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Evoked Response to Stimulation

a technology of evoked response and stimulation, applied in the field of ev, can solve problems such as ignoring temporal correlations between seizures, and achieve the effect of reducing the probability of neurological disorders

Inactive Publication Date: 2007-10-18
MEDTRONIC INC
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

However, all known, useful prior-art closed-loop therapies restrict intervention to be contingent upon discrete event detections and require that signals (EEG or other types) be continuously monitored (around the clock and for the life of the subject) to enable these event detections.
In addition, these approaches ignore temporal correlations between seizures including long-range dependencies.

Method used

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Examples

Experimental program
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Effect test

example 1

[0073] Suppose a subject with primarily nocturnal seizures is monitored continuously for one month (or some period of time that yields a representative or useful sample) with no therapy enabled, and then for a second month (or other period), while being treated with an open loop control program that consists of 5 mA of stimulation at 100 Hz for 1 minute every 10 minutes (i.e., on 1 minute, off 9 minutes). Using time-of-day in generating tREL (as in above example), the graphs in FIG. 8 illustrate PE(τ) for months 1 (solid) and 2 (dash-dot), respectively. In this example, it is apparent that the therapy program had a seizure-reduction effect during the night, but may have increased seizure frequency during the day. Given this information, the user (subject or caretaker) may improve the overall efficacy of therapy by developing a new control program that is obtained by combining the approaches to produce a second control program that is equal to the previous one (on 1 minute, off 9 min...

example 2

[0075] Consider a subject that is being treated with a closed-loop stimulation program. For example, after a period of no therapy, the treatment program provides for 2.5 s of continuous stimulation to the anterior thalamic nucleus, triggered by every other seizure detection (generated by an automated seizure detection algorithm). The subject continues to have seizures, so the stimulation duration is increased to 30 s of continuous stimulation, administered to the same brain location, again triggered by every other seizure detection. After a period of time, the monitoring data is collected and analyzed as described above with the fiducial times equal to the starting time of each stimulation. The corresponding probabilities of seizure survival, relative to elapsed time from start of stimulation, are shown in FIGS. 10 and 11. In this manner, the system enables the user to determine the duration of stimulation that has optimal effect in terms of seizure reduction (approximately 15 s), b...

example 3

[0078] A subject that is being treated with an open-loop therapy may be equipped with a device for intensive continuous monitoring of biological signals (such as EEG or EKG), which will detect and quantify features of these signals (e.g., epileptiform brain activity or heart rate changes) associated with seizures for a period of time (e.g., 48 hr). The monitored activity will be analyzed with respect to some fiducial time sequence (e.g., times of onset of stimulation delivery, times of changing of stimulation intensity, time of day, etc.) and the empirical probability density of seizures relative to time with respect to the fiducial sequence is generated.

[0079]FIG. 12 provides an illustration of such information, in which the fiducial times are the times of onset of trains of electrical stimulation delivered for 30 s every 10 minutes. From this analysis it becomes apparent that the open-loop stimulation program provides very little immediate effect, but has a carry-over, protective...

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PUM

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Abstract

In an embodiment, an evoked response of an electrode may be determined. The evoked response may be compared to other evoked responses to determine the location of the electrode. The evoked response may be measured during electrode implantation so that desired changes can be made and if electrodes are being implanted in both the right and left hemisphere, it can be determined that both electrodes are positioned in the same target in both the right and left hemisphere. The evoked responses may be used to determine if the stimulation target has functional connectivity with the treatment areas. Stimulation parameters for the electrodes may be determined in a closed-loop configuration and used to stimulation the electrodes in an open-loop configuration designed to reduce the probability of neurological events such as seizures.

Description

[0001] This is a continuation-in-part of U.S. application Ser. No. 11 / 380,752, filed Apr. 28, 2006 (Attorney Docket No. 011738.00310), which in turn claims priority to U.S. Provisional Application Ser. No. 60 / 780,954 filed Mar. 10, 2006 (Attorney Docket No. 011738.00294), both of which are incorporated herein by reference in their entirety.BACKGROUND OF THE INVENTION [0002] The invention relates to the evaluation, warning and treatment of neurological disorders such as epilepsy, devices for such evaluation, warning and treatment, including external and implantable devices and systems, and methods and techniques by which the devices and systems operate, and the methods by which patients suffering disorders such as epilepsy are evaluated, warned, and treated by electrical stimulation or some other modality. Specifically, the invention discloses a probabilistic approach for issuing warnings and / or triggering therapy delivery without relying on conventional event detection or prediction...

Claims

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Application Information

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Patent Type & Authority Applications(United States)
IPC IPC(8): A61B5/0476G16H20/70G16H50/20
CPCA61B5/0006A61B5/0476A61B5/4094G06F19/3481A61N1/361G06F19/345A61N1/36082G16H50/20G16H20/70A61B5/369
Inventor OSORIO, IVAN
Owner MEDTRONIC INC
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