and the data for a pulse sequence must be stored in a suitable manner in the memory of the central processing unit 5 . The pulse sequence is typically input via a control device shown in FIG. 3. The software of the control device and that of the neurostimulator preferably uses similar data structures in order to effectively store a pulse train, ie in the smallest possible memory area.

To display the programmed pulse sequence, the shape of the programmed pulses 62 is preferably displayed on a monitor or a display of the control unit. The timeline runs from left to right. A period duration for periodic signals and the frequency corresponding to the period duration are preferably entered on it. The period is preferably in the range from 5 ms to 200 s, which corresponds to a frequency of 0.01 Hz to 200 Hz. The pulse height is plotted on the Y axis either as voltage or as current. The aim is to generate pulse heights of ± 250 mV in nerve tissue. In the case of capacitive coupling in particular, the voltages to be output by the electrical circuit 4 can be much higher and can reach up to approximately ± 20 V.

A period begins with a pulse when working with a pair of electrodes. A large number of further pulses can be programmed thereon, the number of which is limited only by the memory available in the neurostimulator. The memory available in the control unit also limits the number of pulses, but the control unit has memory that is several orders of magnitude larger, so this is not the limiting factor. Periodic and non-periodic pulse sequences can be used for stimulation. The data structures shown in FIG. 7 are preferably used for this. These can also advantageously be implemented in an object-oriented programming language, such as C ++.

Each of the data structures 70 to 78 has a field labeled "Type:". This contains a unique identifier for the data structure - without the letters "Type:". However, the identifier need not be unique in itself. Rather, the uniqueness can only arise if, for example, the location at which the data structure is located in the memory or the location at which a reference to this data structure is located is added.

The data structure 70 with the identifier 0 and the data structure 78 with the identifier 3 are provided for the description of a pulse sequence. The data structures 71 to 74 with the identifiers 0 to 3 are only provided for the description of further pulses, that is to say with the exception of the first pulse in connection with the data structure 70 .

In the preferred embodiment, the data structure 70 has a storage location for the frequency or the period, for the pulse height, for the pulse width, for a reference to further data structures and for a reference to the shape of the pulse. The frequency results as a reverse break from the pulse duration, so that either one or the other value can be saved. The frequency or pulse duration, pulse height and pulse width do not need to be saved as SI units. Rather, they can be scaled in a suitable manner, that is to say multiplied by a factor, so that their values only comprise a small memory area, such as 1 or 2 bytes. With regard to the lower limit of the frequency range of 0.01 Hz, the frequency can be stored in units of 0.01 Hz. To save memory, a function value, such as the logarithm of frequency, pulse duration or pulse height, can also be stored.

The reference "more?" may contain a reference to one of the data structures 71 to 76 . It should be noted here that the identifiers 0 to 5 clearly indicate a data structure at this point, since references to the data structures 70 and 78 are not provided.

The data structures 71 to 74 describe further rectangular pulses within a pulse cycle. Another rectangular pulse is described by its start time, its pulse height and its pulse width. However, all of this information can only be given in the data structure 74 . The missing information in the data structures 71 to 73 is supplemented by the corresponding information in the data structure 70 , so that the pulse height and the pulse width in the data structure 70 have the meaning of a standard pulse height and a standard pulse width. The data structures 71 to 76 each have a field with the designation “further?” In which a further reference to one of the data structures 71 to 76 can be stored. In this way, an arbitrarily long chain of pulses can be generated.

The "further?" Field of the data structure that describes the last impulse contains a value known to not apply to another data structure points. This value is referred to as NULL in some programming languages and preferably has the value 0.

