Shape control of electrostimulation therapy

Abstract

Devices, systems, and techniques for adjusting therapy parameters that define electrical stimulation therapy delivered by a plurality of electrodes while maintaining a ratio of values of the therapy parameters between the plurality of electrodes are described. In one example, a device defines a relationship of the plurality of electrodes, the relationship of the plurality of electrodes defining a ratio of values of the therapy parameters between the plurality of electrodes. The device performs a master adjustment that adjusts each value of the therapy parameters for each respective electrode of the plurality of electrodes by an amount specified by the relationship to maintain the ratio of values of the therapy parameters between the plurality of electrodes. The device controls delivery of the electrical stimulation therapy in accordance with the master adjustment.

Description

[0001] This application claims priority and benefit to U.S. Patent Application No. 16 / 780,633, filed February 3, 2020, entitled “SHAPE CONTROL FOR ELECTRICALSTIMULATION THERAPY,” the entire contents of which are incorporated herein by reference. Invention Field

[0002] This disclosure relates generally to medical devices, and more specifically, to medical devices for delivering electrical stimulation therapy. Background Technology

[0003] Medical devices can be used to treat a variety of medical conditions. For example, a medical electrical stimulation device can deliver electrical stimulation therapy to a patient. Electrical stimulation therapy can include stimulation of nerves, muscles, or brain tissue, or other tissues within the patient. Electrical stimulation devices can be fully implanted within the patient. For example, an electrical stimulation device can include an implantable electrical stimulation generator and one or more implantable leads carrying electrodes. Electrical stimulation devices can include leadless stimulators. In some cases, implantable electrodes can be coupled to an external electrical stimulation generator via one or more percutaneous leads or fully implanted leads.

[0004] Medical electrical stimulators can be used to deliver electrical stimulation to patients to relieve a variety of symptoms or conditions, such as chronic pain, tremor, Parkinson's disease, depression, epilepsy, urinary or fecal incontinence, pelvic pain, sexual dysfunction, obesity, or gastroparesis. The stimulator can be configured to deliver electrical stimulation via leads, which include electrodes placed near the spinal cord, pelvic nerves, gastrointestinal organs, peripheral nerves, or located within the patient's brain. Stimulation near the spinal cord and within the brain is commonly referred to as spinal cord stimulation (SCS) and deep brain stimulation (DBS), respectively. Summary of the Invention

[0005] In general, this disclosure describes apparatus, systems, and techniques for maintaining a ratio of the values ​​of treatment parameters among multiple electrodes when adjusting treatment parameters. Treatment parameters may define the electrical stimulation delivered by each electrode. In one example, an apparatus, such as an external programmer for an implantable medical device, defines a relationship between one or more treatment parameters of multiple electrodes among a plurality of electrodes of the implantable medical device. The relationship may define a ratio of the values ​​of the treatment parameters of the multiple electrodes. In this way, a ratio can be set between one or more electrodes and another one or more electrodes. Treatment parameters may at least partially define the electrical stimulation delivered via the electrodes and may include, for example, current amplitude, voltage amplitude, electrical stimulation pulse count, frequency, pulse width, etc.

[0006] When two or more electrodes are “locked” to a ratio of treatment parameters, the device can perform master adjustments to adjust each value of the treatment parameter for each of the multiple electrodes by a specified amount to maintain the ratio of the treatment parameter values ​​across the multiple electrodes. The device can thus control the delivery of electrical stimulation therapy based on the master adjustments.

[0007] In some examples, the device presents a user interface including a representation of numerous electrodes for display to the user. The user interface may describe, for example, values ​​of treatment parameters specific to each of the numerous electrodes, selection of multiple electrodes with defined relationships, and values ​​of master adjustments for the selected electrodes. The user interface may also describe a representation of the state of the relationships. For example, the user interface may indicate whether the relationship between the multiple electrodes is "locked." When locked, the user can request the device via the user interface to perform master adjustments to the treatment parameters of each selected electrode among the selected electrodes to maintain the ratio of the treatment parameter values ​​across the multiple electrodes. Furthermore, the user interface may indicate whether the relationship between the multiple electrodes is "unlocked." When unlocked, the user can request the device via the user interface to adjust the values ​​of individual treatment parameters of a specific electrode among the numerous electrodes without maintaining any relationship between the treatment parameter values.

[0008] The technology disclosed herein can provide specific improvements to the field of computer-related neurostimulation therapy with practical applications. For example, the technology described herein implements a user interface that enables clinicians to define the shape of the electric field generated by electrical stimulation therapy. Furthermore, the technology described herein implements a user interface that enables clinicians to adjust one or more parameter values ​​of electrical stimulation therapy while maintaining the desired shape of the electric field generated by the electrical stimulation therapy. For example, when the amplitude of stimulation is changed, electrodes locked to a relationship of parameter values ​​can maintain the desired shape of the electric field. In this way, the technology disclosed herein can describe a user interface that allows clinicians to easily define highly complex configurations of electrical stimulation therapy while simplifying the adjustment of individual parameters of each electrode of the electrical stimulation therapy through specified therapeutic parameter relationships between the electrodes. Therefore, by using the technology described herein, medical devices can deliver electrical stimulation therapy highly tailored to a specific patient, thereby improving the therapeutic efficacy of electrical stimulation therapy and reducing the occurrence and / or severity of side effects.

[0009] In one example, this disclosure describes a method comprising: defining a relationship among a plurality of electrodes by processing circuitry, wherein the relationship defines a ratio of therapeutic parameter values ​​among the plurality of electrodes; performing a master adjustment by processing circuitry adjusting each value of a therapeutic parameter of each corresponding electrode among the plurality of electrodes by an amount specified by the relationship to maintain a ratio of therapeutic parameter values ​​among the plurality of electrodes; and controlling the delivery of electrical stimulation by processing circuitry according to the master adjustment.

[0010] In another example, this disclosure describes a system including: a memory; and processing circuitry operatively coupled to the memory and configured to: define a relationship among a plurality of electrodes, wherein the relationship defines a ratio of therapeutic parameter values ​​among the plurality of electrodes; perform a master adjustment that adjusts each value of a therapeutic parameter of each of the plurality of electrodes by an amount specified by the relationship to maintain the ratio of therapeutic parameter values ​​among the plurality of electrodes; and control the delivery of electrical stimulation according to the master adjustment.

[0011] In another example, this disclosure describes a device including: a display; a memory; and processing circuitry operatively coupled to the memory and configured to: control the display to output a representation of a plurality of electrodes for display to a user; receive a first input specifying the selection of a plurality of electrodes among the plurality of electrodes; control the display to output a representation of the selected plurality of electrodes for display to a user and in response to receiving the first input; receive a second input specifying the value of a treatment parameter for each of the plurality of electrodes; control the display to output a representation of the value of the treatment parameter for each of the plurality of electrodes for display to a user and in response to receiving the second input; receive a third input to lock a relationship between the selected plurality of electrodes among the plurality of electrodes, wherein the relationship defines a ratio of the values ​​of the treatment parameters among the plurality of electrodes; control the display to output an indication that the relationship between the selected plurality of electrodes among the plurality of electrodes is locked for display to a user and in response to receiving the third input; receive a fourth input specifying a master adjustment that adjusts each value of the treatment parameter of each corresponding electrode of the selected plurality of electrodes by an amount specified by the relationship to maintain a ratio of the values ​​of the treatment parameters among the plurality of electrodes; and control the display to output a representation of the master adjustment of the values ​​of the treatment parameters for the plurality of electrodes for display to a user and in response to receiving the fourth input.

[0012] Details of one or more examples of the technology disclosed herein are set forth in the accompanying drawings and the following description. Other features, objects, and advantages of the technology will be apparent from the description, the drawings, and the claims. Attached Figure Description

[0013] Figure 1 This is a conceptual diagram illustrating an example therapeutic system comprising an electrical stimulator coupled to a stimulation lead, according to various techniques of this disclosure.

[0014] Figure 2 To show in more detail Figure 1 A block diagram of an example programmer.

[0015] Figure 3 To show in more detail Figure 1 A block diagram of an example electrical stimulator.

[0016] Figure 4 To show in more detail Figure 3 A block diagram of an example of the electrical stimulation generation circuit of an electrical stimulator.

[0017] Figure 5 This is a block diagram illustrating an example user interface according to the technology disclosed herein.

[0018] Figure 6A This is a flowchart illustrating example operations for performing the techniques disclosed herein.

[0019] Figure 6B This is a flowchart illustrating example operations for performing the techniques disclosed herein.

[0020] Figures 7A-7B This is a conceptual diagram of a screen illustrating an example user interface according to the technology disclosed herein.

[0021] Figures 8A-8B This is a conceptual diagram of a screen illustrating an example user interface according to the technology disclosed herein.

[0022] Throughout the accompanying drawings and description, the same reference numerals refer to the same elements. Detailed Implementation

[0023] This article describes devices, systems, and techniques for maintaining the ratio of treatment parameter values ​​across multiple electrodes when adjusting treatment parameters. When programming deep brain stimulation (DBS) therapy, clinicians can specify electrode configurations and then define the delivery of electrical stimulation via the electrode configuration by assigning values ​​of one or more treatment parameters to the individual electrodes and / or adjusting the values ​​of these treatment parameters. Clinicians typically assign values ​​by, for example, assigning a single amplitude value to all active electrodes or assigning a percentage of a single total amplitude to each electrode to achieve multiple different amplitude values ​​for the corresponding electrode. This electrode-specific programming approach can be cumbersome, inefficient, and time-consuming for clinicians, especially when programming more complex electrode configurations. For example, if a clinician wants to adjust the overall size of the stimulation field or the overall size of a specific region of the stimulation field, the clinician may need to manually adjust the amplitude value of each electrode associated with the desired change.

[0024] This document discloses devices, systems, and techniques for programming therapeutic parameters that enable a user to control or adjust stimulation settings (such as stimulation amplitude) to simultaneously select multiple electrodes. The techniques described herein provide a software user interface (UI) element or other user interface device capable of receiving user input that requests the system to virtually "lock" desired electrode groups while proportionally increasing or decreasing the values ​​of stimulation parameters, thereby making overall adjustments to the entire stimulation field. Locking can be applied to one or more parameters that define the electrical stimulation parameters.

