US20050234432A1

US20050234432A1 - Therapeutic treatment of disorders based on timing information

Info

Publication number: US20050234432A1
Application number: US11/093,747
Authority: US
Inventors: Marc Stein
Original assignee: Medtronic Inc
Current assignee: Medtronic Inc
Priority date: 1999-04-30
Filing date: 2005-03-30
Publication date: 2005-10-20
Also published as: US20020038137A1; US6923784B2

Abstract

Techniques for operation of neurostimulation or drug delivery devices to adjust treatment therapy during specific times of the day are disclosed. Advantageously, battery usage and/or drug dosage can be reduced during periods when treatment therapy need not be provided. Furthermore, tolerance of the patient toward the neurostimulation or drug delivery that may develop from the regular application of electrical stimulation or treatment therapy may be reduced or slowed. In one embodiment, a device includes a real time clock for shutting off the device in accordance with a preset schedule. The device can be configured to turn off after the patient has fallen asleep and turns on right before the patient awakes. The device may include a sensor for sensing symptoms related to a disorder being treated and treatment therapy can be adjusted accordingly.

Description

BACKGROUND OF THE INVENTION

The application is a continuation of application Ser. No. 10/000,638, filed on Oct. 31, 2001, which was a divisional of and claimed priority to application Ser. No. 09/303,144, filed Apr. 30, 1999, this application therefore claims priority to both prior applications and both are incorporated in their entirety herein.

FIELD OF THE INVENTION

The present invention relates to neurostimulation or drug infusion devices, and more particularly relates to techniques for activating or deactivating a neurostimulator or drug delivery system based on time-of-day or biological rhythmic patterns.

DESCRIPTION OF RELATED ART

Neurostimulation devices and drug delivery devices are now capable of treating any number of disorders as well as symptoms of disorders. In the context of neurostimulators, an electrical lead having one or more electrodes is typically implanted near a specific site in the brain or spinal cord of a patient. The lead is coupled to a signal generator which delivers electrical energy through the electrodes to nearby neurons and neural tissue. The electrical energy delivered through the electrodes creates an electrical field causing excitation of the nearby neurons to directly or indirectly treat the neurological disorder or a symptom of the disorder. In the context of a drug delivery system, a catheter coupled to a pump is implanted near a treatment site in the brain or spinal cord. These systems are commonly implanted within the body and are operated by a power source such as a battery.
Recent advances have allowed these neurostimulation devices and drug delivery systems to adjust treatment in accordance with the patient's needs. Generally, these systems incorporate a sensor for sensing a physical or chemical characteristic of the body and generating a sensor signal in response. The sensor signal may then be used to adjust the treatment therapy. U.S. Pat. No. 5,716,377, for example, discloses a method of treating movement disorders by closed loop brain stimulation.
These systems, however, provide electrical stimulation or drug delivery regardless of the time of day or the patient's needs. These systems are capable of adjusting the treatment but are incapable of recognizing periods when a patient does not require any therapy. For example, patients often will not require any stimulation or drug therapy during periods when he/she is resting or sleeping. During such time periods, the manifestation of the movement disorder may be minimal or even non-existent. This is often the case for patients suffering from movement disorders and certain types of pain.
Stimulation or drug delivery at times when it is not required by the patient unnecessarily depletes the battery or the drug reserve which is often implanted within the body. This requires more frequent surgical procedures to replace the spent battery or more frequent drug injections. An even greater concern with continuous therapy systems is that the patient may develop a higher tolerance to the treatment, thereby requiring higher dosage or stronger stimulation to achieve the desired result.
Often, physicians will request the patient to turn off his/her neurostimulator at night. This requires the patient or care giver to manually turn the device off at night before falling asleep and turn on the device after waking up the next day. However, after the neurostimulator is turned off but before the patient has fallen asleep, symptoms of movement disorders, illnesses or other maladies (such as tremor) or pain often return, thereby rendering sleep difficult. Accordingly, there remains a need in the art for automatically shutting off the electrical stimulation or drug delivery during periods when the patient does not require treatment therapy.