The data structures 75 and 76 are provided for the description of non-rectangular pulses. Signals that are naturally generated by nerves are preferably used. Such signals are non-linear, multi-phase, ie containing several phases and spike-like. Both data structures 75 and 76 contain the "start time" field. As in data structures 71 to 74, it indicates the time at which the pulse begins. In the "Duration" field of the data structure 75 , the length of the pulse is specified in seconds or any other unit. The course of the pulse is indicated by pulse code modulation. The pulse is composed of n sub-pulses. The value n is given in the next field "Number of partial pulses". In the next n fields, n heights are then given for the respective pulse height of the partial pulses. In another data structure, instead of the duration of the pulse, the duration of the partial pulses or the reciprocal of the duration of the pulse or partial pulses can also be specified in the "Duration" field.

The data structure 76 is constructed similarly to the data structure 75 . However, the reciprocal of the duration of a partial pulse is specified in the "sampling frequency" field. In addition, the number of partial pulses is not specified. Rather, a special height, preferably the largest or lowest height or the height 0, is excluded as the pulse height of the partial pulses. This particular height completes the list of pulse heights.

In another preferred embodiment, the number of partial pulses is preferably set to 100 or 1000. In this embodiment, the "number of partial pulses" field in data structure 75 and the "special height" field in data structure 76 are omitted.

Finally, in the data structure 70 there is a "Form?" intended. It can contain a reference to data structure 75 or 76 . If it contains such a reference, it is not the "pulse height" and "pulse width" fields of the data structure 70 that determine the shape of the corresponding pulse, but rather the data structures 75 and 76 . The field 'shape?' contains the value NULL to indicate that it contains no reference to another data structure.

The data structure 78 is provided in order to define a random pulse sequence with a few parameters. Here, the average frequency of the impulses or the reverse break thereof, namely the mean, time interval between the beginning of the impulses, is determined in the field "average frequency". The actual distance between the start of the pulses is determined by a random function, which can be based, for example, on the evaluation of white noise. However, strict randomness is usually not necessary, so that the random function can also be based on mathematical series that only produce seemingly random values. A further data structure similar to the data structure 78 can be provided, which additionally defines a lower limit and / or an upper limit for the distance between the start of the pulses. If the random function returns an unsuitable value, this value is discarded and another value is generated by the random function instead. The meaning of the fields "pulse height", "pulse width" and "shape?" corresponds to that of the respective fields in the data structure 70 .

The data structure 70 can be entered, for example, using an input dialog 80 or a similar input dialog. In the input fields to the right of the words "repetition frequency", "pulse width" and "pulse height", values for the fields "frequency", "pulse height" and "pulse width" of the data structure 70 can be entered. The buttons labeled "Import", "OK, others", "OK, end" and "Cancel" can be clicked. When you click on "Import", a usual file dialog opens, with which, for example, a wave file (* .wav) can be imported and read into one of the data structures 75 or 76 . A reference to the latter data structure is entered in the "Form?" Field when the input dialog 80 is closed. entered.

By clicking the "Cancel" button, the input dialog 80 is closed without the entered values being saved in a data structure 70 . If the "OK, end" button is clicked, the input dialog is closed and the entered parameters are saved in the corresponding fields of a data structure 70 . These steps are also carried out when the "OK, further" button is clicked. In addition, a new input dialog is opened. It is used to enter one of the data structures 70 to 74 and preferably differs from the input dialog 80 in that the word "repetition frequency" is replaced by "start time".

If no pulse width or the same pulse width as in the data structure 70 is entered in this input dialog, one of the data structures 72 or 73 is preferably created when this input dialog is closed. If no pulse height or the identical pulse height as in the data structure 70 is entered, one of the data structures 71 or 72 is preferably created. If a pulse shape is read in via the "Import" button, one of the data structures 75 or 76 is created instead of the data structures 71 or 74 when the dialog is closed.

With this operation, the operator is not forced to Enter impulses in their chronological order. It will therefore preferably a sorting function is provided in the control device, which the Data structures sorted in such a way that a reference in the field "further?" one Data structure points to a data structure with a later start time. On the neurostimulator does not become this way when evaluating the data structures forced after each pulse the remaining list after the next Search impulse. Before the sorting step, it is checked whether the The starting times of the pulses are still within a period. Became a longer than the period specified, the The period is deducted until the start time is between 0 and the period. This can be done through a module function will be realized.