[0025] For example, electrode groups may include two or more active electrodes, and clinicians can adjust the values ​​of treatment parameters for batches / groups of electrodes together as a single lead loop layer (e.g., a layer control loop that can be associated with all electrodes located at the same axial position along the lead) or over the entire stimulation field shape. Users can lock the electrodes together using an optional "lock" button on a user interface for programming the medical device. The user interface may also include elements configured to receive user input (e.g., optional buttons, input fields, etc.) requesting simultaneous adjustment of the values ​​of one or more stimulation parameters for multiple electrodes (e.g., master amplitude slider, patient restriction indicator). The user interface may also present a volumetric activation (VNA) model depicting an increase or decrease in the stimulation field shape due to any change in stimulation parameters. Furthermore, the techniques disclosed herein enable the medical device to display any changes in the stimulation field shape to the user via treatment parameters and a representation of the selected electrodes displayed on the medical device's screen. The techniques described herein for setting and adjusting stimulation parameters reduce complexity and improve the efficiency of the user programming experience.

[0026] Figure 1 This is a conceptual diagram illustrating an example treatment system 2 including an electrical stimulator 4 coupled to a stimulation lead 10, according to various techniques of this disclosure. The treatment system 2 can be configured to deliver stimulation therapy to a patient 6. The patient 6 is typically a person, but not necessarily a person. Typically, the treatment system 2 includes an electrical stimulator 4 (e.g., an implantable medical device (IMD)) that delivers electrical stimulation to the patient 6 via one or more electrodes disposed on the stimulation lead extension 10. The electrical stimulator 4 delivers stimulation therapy, for example, stimulation therapy in the form of electrical stimulation, via one or more electrodes 48 disposed along one or more medical leads 12A and 12B connected to the lead extension 10. For the purposes of description, the electrodes 48 are described as implantable electrodes. However, the example techniques are not limited to implantable electrodes.

[0027] Electrode 48 may be deployed on one or more medical leads, such as medical leads 12A and 12B, and in some cases on a housing electrode. Electrical stimulation may be in the form of controlled current pulses or voltage pulses or substantially continuous current or voltage waveforms. The stimulation program may define various parameters of the pulses or waveforms. The pulses or waveforms may be delivered substantially continuously or in bursts, segments, or patterns, and may be delivered alone or in combination with pulses or waveforms defined by one or more other stimulation programs. In some examples, one or more electrodes of the electrode may be located on the housing 14 of the electrical stimulator 4. Furthermore, implantable electrodes may be deployed on a leadless stimulator.

[0028] In some examples, the electrical stimulator 4 can deliver, for example, deep brain stimulation (DBS) or cortical stimulation (CS) to the patient 6 via electrodes carried by the lead 12. Although Figure 1 A specific stimulation environment (e.g., DBS) is shown, but the technology disclosed herein is not limited thereto, and the electrical stimulator 4 can deliver stimulation therapy to other sites of the patient 6, such as the spinal cord of the patient 6, as described in U.S. Patent No. 8,560,080, entitled "Programming Techniques for Controlling Rate of Change of Electrical Stimulation Therapy" by Goetz et al., and U.S. Patent No. 8,996,123, entitled "Managing Electrical Stimulation Therapy Based on Varibable Electrode Combinations" by Goetz et al. For example, other electrical stimulation systems can be configured to deliver electrical stimulation to gastrointestinal organs, pelvic nerves or muscles, peripheral nerves, or other stimulation sites. Furthermore, although... Figure 1 A fully implantable electrical stimulator 4 is shown, but the techniques described in this disclosure can be applied to external stimulators with electrodes deployed via percutaneous leads.

[0029] exist Figure 1 In the example shown, the electrical stimulator 4 is implanted in the clavicle region of the patient 6. The electrical stimulator 4 generates programmable electrical stimulation (e.g., a current waveform or voltage waveform, or a current pulse or voltage pulse) and delivers the stimulation via medical leads 10 carrying an array of stimulating electrodes 48. Generally, for illustrative purposes, the delivery of electrical stimulation using controlled current pulses will be described in this disclosure. In some cases, the electrical stimulator may include multiple leads. Figure 1 In the example, the distal end of lead 10 is forked and includes two leads 12A and 12B (collectively referred to as "leads 12"). Leads 12A and 12B each include a set of electrodes forming part of an array of electrodes 48. In various examples, leads 12A and 12B may each carry four, eight, or sixteen electrodes. Figure 1 In this, each lead 12A, 12B carries four electrodes, which are configured as ring electrodes at different axial positions near the distal end of the lead 12.

[0030] In other examples, one or more leads 12A or 12B may include different arrays of electrodes. For example, lead 12A may include electrodes at different locations around the perimeter of the lead. In one example, three, four, or more electrodes may be at the same axial location but at different circumferential locations around the lead. These electrodes at different circumferential locations may be referred to as “segmented electrodes” because they represent “segments” of the loop around the lead. These electrodes at the same axial location may be referred to as being positioned at the same “layer” of the lead. In some examples, the lead may include one or more layers of multiple electrodes, and in addition to one or more layers of multiple electrodes, may include one or more complete loops (or cylindrical electrodes). An example lead may include a proximal loop electrode, a first layer of three electrodes, a second layer of three electrodes, and a distal loop electrode from the proximal end of the lead to the distal end. In other examples, the lead may include four layers of electrodes, each layer having two, three, four, or more electrodes. The electrodes may be circumferentially aligned or offset between layers.

[0031] Figure 1 A housing electrode 13 is also depicted. The housing electrode 13 may be integrally formed with or otherwise coupled to the outer surface of the hermetically sealed housing 14 of the electrical stimulator 4. In one example, the housing electrode 13 may be described as an active, non-removable electrode on the electrical stimulator 4. In some examples, the housing electrode 13 is defined by a non-insulated portion of the outward-facing portion of the housing 14 of the electrical stimulator 4. Other divisions between the insulating and non-insulated portions of the housing 14 may be used to define two or more housing electrodes. In some examples, the housing electrode 13 substantially comprises the entire housing 14, one side of the housing 14, a portion of the housing 14, or multiple portions of the housing 14.

[0032] In some examples, the electrical stimulator 4 may be coupled to one or more leads, which may be branched or unbranched. In such examples, the leads may be coupled to the electrical stimulator 4 directly or via a common lead extension (such as lead extension 10) or a separate lead extension. The proximal end of lead extension 10 may be coupled to the head on the electrical stimulator 4. Conductors in the lead body may electrically connect the stimulating electrodes located on lead 12 to the electrical stimulator 4. Lead extension 10 passes along the neck of the patient 6 from the implantation site of the electrical stimulator 4 before being coupled to leads 12A and 12B. Leads 12A and 12B continue through the brain 16 of the patient 6. In some examples, leads 12A and 12B may be implanted in the right and left hemispheres, respectively, to deliver electrical stimulation to more than one region of the brain 16.

[0033] Leads 12A and 12B can be implanted into the desired location in the brain 16 through corresponding holes in the skull of patient 6. Leads 12A and 12B can be placed anywhere within the brain 16, such that electrodes on leads 12A and 12B can provide electrical stimulation to target tissue. The electrodes of leads 12A and 12B are shown as loop electrodes. In some examples, the electrodes of leads 12A and 12B can have different configurations. For example, the electrodes of leads 12A and 12B can have a complex electrode array geometry capable of generating a shaped electric field. A complex electrode array geometry can include multiple electrodes (e.g., partial loops or electrode “segments”) surrounding the periphery of each lead 12A and 12B. In some examples, leads 12A and 12B can have different configurations than those shown above. Figure 1 The shape of the elongated column shown. For example, lead 12 can be a paddle-shaped lead, a spherical lead, a flexible lead, or any other type of shape that effectively treats patient 6. In addition, the electrode can be an electrode pad on the paddle-shaped lead, a circular electrode surrounding the lead body, a conformal electrode, a cuff electrode, a segmented electrode, or any other type of electrode capable of forming a monopolar, bipolar, multipolar, or other electrode configuration.

[0034] In some examples, the electrical stimulator 4 delivers stimulation at a given time according to a set of programs. Each program in such a set of programs may include a corresponding value for each of a number of therapeutic parameters. Therapeutic parameters may include, for example, one of current or voltage amplitude, pulse width, pulse shape, pulse rate or pulse frequency, number of pulses, or electrode configuration (e.g., electrode combination and polarity). The electrical stimulator 4 may interweave pulses or other signals according to different programs in the set of programs. In such examples, a programmer 40 may be used to create programs and assemble programs into a set of programs. In some examples, the programmer 40 may be used to adjust the stimulation parameters of one or more programs in the set of programs and select the set of programs as the current set of programs to control the stimulation delivery of the electrical stimulator 4.

[0035] Typically, system 2 delivers stimulation therapy to patient 6 in the form of a constant current waveform or voltage waveform, or a constant current pulse or voltage pulse. The shape of the pulse can vary depending on different design goals and can include ramp pulses or trapezoidal pulses, sinusoidal pulses or other curved pulses, stepped pulses with two or more discrete amplitudes, closely spaced pulse pairs, and biphasic (positive and negative aspects within a single pulse) or monophasic (positive or negative aspects only within a single pulse) variations of any of the above. In the case of current-based stimulation, the electrical stimulator 4 regulates the current supplied or absorbed by one or more electrodes (referred to as regulated electrodes). In some examples, one or more of the electrodes may be unregulated. In such configurations, the shell electrode and / or lead electrode may be unregulated electrodes.

[0036] Source current can refer to the positive current flowing out of the electrode (anode), while sink current can refer to the negative current flowing into the electrode (cathode). Regulated source currents can be added together to produce a larger total source current (e.g., currents from multiple source currents added together to produce a total source current). Similarly, regulated sink currents can be added together to produce a larger total sink current (e.g., currents from multiple sink currents added together to produce a total sink current). Regulated source currents and regulated sink currents can partially or completely cancel each other out, resulting in a net difference in the form of source or sink current when partially canceled out. In some examples, an unregulated current path can provide or absorb a current approximately equal to this net difference. In some examples, regulated source currents and sink currents can be substantially balanced.

[0037] In some exemplary implementations (e.g., bipolar / multipolar arrangements), one or more electrodes 48 may be configured to act as anodes and provide current, while one or more different electrodes 48 may be configured to act as cathodes and absorb current. In another exemplary implementation (e.g., unipolar arrangement), the housing electrode 13 may be configured to act as anodes and provide current, while one or more electrodes 48 on one or more leads are configured to act as cathodes and absorb current. The techniques disclosed herein can be implemented using, for example, unipolar or bipolar / multipolar arrangements.