SUMMARY OF THE INVENTION

As explained in more detail below, the present invention overcomes the above-noted and other shortcomings of the prior art neurostimulation devices. The present invention provides a technique for shutting off the electrical stimulation or drug delivery during periods when the treatment therapy is not desired. In one embodiment, the neurostimulator has a timer or a clock capable of turning on or off the treatment therapy at predetermined times. Accordingly, the system may be automatically turned off at a time when the patient is usually fast asleep and turned on at a time prior to the patient awakening. In the context of a neurostimulation device, the present invention includes an implantable signal generator, a timer coupled to the signal generator for providing timing information to the signal generator, and circuitry (a microprocessor) within the signal generator for determining whether the signal generator is turned off or on in response to the timer information. Timer may alternatively be a real time clock.
In another embodiment, the present invention includes a sensor coupled to the signal generator for generating a signal indicative of whether a patient is asleep or awake. The microprocessor receives time of day information from the timer and information as to whether the patient is awake or asleep from the sensor. Based on these signals, the microprocessor may automatically initiate or stop the treatment therapy to the patient.
The present invention may also be implemented within an implantable drug delivery system in accordance with the principles of the above-described embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other advantages and features of the invention will become apparent upon reading the following detailed description and referring to the accompanying drawings in which like numbers refer to like parts throughout and in which:
FIG. 1 depicts a neurostimulation device in accordance with an embodiment of the present invention;
FIG. 2 is a schematic block diagram of the circuitry of device or signal generator in accordance with a preferred embodiment of the present invention;
FIG. 2A is a schematic block diagram of the circuitry of device or signal generator in accordance with another preferred embodiment of the present invention.
FIG. 3 illustrates a schematic block diagram of another embodiment of signal generator wherein timer is coupled to a power source such as battery of signal generator;
FIG. 4 discloses another embodiment of the present invention wherein a sensor provides feedback as to whether the patient is awake or asleep to determine whether signal generator should be turned on or off;
FIG. 5 illustrates a schematic block diagram of the signal generator of FIG. 2 including a sensor signal input from sensor; and
FIG. 6 depicts a drug infusion system in accordance with an embodiment of the present invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIG. 1 depicts a neurostimulation device 10 in accordance with an embodiment of the present invention. Device 10 made in accordance with the preferred embodiment is preferably implanted below the skin of a patient or, alternatively, may be an external device. Device 10 may be implanted as shown in FIG. 1, in the abdomen or any other portion of the body. A lead 22A is positioned to stimulate a specific site in a brain (B). Device 10 may take the form of a modified signal generator Model 7424 manufactured by Medtronic, Inc. under the trademark Itrel II. Lead 22A may take the form of any of the leads sold with the Model 7424, for stimulating the brain, and is coupled to device 10 by a conventional conductor 22. Alternatively, lead 22A may be any lead suitable for stimulation of a spinal cord. Lead 22A may include a paddle lead, a lead having recording and stimulation electrodes, or a combination catheter/lead capable of providing electrical stimulation and drug delivery.
As shown in FIG. 1, the distal end of lead 22A terminates in one or more stimulation electrodes generally implanted into a portion of the brain by conventional stereotactic surgical techniques. Any number of electrodes may be used for various applications. Each of the electrodes is individually connected to device 10 through lead 22A and conductor 22. Lead 22A is surgically implanted through a hole in the skull and conductor 22 is implanted between the skull and the scalp. Conductor 22 is joined to implanted device 10 in the manner shown.
Conductor 22 may be divided into twin leads 22A and 22B that are implanted into the brain bilaterally as shown. Alternatively, lead 22B may be supplied with stimulating pulses from a separate conductor and signal generator. Leads 22A and 22B could be two electrodes in 1) two separate nuclei that potentiate each other's effects or 2) nuclei with opposite effects with the stimulation being used to fine tune the response through the application of one stimulation pattern to one cite and the application of another stimulation pattern to the other cite.
FIG. 2 is a schematic block diagram of the circuitry of device or signal generator 10 in accordance with a preferred embodiment of the present invention. As preferred, signal generator 10 includes a timer 201 coupled to a microprocessor or a controller 200. Timer 201 establishes when the system is “on” or “off.” in accordance with predetermined counts of timer 201. The operator or patient may calibrate timer 201 such that signal generator 10 is “on” at a specific time in the morning right before the patient usually wakes up and is “off” at a specific time in the evening after the patient has fallen asleep. This calibration may be accomplished during the implantation of signal generator 10. As preferred, timer 201 may be remotely calibrated to adjust for changing time conditions or preferences of the patient (such as changing sleep habits). The additional components of signal generator 10 are discussed in further detail herein.
FIG. 3 illustrates a schematic block diagram of another embodiment of signal generator 10 wherein timer 201 is coupled to a power source 203 such as battery of signal generator 10. During “off” periods, timer 201 disconnects power source 203 from providing any electrical energy to signal generator 10. During the “on” stage, timer 201 reconnects power source 203 to provide electrical energy to signal generator 10. Operation of signal generator 10 during the “on” stage may be handled under techniques known in the art.
In yet another embodiment of the present invention, timer 201 may be a real time clock. Clock may be adjusted manually such as, for example, by a switch 230 (FIG. 2A) that the patient may access via telemetry or, alternatively, clock may be responsive to an external source, such as a wristwatch or a central satellite, to ensure that the clock is timed properly. Advantageously under the latter embodiment, clock may be periodically adjusted to reflect the accurate time-of-day. As such, changes due to daylight savings time changes as well as changes in time zones (if the patient is traveling outside of his/her time zone) may be automatically accounted.