If two impulses overlap, the impulse height of the impulse is equal to issued later starting time. In another embodiment, in Overlap area adds the pulse heights of the overlapping pulses. However, this requires higher computing power, which in turn leads to a leads to higher power consumption.

Instead of the data structure 70 , a pulse sequence can also only be defined by a data structure 75 or a data structure 76 . The duration specified in data structure 75 corresponds to the period. The period duration in data structure 76 results from the number of partial pulses divided by the sampling frequency. If a constant number of partial pulses or support points is to be used here, a number of 1000 is preferred.

If the control device is to control a plurality of electrodes via a neurostimulator, the data structure 70 is supplemented by a “start time” field. The first pulse then no longer begins at the beginning of a pulse period, but at the beginning. In this way, pulse sequences with a different phase position can be defined for several electrodes. A data structure 70 or 78 is created for each pulse sequence. A selection of the periodic data structures can preferably be shown on the display of the control device 24 . The individual pulse sequences are shown in height-offset diagrams with a common time axis and / or in different colors. A function is provided to compress and stretch all or selected pulse sequences in height and / or on the time axis.

The input dialog 80 can be opened by clicking on a menu item of a drop-down menu 91 , the drop-down menu being opened upon selection of a menu item in a menu bar 91 .

The data structures 70 to 78 are also used to transmit the information about the pulses to be generated from the control device to the neurostimulator. When programming the control unit, a reference is implemented, preferably by means of a pointer or also by a handle.

A pointer specifies a fixed address in the working memory while a Handle (German: Griff) an identifier for a movable Represents memory area. When transferring data from the control unit to Neurostimulator, the reference preferably indicates the amount of data that between the beginning of the reference and the data packet with the Data structure to which the reference points. The amount of data is included preferably specified in bits, bytes or integer multiples thereof.

The invention was previously explained in more detail on the basis of preferred exemplary embodiments. However, it will be apparent to those skilled in the art that various changes and modifications can be made without departing from the spirit of the invention. Therefore, the scope of protection is determined by the following claims and their equivalents. LIST OF REFERENCES 1 neurostimulator
2 application device
3 application electrodes
4 electronic circuit
5 central processing unit
6 digital-to-analog converters
7 analog-to-digital converters
8 light emitting diode (LED)
9 photodiode
10 antenna
11 sensor electrodes
12 microphone
13 piezoresistive shoe inserts
14 acceleration sensor
15 gyroscope
16 Supply and communication line
17 analog-to-digital converters
18 capacitor
19 drivers
20 capacitor
21 coil
22 capacitor
23 battery
24 laptop
25 antenna
26 light emitting diode (LED)
27 photodiode
40 cannula
41 wires
43 nerve tissue
44 application electrodes
45 scalp
46 end to be implanted
47 leading end
50 mesh electrode
51 electrodes
52 carriers
53 contact points
54 integrated circuit
60 time analysis
61 tension axis
62 impulse
70-78 data structures
80 Entry dialog
90 menu bar
91 drop-down menu

Claims (33)