[0038] The treatment system 2 may include a programmer 40, such as an external programmer operated by a clinician or patient. In some examples, the programmer 40 may be a handheld computing device that allows a clinician to program stimulation therapy for patient 6 via a user interface. For example, using the programmer 40, a clinician can specify stimulation parameters to be used in the delivery of stimulation therapy. The programmer 40 may support telemetry using the electrostimulator 4 to download the program and, optionally, upload operational or physiological data stored by the electrostimulator 4. The programmer 40 may also include a display and input keys to allow patient 6 or clinician to interact with the programmer 40 and the electrostimulator 4. In this way, the programmer 40 provides patient 6 with a user interface for controlling the stimulation therapy delivered by the electrostimulator 4. For example, patient 6 can use the programmer 40 to start, stop, or adjust the electrostimulation. In particular, the programmer 40 may allow patient 6 to adjust stimulation parameters of the program, such as duration, current or voltage amplitude, pulse width, pulse shape, and pulse rate. Patient 6 can also select a program (e.g., from a number of stored programs) as the current program to control the delivery of stimulation from the electrical stimulator 4.

[0039] In some cases, programmer 40 can be characterized as a physician or clinician programmer 40. For example, if programmer 40 is primarily intended for use by a physician or clinician, then programmer 40 may include a clinician programmer. In other cases, if programmer 40 is primarily intended for use by a patient, then programmer 40 may be characterized as a patient programmer. Typically, a physician or clinician programmer can support the clinician in selecting and generating programs for use by stimulator 4, while a patient programmer can support the patient in adjusting and selecting such programs as permitted by the clinician or clinician programmer during normal use.

[0040] Whether the programmer 40 is configured for use by a clinician or a patient, the programmer 40 can communicate wirelessly with the electrostimulator 4 or any other computing device. For example, the programmer 40 can communicate wirelessly with the electrostimulator 4 using radio frequency (RF) telemetry techniques known in the art. The programmer 40 can also use a variety of local wireless communication technologies, such as those based on 802.11 or... The programmer 40 can communicate with another programmer or computing device via a wired or wireless connection using any of the following: RF communication according to the specification set, infrared communication according to the Infrared Data Association (IrDA) specification set, or other standard or proprietary telemetry protocols. The programmer 40 can also communicate with another programming or computing device via exchangeable removable media such as a disk or optical disc, or a memory card or memory stick. Additionally, the programmer 40 can communicate with the electrostimulator 4 and other programming devices via telemetry techniques known in the art, for example, via a local area network (LAN), a wide area network (WAN), a public switched telephone network (PSTN), or a cellular telephone network.

[0041] Users such as clinicians or patients 6 can interact with the user interface of programmer 40 to program the electrostimulator 4. According to various techniques described in this disclosure, programmer 40 can be used to receive user input via the user interface, the user input specifying one or more treatment parameters for defining the electrical stimulation therapy delivered by electrostimulator 4. Programmer 40 can control electrostimulator 4 to deliver electrical stimulation therapy according to the specified treatment parameters, as described in more detail below, or otherwise program stimulator 4. Programming electrostimulator 4 can generally refer to the generation and transmission of commands, programs, or other information to control the operation of electrostimulator 4. For example, programmer 40 can transmit programs, parameter adjustments, program selections, group selections, or other information to control the operation of electrostimulator 4. Furthermore, programming stimulator 4 can include receiving user input via programmer 40 indicating a target stimulation area and controlling the electrostimulator to transition electrical stimulation from an initial stimulation area through a series of one or more intermediate stimulation areas to the target stimulation area.

[0042] The electrical stimulator 4 and the programmer 40 can communicate via cable or wireless communication, such as Figure 1 As shown. For example, programmer 40 can communicate with electrostimulator 4 wirelessly using RF telemetry technology. Programmer 40 can also communicate with other programmers using any of a variety of local wireless communication technologies, such as RF communication according to the 802.11 or Bluetooth™ specification set, infrared communication (e.g., according to the IrDA standard), or other standard or proprietary telemetry protocols. Programmer 40 may include a transceiver to allow bidirectional communication with electrostimulator 4.

[0043] According to the technology disclosed herein, system 2 implements adjustment of treatment parameters for electrical stimulation therapy delivered by electrodes 48, while maintaining the ratio between the values ​​of each treatment parameter of each electrode in the electrodes 48. In one example, external programmer 40 defines the relationship between multiple electrodes among the numerous electrodes 48 of the electrical stimulator 4. The relationship defines the ratio of the treatment parameter value of one or more electrodes to the treatment parameter value of one or more other electrodes 48. In this way, if the value changes, the ratio of the values ​​of all electrodes defined by the relationship will remain unchanged. The treatment parameters at least partially define the electrical stimulation delivered via electrodes 48 and may include, for example, current amplitude, voltage amplitude, electrical stimulation pulse count, frequency, pulse width, etc. External programmer 40 performs a master adjustment by adjusting the value of the treatment parameter of each corresponding electrode in the plurality of electrodes 48 by the amount specified by the relationship to maintain the ratio of the corresponding values ​​of the treatment parameters of the plurality of electrodes 48. External programmer 40 controls electrical stimulator 4 to deliver electrical stimulation therapy to patient 6 according to the master adjustment. The master adjustment may be performed in response to user input requesting adjustment or in response to sensing values ​​or programmed changes in automatic adjustment.

[0044] The technology disclosed herein can provide specific improvements to the field of computer-related neurostimulation therapy with practical applications. For example, the technology described herein enables a user interface to define the shape of the electric field generated by electrical stimulation therapy. Furthermore, the technology described herein enables the user interface to receive user input requesting adjustment of one or more parameters of the electrical stimulation therapy, while maintaining the desired shape of the electric field generated by the electrical stimulation therapy via the relationship between the values ​​of at least some of the electrodes. In this way, the technology disclosed herein provides a user interface that allows clinicians to easily define highly complex configurations of electrical stimulation therapy while simplifying the adjustment of individual parameters of the electrical stimulation therapy. Therefore, by using the technology described herein, medical devices can deliver electrical stimulation therapy highly tailored to a specific patient, thereby improving the therapeutic efficacy of electrical stimulation therapy and reducing the occurrence and / or severity of side effects.

[0045] Figure 2 To show in more detail Figure 1A block diagram of an example programmer 40. (See attached diagram.) Figure 2 As shown, the programmer 40 includes processing circuitry 53, memory 55, telemetry circuitry 58, and user interface 59. Generally, the processing circuitry 53 controls the user interface 59, stores data in and retrieves data from memory, and controls data transmission with the electrostimulator 4 via the telemetry circuitry 58. The processing circuitry 53 may take the form of one or more microprocessors, controllers, digital signal processors (DSPs), application-specific integrated circuits (ASICs), field-programmable gate arrays (FPGAs), or equivalent discrete or integrated logic circuits. The functions attributed herein to the processing circuitry system 53 may be embodied in software, firmware, hardware, or any combination thereof.

[0046] Memory 55 may store instructions that enable processing circuitry 53 to provide various aspects of the functionality belonging to programmer 40 herein. Memory 55 may include any fixed or removable magnetic, optical, or electrical medium, such as random access memory (RAM), read-only memory (ROM), CD-ROM, magnetic storage, electronically erasable programmable ROM (EEPROM), non-volatile random access memory (NVRAM), flash memory, etc. Memory 55 may also include a removable memory portion that can be used to provide memory updates or increase memory capacity. The removable memory may also allow patient data to be easily transferred from programmer 40 to another computing device. Memory 55 may also store information controlling the operation of electrical stimulator 4.

[0047] Telemetry circuit 58 is configured to transmit data to and from electrical stimulator 4. Telemetry circuit 58 can communicate with electrical stimulator 4 automatically at a predetermined time or when telemetry circuit 58 detects the proximity of electrical stimulator 4. Alternatively, telemetry circuit 58 can communicate with electrical stimulator 4 when a signal is emitted by the user via user interface 59. To support RF communication, telemetry circuit 58 may include suitable electronic components such as amplifiers, filters, mixers, encoders, decoders, etc.

[0048] In some examples, programmer 40 can wirelessly communicate with electrical stimulator 4 using, for example, RF communication or proximal induction interaction. This wireless communication is possible using telemetry circuitry 58 that can be coupled to an antenna. Programmer 40 can also be configured to communicate with another computing device via wireless communication technology or directly via a wired connection such as a network. Examples of local wireless communication technologies that can be used to facilitate communication between programmer 40 and another computing device include RF communication based on the 802.11 or Bluetooth specification set, and infrared communication.

[0049] Programmer 40 includes a user interface 59. A user (e.g., a clinician or patient 6) can interact with programmer 40 via user interface 59, such as manually selecting, changing, or modifying programs, adjusting one or more treatment parameters for a specific electrode 48 or a plurality of electrodes 48, or viewing stimulation data. User interface 59 may include one or more input devices and one or more output devices. Input devices of user interface 59 may include communication devices such as a keyboard, pointing device, voice response system, camera, biometric detection / response system, buttons, sensors, control pads, microphone, presence-sensitive screen, touch-sensitive screen, or any other type of device for detecting input from the user.

[0050] The output device of user interface 59 may include a communication unit, such as a display, sound card, video graphics adapter card, speaker, presence-sensitive screen, one or more USB ports, video and / or audio output interfaces, or any other type of device capable of generating tactile, audio, video, or other outputs. The output device of user interface 59 may include a display device, which may be used as an output device employing technologies including liquid crystal displays.

[0051] (LCD), quantum dot display, dot matrix display, light-emitting diode (LED) display, organic light-emitting diode (OLED) display, cathode ray tube (CRT) display, electronic ink, or monochrome, color, or any other type of display capable of producing tactile, audio, and / or visual output. In other examples, the output device of user interface 59 may produce output to the user in another manner, such as via a sound card, video graphics adapter card, speaker, presence-sensitive screen, one or more USB interfaces, video and / or audio output interfaces, or any other type of device capable of producing tactile, audio, video, or other output. In some examples, the output device of user interface 59 may include a presence-sensitive display that can be used as a user interface device, operating as both one or more input devices and one or more output devices. Additional details regarding examples of user interface 59 are available later. Figure 5 , 7A -7B and 8A-8B are described.

[0052] According to the technology disclosed herein, the user interface 59 presents a representation of a plurality of electrodes 48 of the electrostimulator 4. The user interface 59 presents, for example, values ​​of treatment parameters specific to each of the plurality of electrodes 48, selection of a plurality of electrodes 48 with defined relationships, values ​​of the main adjustment for the selected plurality of electrodes 48, etc. The user interface 59 may provide fillable fields or other adjustment input devices, such as increment or decrement input keys, which allow the user to input desired values ​​for treatment parameters of a given electrode 48 as the adjustment target, treatment parameters of the plurality of electrodes 48 as the adjustment target, or the main adjustment of the electrostimulator 4. The processing circuitry 53 may receive input from the user via the user interface 59 specifying adjustments to the values ​​of individual treatment parameters or the main adjustment by receiving increment or decrement inputs specifying increment or decrement inputs for corresponding values ​​of parameters displayed on the user interface 59. Furthermore, the processing circuitry 53 may receive adjustments from the user for one or more treatment parameters corresponding to each specific electrode 48 by receiving increment or decrement inputs specifying increment or decrement inputs for values ​​of one or more treatment parameters displayed on the user interface of the programmer 40.