FIG. 4 discloses another embodiment of the present invention wherein a sensor 130 provides feedback as to whether the patient is awake or asleep to determine whether signal generator 10 should be turned on or off. In one embodiment, sensor 130 may sense a condition of a patient indicating whether the patient is asleep such as whether the eyes are closed, the breathing patterns, or the heart rate. Advantageously, device 10 shuts on or off in response to any number of physical, biological and/or chemical rhythms of the body indicative of whether the patient is sleeping. For example, the system may sense whether the patient's eyes shut for an extended period of time signifying that the patient is napping, sleeping or resting. Alternatively, the system may monitor activity or motion, heart rate, or respiration. Other chemical characteristics may also be monitored to determine whether the treatment therapy should be stopped such as oxygen partial pressure, carbon dioxide concentration, or glucose and insulin concentrations. These characteristics may be measured, for example, in the blood stream or other bodily fluid. Any type of sensor may be used to sense the above characteristics of the body. More detailed description of sensor 130 and other examples of sensors are disclosed in U.S. Pat. No. 5,716,377 entitled “Method of Treating Movement Disorders By Brain Infusion,” issued on Feb. 10, 1998 and assigned to Medtronic, Inc., which is incorporated herein by reference in its entirety. Other such sensors are also disclosed in U.S. Pat. Nos. 5,683,422; 5,702,429; 5,713,923; 5,716,316; 5,792,186; 5,814,014; and 5,824,021, all of which are incorporated herein by reference in their entireties.
Signal generator 10 may be automatically turned on or off if any of the conditions sensed by sensor 130 indicates that the patient is sleeping. Sensor 130 may be used in conjunction with or as an alternative to timer 201 (or a real time clock). If used in conjunction with timer 201, signal generator 10 may operate with a default of being “off” at night and a default of being “on” during the day. The default is determined by timer 201. During the day, device 10 may shut off only when a certain threshold of characteristics are sensed by sensor 130 such that it is clear that the patient is asleep. At night when the patient is normally asleep, device 10 may be turned on only when sensor 130 senses characteristics that clearly indicate that the patient has awaken. Sensor 130 provides information to signal generator 10 to determine whether to deviate from the default. These threshold parameters may be adjusted by the physician or the patient. The patient may also have the capability to manually turn on or off signal generator 10 as provided in the art.
Sensor 130 may also be used to provide closed-loop feedback control of the treatment therapy during periods when device 10 is in operation. Alternatively, one or more additional sensors may be implemented for feedback control. The additional sensor is attached to or implanted into a portion of a patient's body suitable for detecting symptoms of a disorder being treated, such as a movement disorder or ischemic pain. The additional sensor is adapted to sense an attribute of the symptom to be controlled or an important related symptom. For motion disorders that result in abnormal movement of an arm, such as arm 122, sensor may be a motion detector implanted in arm 122 as shown in FIG. 4. Such feedback control techniques are disclosed in the patents described above.
Referring to FIG. 4, the output of sensor 130 is coupled by cable 132 to signal generator 10. Alternatively, the output of an external sensor would communicate with signal generator 10 via telemetry. In the embodiment of FIG. 4, sensor 130 monitors heart rate and optionally movement.
FIG. 5 illustrates a schematic block diagram of the signal generator 10 of FIG. 2 including a sensor signal input from sensor 130. Sensor 130 is coupled to an analog to digital converter 206 of signal generator 10. The output of the analog to digital converter 206 is connected to a microprocessor 200 through a peripheral bus 202 including address, data and control lines. Depending upon the particular sensor signal used, an analog to digital converter would not be necessary. The output from sensor 130 can be filtered by an appropriate electronic filter in order to provide a control signal for signal generator 10.
Microprocessor 200 is coupled to timer 201 to receive timing information and to sensor 130 to receive patient information. Microprocessor 200 may then responsively determine whether the treatment therapy should be turned on or off. Other componentry of signal generator 10 is shown to generate the desired signal pulsing parameters and/or to provide feedback control of the treatment therapy. The present invention may be practiced without microprocessor 200. For example, a controller or electrical circuitry having the desired functionality may be implemented in place of microprocessor 200 to receive the timer and/or sensor information and process the information to determine whether treatment therapy is to be delivered.
The present invention is equally suitable for use in drug infusion systems to automatically provide or cease providing drug therapy to a patient. As shown in FIG. 6, the drug infusion system includes a pump 410 having at least one reservoir for storing at least one drug. The drug may be delivered via a catheter 422. Catheter 422 may be coupled to a single tube 422A or tube 422A may be divided into twin tubes, tube 422A and a second tube (not shown), that are implanted into the brain bilaterally. The second tube may supply drugs from a second catheter and pump or may supply drugs from catheter 422 to a second location within the brain B. Such drug infusion systems that may incorporate the present invention are disclosed in U.S. Pat. Nos. 5,711,316; 5,713,923; 5,735,814; and 5,782,798, each of which are incorporated herein by reference in their entireties. The drug pump may include similar componentry as that of the signal generators 10 discussed in FIGS. 2, 3 and 5.
Advantageously, the present invention may be utilized in a number of different treatment therapies, including, but not limited to, treatment of pain, movement disorders and other neurological disorders such as epilepsy, to provide a mechanism to automatically turn off treatment therapy during periods that it is not required or necessary. As used herein, the term disorder includes any disorder, illness or maladies. Additionally, the present invention may automatically turn on the treatment therapy during or right before the patient requires the treatment therapy.
Those skilled in that art will recognize that the preferred embodiments may be altered or amended without departing from the true spirit and scope of the invention, as defined in the accompanying claims.