1. Neurostimulator ( 1 ) with:
an application device ( 2 ) which comprises at least one application electrode ( 3 ), and
an electronic circuit ( 4 ),
characterized in that
the application device is a brush electrode consisting of a cannula ( 40 ) and wires ( 41 ), the cannula ( 40 ) being at least partially implantable in a patient's body and an end ( 46 ) to be implanted and an end leading out of the body ( 47 ), the wires being able to be pushed beyond the end of the cannula to be implanted into the nerve tissue to be stimulated and the tissue-side end of the wires forming application electrodes, the wires in the cannula being insulated from one another so that the electronic circuitry connects each wire can supply different electrical signal. 2. Neurostimulator according to claim 1, characterized in that the cannula ( 40 ) consists of an electrically conductive material and is connected to the electronic circuit ( 4 ) and can be used as an additional application electrode. 3. Neurostimulator with:
an application device ( 2 ) and
an electronic circuit ( 4 , 54 ),
characterized in that
the application device consists of a network electrode ( 50 ), the network electrode being flat and having a large number of individual application electrodes ( 51 ) which are insulated from one another and can thus be controlled separately from the electrical circuit ( 4 , 54 ) and which are electrically connected to the electrical circuit , 4. Neurostimulator according to claim 3, characterized in that the electronic circuit ( 4 , 54 ) in the network electrode ( 50 ) is integrated. 5. Neurostimulator according to claim 4, characterized in that the electronic circuit can be connected via wires ( 16 ) to an energy source outside the body and can be supplied with energy from the energy source. 6. Neurostimulator according to claim 5, characterized in that the electronic circuit has a transmitter ( 19 ) and / or receiver ( 17 ) so that it can also send or receive data via the wires ( 16 ) to the energy source. 7. Neurostimulator with:
an application device ( 2 ) which comprises at least one application electrode ( 3 ), and
an electronic circuit ( 4 ) which controls the application electrode ( 3 ) of the application device with electrical signals,
characterized in that the electrode of the application device is determined and is suitable for stimulating the balance organ. 8. Neurostimulator with:
an application device ( 2 ) which comprises at least one application electrode ( 3 ), and
an electronic circuit ( 4 ) which supplies electrical signals to the electrode ( 3 ) of the application device, receives signals from a sensor ( 11 , 12 , 13 , 14 , 15 ) and controls the electrical signals as a function of the sensor signals,
characterized in that the sensor is determined and suitable for measuring EMG signals or EEG signals. 9. Neurostimulator with:
an application device ( 2 ) comprising at least one electrode ( 3 ), and
an electronic circuit ( 4 ) which supplies electrical signals to the electrode ( 3 ) of the application device, receives signals from a sensor ( 11 , 12 , 13 , 14 , 15 ) and controls the electrical signals as a function of the sensor signals,
characterized in that the sensor is a microphone ( 12 ). 10. Neurostimulator with:
an application device ( 2 ) comprising at least one electrode ( 3 ), and
an electronic circuit ( 4 ) which supplies electrical signals to the electrode ( 3 ) of the application device, receives signals from a sensor ( 11 , 12 , 13 , 14 , 15 ) and controls the electrical signals as a function of the sensor signals,
characterized in that the sensor is suitable for tapping electrical signals at the equilibrium organ by means of implanted electrodes ( 11 ). 11. Neurostimulator with:
an application device ( 2 ) comprising at least one electrode ( 3 ), and
an electronic circuit ( 4 ) which supplies electrical signals to the electrode ( 3 ) of the application device, receives signals from a sensor ( 11 , 12 , 13 , 14 , 15 ) and controls the electrical signals as a function of the sensor signals,
characterized in that the sensor ( 13 ) picks up a signal which can be in a monotonous relationship with the force which is transmitted to the ground via the feet of a patient. 12. Neurostimulator according to claim 11, characterized in that the force is measured by piezoelectric or piezoresistive shoe inserts ( 13 ). 13. Neurostimulator with:
an application device ( 2 ) comprising at least one electrode ( 3 ), and
an electronic circuit ( 4 ) which supplies electrical signals to the electrode ( 3 ) of the application device, receives signals from a sensor ( 11 , 12 , 13 , 14 , 15 ) and controls the electrical signals as a function of the sensor signals,