[0053] User interface 59 can also depict a representation of the state of relationships. For example, user interface 59 can indicate whether the relationship between multiple electrodes is "locked," allowing the system to perform master adjustments to the treatment parameters of each of the selected electrodes 48 in response to a user input request, thereby maintaining the ratio of the values ​​of the treatment parameters of the multiple electrodes 48. Furthermore, user interface 59 can indicate whether the relationship between multiple electrodes 48 is "unlocked," allowing external programmer 40 to adjust the individual treatment parameters of a specific electrode among the numerous electrodes 48 in response to a user request. In some cases, user interface 59 of programmer 40 displays the master adjustment and the number of fractions of the master adjustment associated with each treatment parameter of each of the numerous electrodes 48 to depict the locking relationship of the treatment parameters. In some examples, user interface 59 provides fillable fields or other adjustment input devices, such as increment or decrement input keys, which allow the user to input desired values ​​for a given electrode 48 as the adjustment target, the treatment parameters of the multiple electrodes 48 as the adjustment target, or the master adjustment. If the user selects an electrode that is locked with other electrodes, processing circuitry 53 can responsively unlock that electrode to anticipate a user request to adjust the individual selected electrodes.

[0054] In operation, processing circuitry 53 receives from the user via user interface 59 a request to adjust one or more treatment parameters corresponding to each specific electrode 48. For example, processing circuitry 53 may receive input specifying an increase or decrease in the value of one or more treatment parameters displayed on the user interface of programmer 40. Processing circuitry 53 transmits the specified treatment parameters to electrical stimulation 4 via telemetry circuitry 58 to control electrical stimulator 4 to deliver electrical stimulation treatment via the plurality of electrodes 48 according to the corresponding treatment parameters of each electrode.

[0055] Furthermore, processing circuitry 53 receives an instruction from a user via user interface 59 to lock the relationship between multiple electrodes 48 and transmits the instruction to lock the relationship between the multiple electrodes 48 to electrostimulator 4 via telemetry circuitry 58. In some examples, by "locking" the relationship between multiple electrodes, programmer 40 can cause electrostimulator 4 to "lock" (e.g., maintain or preserve) the ratio of the value of the treatment parameter of each electrode to the value of the corresponding treatment parameter of the mutual electrodes among the multiple electrodes 48. For example, processing circuitry 53 may receive a selection of all electrodes to be locked and a selection of a lock icon for submitting a request to lock those selected electrodes.

[0056] Subsequently, processing circuitry 53 can receive instructions from the user via user interface 59 regarding a request for master adjustment. Processing circuitry 53 controls the electrical stimulator 4 to adjust each value of the treatment parameter of each of the plurality of electrodes 48 by a relationship-specified amount, based on the master adjustment, to maintain the ratio of the treatment parameter values ​​of the plurality of electrodes 48 locked together (e.g., all electrodes 48 or a subset other than all electrodes). In this manner, processing circuitry 53 controls the electrical stimulator 4 to adjust the value of the treatment parameter (such as current or voltage amplitude, electrical stimulation pulse count, frequency, etc.) of electrical stimulation of a particular electrode 48 while maintaining the relationship between the treatment parameter value and the corresponding treatment parameter value of the other electrodes 48. Therefore, clinicians can use medical devices operating according to the techniques described herein to adjust various treatment parameters defining electrical stimulation therapy, thereby optimizing the therapeutic efficacy of electrical stimulation therapy and reducing the occurrence and / or severity of side effects.

[0057] Figure 3 To show in more detail Figure 1 A block diagram of an example electrical stimulator 4 is provided. In some examples, the electrical stimulator 4 includes processing circuitry 50, memory 52, telemetry circuitry 56, antenna 57, and stimulation generation circuitry 60. Stimulation generation circuitry 60 also includes... Figure 3 The electrodes are shown as coupled to electrodes 48A-Q (collectively referred to as "electrodes 48"). In some examples, electrodes 48A-48P may be implantable and may be deployed on one or more leads 12. Regarding... Figure 1Leads 12A and 12B can carry electrodes 48A-H and 48I-P, respectively. In some cases, one or more additional electrodes can be located on or inside the housing of the electrical stimulator 4, for example, to provide a common electrode, a ground electrode, or a housing anode. In some examples, the leads or leads carry eight electrodes to provide a 2x8 electrode configuration (two leads, each with eight electrodes), providing a total of sixteen different electrodes.

[0058] In some examples, different electrode configurations, including single leads, two leads, three leads, or more leads, can be provided. Furthermore, the number of electrodes on the leads may vary and may be the same or different from lead to lead. Examples of other configurations include: one lead with eight electrodes (1x8); one lead with 12 electrodes (1x12); one lead with 16 electrodes (1x16); two leads with four electrodes (2x4); three leads with four electrodes each (3x4); three leads with eight electrodes each (3x8); three leads with four, eight, and four electrodes respectively (4-8-4); two leads with 12 or 16 electrodes (2x12, 2x16); two or more leads with 11 or 13 electrodes; or other configurations. Processing circuitry 50 can select different electrodes to form various electrode combinations. Furthermore, processing circuitry 50 can assign various polarities to selected electrodes to designate them as anodes or cathodes and thereby form additional electrode configurations. In other examples, fewer or more electrodes may be controlled by the electrical stimulator 4. For example, the stimulation generation circuit 60 may be coupled to 16 electrodes, with 8 electrodes on each of the two leads. For example, each lead may include two loop electrodes and two layers of three electrodes at different circumferential locations around the perimeter of the lead.

[0059] Electrode 48Q represents one or more electrodes that can be carried on the housing of the electrostimulator 4. Electrode 48Q may also be a dedicated short lead extending from the housing, or a proximal portion of one of the leads carrying electrodes 48A-48P. The proximal portion may be closely adjacent to the housing, for example, at or near the point where the lead is coupled to the housing. Electrode 48Q may be configured as a regulated or unregulated electrode for use in an electrode configuration having selected regulated and / or unregulated electrodes among electrodes 48A-48P, which may be located on the lead body of one or more leads, as described above. Electrode 48Q may be formed together on the housing, which carries the electrodes and houses components of the electrostimulator 4, such as stimulation generation circuitry 60, processing circuitry 50, memory 52, and telemetry circuitry 56.

[0060] In a monopolar arrangement, the outer casing electrode 48Q can be configured to serve as an anode, providing current substantially simultaneously with one or more electrodes 48A-48P configured to serve as cathodes for absorbing current. As a specific example, electrodes 48A, 48B and the outer casing electrode 48Q can each be configured to serve as an anode. Electrodes 48A, 48B can deliver an electrical stimulation current substantially simultaneously with the electrical stimulation current delivered via the outer casing electrode 48Q. In this illustration, one or more cathodes can be formed together with other electrodes on the leads (e.g., any one of electrodes 48C-48P) to absorb the current provided by the anodes 48A, 48B, and 48Q.

[0061] The memory 52 may store instructions for execution by the processing circuit 50, stimulation therapy data, sensor data, and / or other information regarding the treatment of the patient 6. The processor 50 may control the stimulation generation circuit 60 to deliver stimulation according to one or more selected programs or program groups stored in the memory 52. ​​The memory 52 may include any electronic data storage medium, such as RAM, ROM, EEPROM, NVRAM, flash memory, magnetic memory, etc. The memory 52 may store program instructions that, when executed by the processing circuit 50, cause the processing circuit 50 to perform various functions belonging to the processing circuit 50 and the electrostimulator 4 of this disclosure.

[0062] Processing circuitry 50 may include one or more microprocessors, DSPs, ASICs, FPGAs, or other digital logic circuits. Processing circuitry 50 controls the operation of the electrical stimulator 4. For example, processing circuitry 50 may control stimulation generation circuitry 60 to deliver stimulation therapy according to a selected program or set of programs retrieved from memory 52. ​​In some examples, processing circuitry 50 may control stimulation generation circuitry 60 to deliver electrical signals having current amplitude, pulse width (if applicable), and pulse rate specified by one or more stimulation programs, such as stimulation pulses or continuous waveforms. Processing circuitry 50 may also control stimulation generation circuitry 60 to selectively deliver stimulation via a subset of electrodes 48 (also referred to as electrode combinations), with polarity specified by one or more programs. The functionality attributable herein to processing circuitry 50 may be embodied in software, firmware, hardware, or any combination thereof.

[0063] When a specific program group is selected, the processing circuit 50 can control the stimulation generation circuit 60 to deliver stimulation according to the program in the group. If applicable, each program can specify a set of stimulation parameters, such as amplitude, pulse width, and pulse rate. For continuous waveforms, parameters may include amplitude and frequency. Furthermore, each program can specify a specific electrode combination for delivering stimulation, and an electrode configuration based on electrode polarity and steady-state / unsteady-state / state. Electrode combinations can be specified in a single array or multiple arrays, and on a single lead or among multiple leads. An electrode combination may include at least one anode (e.g., electrode 48Q) on the housing of the electrostimulator 4, at least one anode on a lead, and at least one cathode on a lead. If more than one lead is provided, the anode and cathode carried by the lead may be on the same lead or different leads. Programs can be directly defined by selecting parameters and electrodes or by region-based programming, where parameters and electrodes are automatically determined by a programmer in response to manipulation or positioning of the stimulation region.

[0064] Stimulus generation circuit 60 via corresponding leads such as Figure 1 The conductor of lead 12 is electrically coupled to electrodes 48A-P. The stimulation generation circuit 60 can be electrically coupled to one or more housing electrodes 48Q via an electrical conductor disposed within the housing of the electrostimulator 4. Housing electrodes 48Q can be configured as regulated or unregulated electrodes to form an electrode configuration in conjunction with one or more electrodes among electrodes 48A-48P. Housing electrodes 48Q can be configured as anodes to substantially simultaneously provide current with one or more electrodes on one or more leads configured as anodes, such as any one of electrodes 48A-48P.