Claims

1. A drug delivery system for treatment of a disorder comprising in combination:

(a) an implantable pump having at least one reservoir for storing at least one drug;

(b) a real time clock coupled to the pump and providing time-of-day information; and

(c) at least one implantable catheter coupled to the pump and adapted to deliver the drug to at least one predetermined site in a body of a patient, wherein the pump is configured to adapt delivery of the drug in response to the time-of-day information provided by the real time clock and the pump is further configured to adapt delivery of the drug in response to a change in rhythms of the patient.

2. A drug delivery system for treatment of a disorder comprising in combination:

an implantable pump having a reservoir for storing a drug;

a implantable microprocessor for controlling the pump;

a real time clock coupled to the microprocessor and providing time-of-day information; and

an implantable catheter couple to the pump, the catheter configured to deliver the drug to a predetermined site in a body of the patient at a controlled delivery rate, wherein the microprocessor varies the delivery rate of the drug in response to the time-of-day information provided by the real time clock.

3. The drug delivery system of claim 2, wherein the microprocessor causes the pump to provide a first delivery rate in response to a first time-of-day information from the real time clock and the microprocessor causes the pump to provide a second delivery rate in response to a second time-of-day information from the real time clock.

4. The drug delivery system of claim 3, further comprising a sensor configured to provide feedback regarding a patient characteristic, wherein the microprocessor modifies the drug delivery in response to both the feedback provided by the sensor and the time-of-day information provided by the real time clock.

5. The drug delivery system of claim 3, wherein the second delivery rate is zero.

6. A method of delivering a drug to a patient from an implanted pump, comprising:

determining a time-of-day;

determining an appropriate delivery rate of the drug based on the time-of-day; and

providing the drug to the patient via an implanted catheter at the appropriate rate.

7. The method of claim 6, further comprising the step of providing a feedback signal based on a patient characteristic, wherein the step of determining the appropriate delivery rate includes consideration of the feedback signal.

8. The method of claim 6, further comprising the step of modifying the delivery rate in response to a change in the time-of-day information.