characterized in that the sensor is a goniometer, an acceleration sensor ( 14 ) or a rotation rate sensor ( 15 ). 14. Neurostimulator according to claim 13, characterized in that the sensor is a gyroscope ( 15 ). 15. Neurostimulator according to one of the above claims, characterized in that the electrical circuit receives control commands via a radio link ( 10 , 25 ), the radio link working according to the Bluetooth standard. 16. Neurostimulator according to claim 15, characterized in that the Antenna for the radio connection as close as possible to the body surface, however under the skin. 17. Neurostimulator according to one of the above claims, characterized in that the electronic circuit receives control commands via an optical interface ( 9 , 26 ), preferably an infrared interface. 18. Neurostimulator according to one of claims 8 to 14 and 15 to 17, insofar as they refer to claims 8 to 14, characterized in that the neurostimulator has a transmitting device for transmitting measured sensor data via radio ( 10 , 25 ) or light ( 8 , 27 ), preferably infrared. 19. Neurostimulator according to one of claims 1 to 7 and claim 18, characterized in that the electrical circuit has an operating mode in which a part of the application electrodes ( 3 ) is used as sensor electrodes. 20. Neurostimulator ( 1 ) with:
an application device ( 2 ) which comprises at least one application electrode ( 3 ), and
an electronic circuit ( 4 ),
characterized in that the electronic circuit ( 4 ) comprises a processor ( 5 ) and a memory ( 5 ), wherein a signal curve with more than one pulse per period can be stored in the memory and this signal curve can also be output via the electrode. 21. Neurostimulator ( 1 ) with:
an application device ( 2 ) which comprises at least one application electrode ( 3 ), and
an electronic circuit ( 4 ),
characterized in that the electronic circuit comprises a processor ( 5 ) and a memory ( 5 ), wherein information about an aperiodic signal curve with a large number of pulses can be stored in the memory. 22. Neurostimulator, characterized in that it is characterized by mechanical Coupling, magnetic coupling, chemical coupling or thermal coupling creates a stimulus. 23. Control device ( 24 ) for a neurostimulator ( 1 ) with:
a memory,
a processor, and
an interface ( 10 , 25 , 9 , 26 ) to the neurostimulator, characterized by
an input device ( 70-76 , 80 , 90 ) with which a periodic signal curve with more than one pulse per period can be input. 24. Control unit according to claim 23, characterized in that program sections are stored in the memory in order to store a data structure ( 70 ) in the memory of the control unit, the data representing the period of the periodic signal, a standard pulse width which is equal to the pulse width of the first pulse Standard pulse height, which is equal to the pulse height of the first pulse, and contains a memory space for a reference to a further data structure, the period of the standard pulse width and height and the reference can be entered by an input device. 25. Control device according to claim 23 or 24, characterized in that program steps are stored in the memory of the control device in order to store a data structure ( 71-74 ) in the memory which contains the starting time for the beginning of a pulse after the beginning of a period, the pulse duration of the pulse, the pulse height and / or a storage space for a reference to a further data structure. 26. Control device ( 24 ) for a neurostimulator ( 1 ) with:
a memory,
a processor,
an interface ( 10 , 25 , 9 , 26 ) to the neurostimulator, characterized by
an input device ( 78 , 90 , 91 ) with which an aperiodic signal curve can be input. 27. Control device according to claim 26, characterized in that the aperiodic signal curve is determined by an average frequency of the pulses, the pulse height and the pulse width, wherein the parameters can be entered by the input device and are stored in a data structure ( 78 ). 28. Control device according to one of claims 24 or 25 thereby characterized in that the data structures also have a storage space include, in which a reference to another data structure is stored can be the data on the shape of the corresponding pulse contains. 29. Control device according to one of claims 24, 27 or 28, characterized characterized that via the interface to the neurostimulator stored data structures are transferred. 30. Data transmission method from a control device ( 24 ) to a neurostimulator ( 1 ) with the steps:
Transmission of the period duration or a corresponding frequency,
Transfer of data defining a standard pulse shape, such as the width or height of the pulses, characterized by the step:
Transferring a reference to a data packet that contains information about the start of a further pulse, or transferring the information that no further data packet follows. 31. The method according to claim 30, characterized in that the reference on another data packet indicates the amount of data between the beginning of the reference and the further data packet become. 32. Data transmission method from a control device to a neurostimulator with the step:
Transmitting data ( 78 ) defining an aperiodic pulse shape. 33. The method according to claim 32, characterized in that a medium Pulse frequency is transmitted.