[0065] The stimulation generation circuit 60 may include circuitry for generating stimulation pulses or waveforms and circuitry for switching stimulation between different electrode combinations, for example, in response to control by the processing circuit 50. The stimulation generation circuit 60 generates electrical stimulation signals according to a program based on control signals from the processor 50.

[0066] In one example implementation, the stimulation generation circuit 60 can be configured to deliver stimulation using one or more of the electrodes 48A-P and the housing electrode 48Q as stimulation electrodes, such as anodes. Anodes on the leads and housing can be used together with one or more cathodes on the leads to deliver stimulation. As an example, the electrode combination selected for delivering the stimulation current may include housing anodes, anodes on the leads, and cathodes on the same or different leads. In other examples, the electrode combination may include multiple anodes and / or multiple cathodes on one or more leads, together with at least one anode on the housing 14. In some examples, the electrode combination may include one or more anodes on one or more leads, and one or more cathodes on the same or different leads, such as a bipolar / multipolar arrangement.

[0067] Telemetry circuitry 56 may include an RF transceiver to allow bidirectional communication between the electrostimulator 4 and the programmer 40. Telemetry circuitry 56 may include an antenna 57, which may take various forms. For example, antenna 57 may be formed from a conductive coil or wire embedded in a housing associated with the medical device 4. In some examples, antenna 57 may be mounted on a circuit board carrying other components of the electrostimulator 4 or may take the form of a circuit trace on the circuit board. In this way, telemetry circuitry 56 can allow communication with... Figure 1 The programmer 40 communicates with the programmable circuit to receive, for example, new programs or program groups, or adjustments to programs or program groups. The telemetry circuit 56 may be similar to the telemetry circuit 58 of the programmer 40.

[0068] Figure 4 To show in more detail Figure 3 A block diagram illustrating an example of the electrical stimulation generation circuit 60 of the electrical stimulator 4. The stimulation generation circuit 60 can be used with the electrical stimulator, for example, to perform a reference... Figure 3 The function of the stimulus generation circuit 60 is described. Figure 4 In one example, the stimulation generation circuit 60 is selectively configured to deliver an electrical stimulation pulse to the patient 6 via electrode 48. However, this disclosure is not limited to the example of delivering regulated current pulses. In other examples, the stimulation generation circuit 60 may provide a continuous, regulated current waveform instead of regulated current pulses. In some examples, the stimulation generation circuit 60 may deliver a combination of continuous waveforms and pulses, or selectively deliver either continuous waveforms or pulses. The stimulation generation circuit 60 may generate stimulation based on constant current or constant voltage in the form of pulses or continuous waveforms. The stimulation generation circuit 60 may also be controlled to provide constant power (current-voltage product) or controlled charge stimulation pulses.

[0069] exist Figure 4In the example shown, the stimulus generation circuit 60 includes a main current / voltage 64 and a current / voltage regulator array 68. In some examples, the stimulus generation circuit 60 may also include a switch array 66. The main current / voltage 64 may provide operating power to the current / voltage regulator array 68 and may include a regulated current or regulated voltage that sets the level of the main current (e.g., the main current amplitude) or the main voltage. Figure 4 As shown, the main current / voltage 64 can be coupled to provide operating power to the current / voltage regulator array 68 and, where appropriate, provide the main current or main voltage for connection to the electrode 48. The maximum operating current level and the main current level provided for regulating the current regulator array 68 can be different at any given time. For example, the main current amplitude can be less than the maximum operating current level, allowing the main current amplitude to be increased or decreased according to minimum and maximum operating conditions. In some examples, such as reference... Figure 5 As described, the user interface 59 of the external programmer 40 can display information for the user's reference, while adjusting the current amplitude of various electrodes.

[0070] Processing circuitry 50 can control (e.g., via a stimulation controller) the switching array 66 and the current / voltage regulator array 68 to deliver stimulation via electrodes 48. In operation, processing circuitry 50 can control the delivery of electrical stimulation according to one or more programs that can specify stimulation parameters such as electrode combination, electrode polarity, stimulation current amplitude, pulse rate and / or pulse width, and the percentage of source current distributed or contributed between the housing anode and one or more lead anodes on one or more leads, and the percentage of sink current absorbed by one or more cathodes. The programs can be defined by the user and downloaded to the electrical stimulator 4 via an external controller.

[0071] The current / voltage regulator array 68 includes a plurality of regulated current sources or sinks. Current regulators can be used as current sources or sinks, or can be selectively configured to function as sources or sinks. In some examples, the current / voltage regulator array 68 can regulate voltage instead of current, or something other than current. For convenience, the term "current regulator" may be used in certain cases to refer to a source or sink. Thus, each current regulator in the current / voltage regulator array 68 can operate as a regulated current source delivering stimulation via a corresponding electrode in electrode 48 or as a regulated current sink receiving current from a corresponding electrode in electrode 48, which may be disposed on leads, on a stimulator housing, on a leadless stimulator, or in other arrangements. Although multiple current sources or sinks are described herein, the electrostimulator 4 may include a single current source or sink in other examples, and still supports locking multiple electrodes to a ratio of values ​​for one or more therapeutic parameters.

[0072] Each current regulator can correspond to a number of current regulator branches. In some examples, the current regulator branches can be implemented in parallel, such as having parallel current regulator branches. The number of current regulator branches defines the resolution of each current regulator. For example, in some examples, the number of current regulator branches can be 64, allowing the current amplitude of a given electrode to be adjusted in 1 / 64 increments (i.e., 1 / 64 resolution). While 64 current branches are used throughout this disclosure, the technique of this disclosure is not limited to this, and the number of current branches may be more or less than 64. For example, in some implementations, 128 current branches can be used, allowing the current regulator of a particular electrode to be adjusted in 1 / 128 increments (i.e., 1 / 128 resolution). In an exemplary implementation, utilizing 1 / 64 resolution, the ring electrode can implement 64 branches (e.g., 64 / 64) at full output. ths Furthermore, the stimulation generation circuit 60 can be configured such that all 64 parallel current regulator branches are used for each of the highest contributing electrodes in the highest intensity activity region.

[0073] In examples involving leads with electrodes (e.g., segmented electrodes or complex electrode arrays) at different circumferential locations around the lead wire, the electrodes at various axial locations of lead wire 12 can have a fractional maximum value approximately equal to the number of branches available for the electrode divided by the number of electrode segments in the ring of segmented electrodes. For example, in an example involving 64 current regulator branches, the ring electrode can have a maximum fraction of 64 / 64, while each of the N segmented electrodes in the ring of segmented electrodes can have a maximum fraction of approximately 64 / N. In an exemplary example, with three segmented electrodes in the ring, each electrode can have a fractional maximum value of 21 / 64. In some examples, the fractional maximum value for any given electrode, including the ring electrode, can reach the full number of current regulator branches (e.g., 64 branches). That is, processing circuit 53 or processing circuit 50 can be configured to apply any fractional maximum value based on the specific stimulus generation circuit 60 in use (e.g., the number of current regulator branches). For example, in the case of three segmented electrodes in a ring as in the previous example, each electrode may have an X / X fraction (e.g., 64 / 64 fraction) or a fraction less than the maximum value of the X / X fraction that has been predefined by the processing circuit 53 or the processing circuit 50.

[0074] In examples including switch array 66, each switch in switch array 66 can couple a corresponding one of electrodes 48 to a corresponding bidirectional current regulator of current / voltage regulator array 68 or to main current / voltage 64. In some examples, processing circuitry 50 selectively turns switches in switch array 66 on and off to configure the housing electrode (e.g., electrode 48Q) and one or more electrodes 48A-48P on one or more leads as Zener electrodes by connecting to a Zener current source or Zener current sink in current / voltage regulator array 68. In some examples, processing circuitry 50 can selectively turn switches in switch array 66 on and off to configure the housing electrode, such as electrode 48Q, or the electrode on the lead as an unregulated electrode by connecting to main current / voltage 64. Furthermore, processing circuitry 50 can selectively control individual Zener current sources or Zener current sinks in current / voltage regulator array 68 to deliver stimulation current pulses to selected electrodes. In examples not using switch array 66, electrode 48 can still be coupled to current / voltage regulator array 68 and / or main current / voltage 64.

[0075] The main current / voltage 64 can be a high or low voltage supplied by a regulated power supply, depending on whether the electrode is programmed as an unregulated source (high voltage rail) or an unregulated sink (low voltage rail). Therefore, the main current / voltage 64 can generate high and low main currents or voltages as appropriate to selectively couple to the unregulated reference electrode as needed. The regulated power supply can generate one or more regulated voltage levels, serving as the main current / voltage 64 and as the power rails for the current / voltage regulator array 68. Although the same main current / voltage 64 is shown as coupled to... Figure 4 The current / voltage regulator array 68 is used, but different current amplitudes can be used to couple the main current to the switch array 66 and the maximum current amplitude supplied to the current regulator array 68. In any case, the regulated power supply can generate a regulated current amplitude from the current supplied by one or more power sources, such as one or more batteries (e.g., a rechargeable battery).

[0076] Processing circuitry 50 controls the operation of switch array 66 to produce electrode configurations defined by different stimulation programs. In some cases, the switches in switch array 66 may be metal-oxide-semiconductor field-effect transistors (MOSFETs) or other circuit components for switching electronic signals. The switches in switch array 66 may be designed to carry a certain amount of unregulated current, which can be coupled to the corresponding electrode through an unregulated current path associated with the main current / voltage 64. In some examples, two or more Zener electrodes 48 may be intentionally programmed to deliver different amounts of current, resulting in an unbalanced current distribution among the Zener electrodes. In other examples, the Zener source current and Zener sink current may be balanced so that substantially all current can be supplied and absorbed via the corresponding Zener current source and Zener current sink.

[0077] To provide individual control over electrode 48 as either a regulated electrode or an unregulated reference electrode, processing circuitry 50 controls the operation of switch array 66 and current / voltage regulator array 68. When stimulation is delivered to patient 6, such as a current pulse, processing circuitry 50 controls switch array 66 to couple selected stimulation electrodes for the desired electrode combination to the corresponding current regulators of current / voltage regulator array 68 or to the main current / voltage 64 as needed. Processing circuitry 50 controls the regulated bidirectional current sources of current / voltage regulator array 68 coupled to the regulated electrode to provide or absorb a specified amount of current. For example, processing circuitry 50 can control selected current sources or sinks pulse by pulse to deliver current pulses to the corresponding electrodes.

[0078] The processing circuit 50 also disables the regulated bidirectional current regulators of the current / voltage regulator array 68 connected to inactive electrodes, such as electrodes that are inactive as voltage regulator electrodes in a given electrode configuration. Each regulated bidirectional current regulator of the current / voltage regulator array 68 may include an internal enable switch controlled by the processing circuit 50 that disconnects the regulated power from the current regulator or otherwise disables the current source when the corresponding electrode is not used as a voltage regulator electrode.

[0079] The fractional use of the current regulators in the current / voltage regulator array 68 and the switch array 66, as described herein, enables the delivery of current in fractional quantities. In this way, the electrical stimulator 4 can deliver electrical stimulation via each of the electrodes 48, having a fractional current amplitude, for example, that of each of the other electrodes 48. Therefore, the use of the stimulation generation circuit 60 allows for the adjustment of therapeutic parameters of the electrical stimulation delivered by the defined electrodes 48, while also allowing the electrical stimulator 4 to maintain the ratio between the values ​​of each therapeutic parameter of each electrode in each electrode 48.

[0080] For example, Figure 1An external programmer 40 defines relationships among a plurality of electrodes 48 of the electrical stimulator 4. A relationship defines a ratio of the value of a treatment parameter of one or more electrodes to the value of one or more other electrodes 48 used to deliver stimulation. Treatment parameters define the electrical stimulation delivered via the electrodes 48 and may include, for example, one of the following: current or voltage amplitude, electrical stimulation pulse count, frequency, etc. The external programmer 40 performs master adjustments to adjust each value of the treatment parameter of each of the plurality of electrodes 48 by the amount specified by the relationship to maintain the ratio of the values ​​of the treatment parameters of the plurality of electrodes 48. The external programmer 40 controls the electrical stimulator 4 to deliver electrical stimulation therapy to the patient 6 according to the master adjustments. The electrical stimulator 4 may use a stimulation generation circuit 60 to deliver electrical stimulation having, for example, a fractional current amplitude of the current amplitude of each of the other electrodes 48 via each of the electrodes 48 to achieve the master adjustments.

[0081] Figure 5 This is a block diagram illustrating an example user interface 500 according to the technology of this disclosure. In some examples, user interface 500 is... Figure 2 An example of the user interface 59 of the external programmer 40. The user interface 500 can be used to adjust one or more treatment parameters of one or more electrodes 48 of one or more leads 12. Electrode 48 is... Figure 1 Example of electrode 48. Figure 5 A display window 502 of the user interface 500 is depicted, which is displaying an example lead icon 512. In some examples, the user interface 500 may display a number of lead icons representing corresponding leads, each lead having one or more electrodes 48.

[0082] exist Figure 5 In the example, window 502 graphically depicts what can correspond to Figure 1 Example lead icon 512 is one of leads 12A or 12B. In this exemplary example, lead icon 512 includes four electrode icons, namely electrode icons 548A-548D (collectively referred to as "electrode icons 548"). Depending on the specific lead configuration in use, lead icon 512 may have more or fewer electrode icons 548, and more than one lead icon 512 may be displayed on screen 502, such as... Figure 1The icons for each of leads 12A and 12B shown are illustrated. For ease of illustration, only four electrode icons 548 (or a portion of four electrodes) are depicted on lead icon 512, and only two electrode icons 548A and 548B are used to illustrate examples of various treatment parameter adjustments. Furthermore, window 502 may depict stimulation zones, electric field zones, activation zones, etc. (not shown). For example, a zone may be an anodic zone generated by one or more electrodes 48 of lead 12 that provide current. A second zone may be a cathode zone generated by one or more electrodes 48 of lead 12 that absorb current.

[0083] exist Figure 5 In this example, adjacent to each of the four electrodes, display window 502 can indicate the current associated with each of the electrodes 48 or electrode combinations. Specifically, electrode icon 548A may include a fillable bar or other adjustable bar 514A, and electrode icon 548B may include another fillable bar or other adjustable bar 514B (hereinafter referred to as "bar 514"). Bar 514 can indicate the value of a treatment parameter for each of the electrodes 48 (e.g., ...). Figure 5 (The current amplitude in the example). Although shown only relative to electrode icons 548A and 548B (i.e., the example first and second electrodes), column 514 can be equally applied to all electrodes, including segmented electrodes in the case of segmented lead implementation.

[0084] In some examples, the display window 502 of the user interface 500 may include display windows 510 and 518, respectively indicating information about the main treatment parameter value and / or the maximum treatment parameter value. In some examples, the user interface 500 may provide the user with an option (e.g., a selectable toggle icon or menu selection) to hide the information about the main treatment parameter value and / or the maximum treatment parameter value from the display window 502. In this way, the user interface may allow the user to focus on adjusting the treatment parameters of the individual electrodes 48 or combinations of electrodes 48. In some examples, the user interface 500 may alert the user when the desired treatment parameter value approaches the maximum value of the treatment parameter. That is, the user interface 500 may be hidden from display windows 510 or 518 to facilitate the display of the treatment parameter values ​​of the corresponding electrodes or combinations of electrodes.

[0085] In an exemplary example, user interface 500 allows the user to directly provide user input using column 514 to achieve desired therapeutic parameter values ​​for one or more electrodes 48. For example, user interface 500 can accept inputs of "1.1" in column 514A and "1.2" in column 514B as values ​​for current amplitude in milliamperes. In some cases, one or two columns can be pre-filled with therapeutic parameter values, in which case the user can adjust the pre-filled values ​​with adjustment values. In one example, user interface 500 can display "1.1mA" in column 514A, indicating that the electrode corresponding to electrode icon 548A is programmed to have a stimulation current amplitude of 1.1mA. Thus, user interface 500 can accept adjustments to the first electrode icon 548A from "1.1" to higher or lower current amplitude values ​​as input. For example, user interface 500 can accept adjustments to the first electrode icon 548A from "1.1" to "1.3". In the example where column 514B has pre-filled values ​​for the treatment parameters of the electrode corresponding to electrode icon 548B, column 514B can display the same values ​​before and after adjustment of the first electrode icon 548A.

[0086] In some examples, a user can adjust the values ​​of treatment parameters using the user interface 500, but these changes may not take effect until the user provides an explicit command via the user interface 500. For example, a user might adjust the current amplitude of electrode icon 548A from "1.1mA" to "1.3mA," but might want the electrode corresponding to electrode icon 548B to remain at a current value of "1.2mA." Regardless of whether an explicit command is used, the user can use column 514B to adjust electrode icon 548A from "1.1mA" to "1.3mA," and column 514B can display "1.2mA" before and after the adjustment, indicating that the current amplitude of the electrode corresponding to electrode icon 548B remains unchanged from "1.2mA." User input received via the user interface 500 can be transmitted from programmer 40 to electrical stimulator 4. That is, electrical stimulator 4 can receive user input from programmer 40 and implement various programming requests accordingly.

[0087] In the aforementioned example, columns 514A and 514B allow the user to adjust the current amplitude value of the electrodes corresponding to each electrode icon 548A and 548B, respectively. However, in other examples, the user can adjust one or more other treatment parameters, such as either the voltage amplitude or the current amplitude, the electrical stimulation pulse width, the electrical stimulation pulse count, the electrical stimulation duty cycle, the electrical stimulation pulse rate, or the electrical stimulation frequency.

[0088] According to the technology disclosed herein, the external programmer 40 receives, from the user and via the user interface 500, values ​​of the current amplitude corresponding to the electrodes 548A and 548B, respectively, via columns 514A and 514B. The external programmer 40 transmits the values ​​of the current amplitude for the electrodes to the electrical stimulator 4 to control the electrical stimulator 4 to deliver electrical stimulation therapy via the electrodes according to the corresponding current amplitude of each of the electrodes.

[0089] Furthermore, the external programmer 40 can receive an instruction from the user via selection of the lock button 501 to lock the relationship between the electrodes corresponding to electrode icons 548A and 548B. The external programmer 40 stores instructions regarding the relationship between the values ​​of treatment parameters for each of the electrodes corresponding to electrode icons 548A and 548B. For example, the external programmer 40 can determine the ratio of the current amplitude value specified for the electrode corresponding to electrode icon 548A to the current amplitude value specified for the electrode corresponding to electrode icon 548B. In some examples, by “locking” the relationship between electrode icons 548A and 548B, the programmer 40 can “lock” (e.g., keep or maintain) the ratio between the values ​​of the treatment parameters for each of the electrodes corresponding to electrode icons 548A and 548B, so that the treatment parameters can be adjusted later.

[0090] Subsequently, the programmer 40 can receive user input via the user interface 500 requesting master adjustment of the treatment parameters of the electrodes corresponding to electrode icons 548A and 548B. The programmer 40 responsively controls the electrical stimulator 4 to adjust each value of the treatment parameter of each electrode corresponding to electrode icons 548A and 548B by an amount specified by a relation, based on the master adjustment, to maintain the ratio of the values ​​of the treatment parameters corresponding to the electrodes corresponding to electrode icons 548A and 548B. In this way, the programmer 40 controls the electrical stimulator 4 to adjust, for example, the value of the treatment parameter of the electrical stimulation of the electrode corresponding to electrode icon 548A (e.g., in…). Figure 5 In the example, the current amplitude is maintained while keeping the values ​​of the treatment parameters corresponding to electrode icon 548A and the corresponding treatment parameters corresponding to electrode icon 548B constant. Therefore, clinicians can use medical devices operating according to the techniques described herein to adjust various treatment parameters that define electrical stimulation therapy, thereby optimizing the therapeutic efficacy of electrical stimulation therapy and reducing the occurrence and / or severity of side effects.

[0091] Figure 6A This is a flowchart illustrating example operations for performing the techniques of this disclosure. Specifically, Figure 6A The operation for locking the relationship between multiple electrodes 48 is illustrated. For convenience, regarding... Figure 1 Describe Figure 6. In Figure 6AIn one example, the external programmer 40 receives from the user a selection of multiple electrodes 48 from a plurality of electrodes 48 (602). For example, the plurality of electrodes 48 may be all of the plurality of electrodes 48, or a subset of the plurality of electrodes 48. Furthermore, the external programmer 40 receives from the user or from a pre-generated program an indication of the values ​​of treatment parameters for the plurality of electrodes 48 (604). Each value of the treatment parameters may be specified, for example, a value for one of the voltage or current amplitudes of each of the plurality of electrodes 48, the electrical stimulation pulse width, the electrical stimulation pulse count, the electrical stimulation duty cycle, the electrical stimulation pulse rate, or the electrical stimulation frequency, etc. In some examples, the external programmer 40 transmits the selection of the plurality of electrodes 48 and the values ​​of the treatment parameters for the plurality of electrodes 48 to the electrical stimulator 4 to control the electrical stimulator 4 to deliver electrical stimulation via the plurality of electrodes 48 according to the specified treatment parameters.

[0092] External programmer 40 receives user input (606) from a user requesting programmer 40 to lock the relationship between multiple electrodes, and in response, programmer 40 defines the relationship between the multiple electrodes, which defines the ratio of the values ​​of treatment parameters between the multiple electrodes (608). In some examples, external programmer 40 stores an indication of the relationship between the values ​​of treatment parameters of each of the multiple electrodes 48. As an example, external programmer 40 may determine the ratio of the value of the current amplitude specified for, for example, electrode 48A to the value of the current amplitude specified for, for example, electrode 48B.

[0093] Subsequently, the external programmer 40 receives from the user an instruction to perform a master adjustment on the values ​​of the treatment parameters (609). In response to receiving the instruction, the external programmer performs the master adjustment to adjust the value of each treatment parameter of each of the plurality of electrodes by an amount specified by the relationship to maintain the ratio (610). The external programmer 40 then transmits the adjusted values ​​of the treatment parameters of the plurality of electrodes 48 to the electrical stimulator 4 to control the delivery of electrical stimulation by the electrical stimulator 4 according to the master adjustment (612).

[0094] Figure 6B This is a flowchart illustrating example operations for performing the techniques of this disclosure. Specifically, Figure 6B The operation for unlocking the relationship of multiple electrodes 48 is illustrated. For convenience, regarding... Figure 1 Described Figure 6B In some examples, Figure 6B The operation can be performed as described above. Figure 6A The described operation occurs afterward. Figure 6BIn the example, the external programmer 40 receives from the user an instruction (652) to unlock the relationship between multiple electrodes 48 among a plurality of electrodes 48. The relationship between the multiple electrodes defines the ratio of the values ​​of treatment parameters between the multiple electrodes. Each value of the treatment parameter can be specified, for example, a value of one of the voltage or current amplitudes, electrical stimulation pulse width, electrical stimulation pulse count, electrical stimulation duty cycle, electrical stimulation pulse rate, or electrical stimulation frequency of each of the multiple electrodes 48. In some examples, the multiple electrodes 48 can be all of the multiple electrodes 48, or a subset of the multiple electrodes 48.

[0095] In some examples, the user can specify an unlocking indication by selecting an icon corresponding to a specific one of the locked plurality of electrodes 48 displayed by the user interface 59 of the programmer 40. In some examples, the user can specify an unlocking indication by changing the amplitude of one or more specific electrodes 48 via the user interface 59 of the programmer 40. In response to receiving an unlocking indication, the external programmer 40 unlocks the relationship between the plurality of electrodes 48 (654). For example, the external programmer 40 can clear any previous relationship between the electrodes 48 and there is no defined relationship between the electrodes 48.

[0096] After clearing the relationship, the external programmer 40 receives an instruction (656) to adjust the value of the treatment parameter of the first electrode among the plurality of electrodes 48. The external programmer 40 performs the adjustment to adjust the value of the treatment parameter of the first electrode among the plurality of electrodes 48 without maintaining the ratio of the values ​​of the treatment parameters among the plurality of electrodes 48 as specified by the previous relationship (658). The external programmer 40 then transmits the adjusted value of the treatment parameter of the first electrode among the plurality of electrodes 48 to the electrical stimulator 4 to control the electrical stimulation delivery of the electrical stimulator 4 according to the adjusted value of the treatment parameter of the first electrode (660).

[0097] Figures 7A-7B This is a conceptual diagram of a screen illustrating an example user interface 700 according to the technology of this disclosure. The user interface 700 may be... Figure 2 The user interface of the programmer 40 is 59 or Figure 5 Example of user interface 50.

[0098] User interface 700 depicts the representation of electrode icons 748A-48D (hereinafter, "electrode icon 748") on the lead icon 712 set within display window 720. Figures 7A-7B In the examples, each electrode icon in electrode icons 748A-748D corresponds to Figure 1 and Figure 3 The corresponding electrode in electrodes 48A-48D, and lead icon 712 corresponds to Figure 1 Lead 12. In Figure 7AIn the example, electrode icons 748D and 748B indicate that electrodes 48D and 48B are selected as cathodes and electrode icon 748C indicates that electrode 48C is selected as anode. Display window 720 also depicts a representation of the electric field 702 generated by the electrical stimulator 4 delivering electrical stimulation according to the treatment parameters selected for electrodes 48B, 48C, and 48D.

[0099] User interface 700 includes a toggle button 738 that allows clinicians to activate or deactivate the electrical stimulator 4 to deliver electrical stimulation based on the treatment parameters selected for electrodes 48B, 48C, and 48D. User interface 700 also includes a treatment parameter control panel 722 that allows clinicians to adjust the values ​​of treatment parameters for the currently selected electrode 48. Figure 7A In the example, the clinician has selected electrode icon 748C and set the current amplitude of the electrical stimulation delivered via electrode 48C to a value of 1.8 mA. The user can adjust the value of the treatment parameter of electrode 48C by pressing the increment increase button 732 or the increment decrease button 734. In this example, the increment increase button 732 and the increment decrease button 734 adjust the value of the treatment parameter by 0.1 mA. Furthermore, the clinician can adjust the value of the treatment parameter of electrode 48C to the maximum value by pressing the maximum button 730 or to the minimum value by pressing the minimum button 736. The maximum or minimum value can be predetermined based on patient comfort and stimulation efficacy or based on system limitations. Alternatively or additionally, the user can use the amplitude slider to proportionally adjust the stimulation field across the entire active electrode level. The clinician can select the type of treatment parameter (e.g., current amplitude, pulse duration, or pulse frequency) by selecting the corresponding treatment parameter type button such as the mA button 740, the pulse duration button 742, or the pulse frequency button 744.

[0100] exist Figure 7B In the example, electrode icons 748D and 748C indicate that electrodes 48D and 48C are selected as anodes. For example, electrode 48B can be used as a cathode and / or a remote electrode on stimulator 4 can be used as an electrode. Figure 7B As shown, the user interface 700 also includes an electrode selection panel 724. The electrode selection panel 724 includes indicators 758A-758D (collectively referred to as "indicators 758"), each indicator depicting the selection state of a corresponding one of the electrodes 48A-48D. For example... Figure 7BAs depicted in the diagram, indicator 758D (black shading) indicates that the clinician has selected electrode 48D for treatment parameter adjustment (e.g., via treatment parameter control panel 722). As depicted in electrode selection panel 724, the clinician has set a value of 0.7 mA for the current amplitude of the electrical stimulation delivered via electrode 48D. Indicator 758C (gray shading) indicates that the clinician has selected electrode 48C for stimulation delivery but the treatment parameters of electrode 48C are not currently being adjusted. As depicted in electrode selection panel 724, the clinician previously set a value of 1.5 mA for the current amplitude of the electrical stimulation delivered via electrode 48C. Indicators 758A and 758B (white shading) indicate that electrodes 48A and 48B are not used for stimulation delivery. As depicted in electrode selection panel 724, a value of 0.0 mA is set for the current amplitude of the electrical stimulation delivered via electrodes 48A and 48B.

[0101] The color (e.g., black, gray, or white) of the status indicator 758 indicates the current state of treatment delivery performed by the electrical stimulator 4 using the corresponding electrode 48. For example, as described above, Figure 7B The black indicator in the image shows the electrode currently selected for treatment parameter adjustment via the treatment parameter control panel 722. As another example, Figure 7B The gray indicator shows an electrode with a treatment parameter greater than zero (e.g., causing the electrode to be actively used to deliver electrical stimulation therapy) but which is not currently being adjusted via the treatment parameter control panel 722. As another example, Figure 7B The white indicator in the diagram has a treatment parameter equal to zero (e.g., indicating that the electrode is not used to deliver electrical stimulation therapy) and there is currently no electrode to be adjusted via the treatment parameter control panel 722. In an example where the user interface 700 is a touch-sensitive display, a clinician can select a specific electrode 48 for adjustment via the treatment parameter control panel 722 by pressing the indicator 758 corresponding to the desired electrode 48. Furthermore, the treatment parameter control panel 722 can automatically update to display the values ​​of the treatment parameters for the electrode 48 corresponding to the currently selected electrode icon 758. Figure 7B The colors are for ease of indication only, and other colors may be used to indicate various states or configurations of electrode 48.

[0102] According to the technology disclosed herein, Figures 7A-7BThe user display 700 also includes a lock button 701. The user interface 700 can operate in an "unlocked" or "locked" configuration when the user is allowed to limit the values ​​of therapeutic parameters for the electrical stimulation delivered by the electrical stimulator 4. The user can switch between the "unlocked" and "locked" configurations by selecting the lock button 701. The lock button 701 allows the user to "lock" the shape of the electric field 702, as described in further detail below. In some examples, the lock button 701 includes three elements: a button, an icon, and an amplitude value. The lock button 701 allows the user to scale the entire shape of the stimulation field 702 up or down by maintaining the ratio of the parameter values ​​between the locked electrodes.

[0103] In the "unlocked" configuration of the user interface 700, no relationship is defined between any of the electrodes in the electrode 48. The user can adjust the values ​​of individual treatment parameters for each electrode in the electrode 48. In some examples, the user adjusts the values ​​of individual treatment parameters for each electrode in the electrode 48 to achieve the desired shape of the electric field 702 generated by the stimulator 4 delivering electrical stimulation according to the selected treatment parameters. In the "unlocked" configuration, the values ​​on the amplitude stimulation slider of the treatment parameter control panel 722 display the amplitude of a single selected electrode (e.g., the electrode corresponding to electrode icon 758D).

[0104] In the "locked" configuration of the user interface 700, the programmer 40 defines the relationship of the selected electrode 48 (e.g., electrode 48 corresponds to...). Figure 7B Electrode icons 758D and 758C are shown in the diagram. This relationship defines the ratio of treatment parameter values ​​among multiple electrodes. In the "Locked" configuration, the user can request an external programmer 40 to perform a master adjustment. The master adjustment adjusts each value of the treatment parameter of each corresponding electrode in the selected electrodes 48 by the amount specified by the relationship to maintain the ratio of treatment parameter values ​​among the multiple selected electrodes 48. In the "Locked" configuration, the value on the amplitude stimulation slider of the treatment parameter control panel 722 displays the master amplitude.

[0105] After performing the main adjustment, the user selects the lock button 701 again to switch the user interface 700 back to the "unlocked" configuration. In the "unlocked" configuration, any previous relationships between the electrodes 48 are cleared and there are no defining relationships between the electrodes 48. In some examples, the user interface 700 can switch to the "unlocked" configuration by selecting a single electrode icon 758 or by selecting the lock button 701. The user can then adjust the values ​​of the individual treatment parameters for each electrode in the electrodes 48 again without maintaining the previously defining relationships. In this way, the user interface 700 can be configured to allow the user to quickly increase or decrease the stimulation field while maintaining the field shape. The user can then unlock the relationships and adjust individual electrodes, making smaller adjustments to the stimulation field as needed. Alternatively or additionally, the user can select the lock button 701 again to switch the user interface 700 back to the "locked" configuration a second time to perform another main adjustment, etc.

[0106] Figures 8A-8B This is a block diagram illustrating an example user interface according to the technology of this disclosure. User interface 800 may be... Figure 2 The user interface of the programmer 40 is 59 or Figure 5 Example of user interface 50.

[0107] like Figure 8A As depicted, the user interface 800 illustrates the representation of electrode icons 848A, 848B-1, 848B-2, 848B-3, 848C-1, 848C-2, 848C-3, and 848D (hereinafter, "electrode icon 848") on the lead 12 within the display window 820.

[0108] exist Figures 8A-8B In the examples, each electrode icon in electrode icons 848A-848D corresponds to Figure 1 and Figure 3 The corresponding electrode in electrode 48, and the lead icon 812 corresponds to Figure 1 Lead 12.

[0109] exist Figure 8A In the example, electrode icons 848B-1, 848B-2, and 848B-3 (collectively referred to as "electrode icons 848B") represent a first subset of electrodes 48 positioned at different circumferential locations around lead 12. Similarly, electrode icons 848C-1, 848C-2, and 848C-3 (collectively referred to as "electrode icons 48C") represent a second subset of electrodes 48 positioned at different circumferential locations around lead 12. Although in Figure 8AIn the example, each subset of the first subset and the second subset of electrodes 48 is represented by three electrode icons (e.g., electrode icons 848B-1, 848B-2, 848B-3 in the first subset and electrode icons 848C-1, 848C-2, 848C-3 in the second subset), but in other examples, each subset of electrodes 48 can have any number of electrodes (e.g., more or less than 3 electrodes per subset). Furthermore, although in Figure 8A In the example, lead icon 812 has two loops that are a subset of electrode icon 848, but in other examples, lead icon 812 may have more loops, fewer loops, or no loops of electrode icon 848, each loop including one or more subsets of electrode 848, depending on the actual configuration of lead 12.

[0110] exist Figure 8A In the example, electrode icons 848B-1, 848B-2, 848C-1, and 848C-2 indicate that the corresponding electrode 48 is selected as the anode for use with... Figure 1 The electrical stimulator 4 delivers electrical stimulation. One or more of the ring electrodes 48D, 48A, or medical devices such as... Figure 1 The casing of the electrical stimulator 4 (not in) Figure 8A The image depicted in the image can be used as the cathode in this example. Display window 820 also depicts a representation of the electric field 802 generated by the electrical stimulator 4 delivering electrical stimulation according to the treatment parameters selected for the electrodes corresponding to the electrode icons 848B-1, 848B-2, 848C-1, and 848C-2.

[0111] User interface 800 includes a toggle button 838 that allows clinicians to activate or deactivate the electrical stimulator 4 to deliver electrical stimulation based on treatment parameters selected for electrodes corresponding to 848B-1, 848B-2, 848C-1, and 848C-2. The toggle button 838 can be configured in a manner substantially similar to... Figure 7A Operate using the 738 toggle button.

[0112] The user interface 800 also includes an electrode status window 826, which displays a side view of the status of electrode 48. For example, as Figure 8AAs depicted in the example, the electrode status window 826 depicts electrode icons 848B-1, 848B-2, 848C-1, and 848C-2, indicating that the corresponding electrode 48 is used as an anode for delivering electrical stimulation via the electrical stimulator 4. For implementations where the lead 12 includes a subset of electrodes 48 arranged on a loop surrounding the lead 12, such as for electrodes corresponding to, for example, electrode icons 848B-1, 848B-2, and 848B-3, the electrode status window 826 can help clinicians view the status of each electrode among the electrodes 48, where one or more electrode icons among the electrode icons 848 may be obscured from view by a 3D depiction of the lead icon 812 within the display window 820. For example, as... Figure 8A As depicted in the example, electrode icons 848B-1 and 848C-1 are at least partially obscured by the 3D depiction of lead icon 812 within display window 820.

[0113] The user interface 800 also includes an electrode selection panel 824. For example... Figure 8A As depicted, the electrode selection panel 824 includes indicators 858A, 858B-1, 858B-2, 858B-3, 858C-1, 858C-2, 858C-3, and 858D, each of which depicts the selection state of a corresponding axial representation (e.g., cross-sectional views corresponding to different axial positions of the electrode icon 848A, 848B-1, 848B-2, 848B-3, 848C-1, 848C-2, 848C-3, and 848D). Figure 8A As depicted in the diagram, indicators 858C-1 and 858C-3 (black shaded) indicate that the clinician has selected the electrodes corresponding to electrode icons 848C-1 and 848C-3 for treatment parameter adjustment (e.g., via treatment parameter control panel 822). As depicted in electrode selection panel 824, the clinician has set the current amplitude of the electrical stimulation delivered via each of the electrodes corresponding to electrode icons 848C-1 and 848C-3 to a value of 0.5 mA. Indicators 858B-1 and 858B-3 (gray shaded) indicate that the clinician has selected electrode 48 corresponding to electrode icons 848B-1 and 848B-3 for stimulation delivery, but the treatment parameters for such electrodes have not yet been adjusted. As depicted in electrode selection panel 824, the clinician has previously set the current amplitude of the electrical stimulation delivered via each of the electrodes 48 corresponding to electrode icons 848B-1 and 848B-3 to a value of 0.2 mA. Indicators 858A, 858B-2, 858C-2, and 858B (white shading) indicate that electrode 48, corresponding to electrode icons 848A, 848B-2, 848C-2, and 848D, is not currently used to deliver stimulation.

[0114] In some examples, when active, indicator 858 displays the amplitude and marker values ​​for both the active and selected states. Indicator 858 controls are radio buttons; for example, clicking a second button switches from the first button to the second. Each indicator 858 displays the amplitude corresponding to a single electrode 48. In some examples, display window 820 displays the total amplitude for each ring or the amplitude for each electrode within each ring.

[0115] Electrode selection panel 824 also includes ring toggle buttons 828B and 828C. Ring toggle buttons 828B and 828C allow clinicians to turn all electrodes of the ring on or off with a single button. For example, a clinician can select ring toggle button 828B to switch each of the electrodes 48 corresponding to electrode icons 848B-1, 848B-2, and 848B-3 to an "on" state. In some examples, when ring toggle button 828B is selected, each electrode corresponding to electrode icons 848B-1, 848B-2, and 848B-3 that was previously in a "off" state can be switched to an "on" state and use preset values ​​for therapeutic parameters (e.g., initial current amplitude) for the delivery of electrical stimulation. Furthermore, a clinician can select ring toggle button 828B a second time to switch each of the electrodes corresponding to electrode icons 848B-1, 848B-2, and 848B-3 to a "off" state.

[0116] In some examples, each ring toggle button 828B, 828C selects only the active, available electrodes on the same ring. For example, if only two segments 858C-1 and 858C3 are part of the configuration, ring toggle button 828C selects only 858C-1 and 858C3, not 858C-2.

[0117] The user interface 800 also includes a treatment parameter control panel 822, which allows clinicians to adjust the values ​​of treatment parameters for one or more currently selected electrodes 48. Figure 8A In the example, the clinician has selected electrode 48 corresponding to electrode icons 848C-1 and 848C-3, and set a value of 0.5 mA for the current amplitude of the electrical stimulation delivered via the electrodes. The treatment parameter control panel 822 can be used in conjunction with... Figures 7A-7B The treatment parameter control panel 722 operates in a manner essentially similar to this. For example, the user can adjust the value of the treatment parameter corresponding to the electrode 48 with electrode icons 848C-1 and 848C-3 by pressing the increment increase button 832, the increment decrease button 834, the maximum button 830, or the minimum button 836. Each button can be used in a manner similar to... Figure 7AThe operation is similar to that of buttons 732, 734, 730, or 736. Furthermore, clinicians can select the type of treatment parameter (e.g., current amplitude, pulse duration, or pulse frequency) by choosing the corresponding treatment parameter type button, such as the milliampere button 840, the pulse duration button 842, or the pulse frequency button 844.

[0118] The status color of indicator 858 (e.g., black, gray, or white) indicates the current status of treatment delivery performed by electrical stimulator 4 using the corresponding electrode 48. The status color of indicator 858 can be related to the above information. Figure 7A The indicator 758 operates in a manner substantially similar to the status color discussed. As an example, in the case where the user interface 700 is a touch-sensitive display, a clinician can select and adjust a specific electrode 48 via the treatment parameter control panel 822 by pressing the indicator 858 corresponding to the desired electrode 48. Furthermore, the treatment parameter control panel 822 can automatically update to display the values ​​of the treatment parameters for the currently selected electrode 48. Figure 8A The colors are for ease of indication only, and other colors may be used to indicate various states or configurations of electrode 48.

[0119] Electrode selection panel 824 includes a locking button 801. The user interface 800 can operate in an "unlocked" or "locked" configuration when the user is allowed to define the values ​​of the therapeutic parameters used to deliver electrical stimulation to the electrical stimulator 4. The user can switch between the "unlocked" and "locked" configurations by selecting the locking button 801. The locking button 801 allows the user to "lock" the shape of the electric field 802, as described in further detail below. In some examples, the locking button 801 includes three elements: a button, an icon, and an amplitude value. The locking button 801 allows the user to scale the entire shape of the stimulation field 802 up or down by maintaining the ratio of the parameter values ​​between the locked electrodes.

[0120] exist Figure 8A In the example, the user interface 800 is in an "unlocked" configuration. In the "unlocked" configuration, there is no limiting relationship between any of the electrodes in the electrode 48. The user can adjust the values ​​of individual treatment parameters for each electrode in the electrode 48. In some examples, the user adjusts the values ​​of individual treatment parameters for each electrode in the electrode 48 to achieve the desired shape of the electric field 802 generated by the stimulator 4 delivering electrical stimulation according to the selected treatment parameters.

[0121] In response to the user selecting the lock button 801, the user interface 800 transitions to a "locked" configuration. During the transition to the "locked" configuration, the external programmer 40 defines the relationship between each of the electrodes 48. In some examples, the relationship defines the ratio of the value of the treatment parameter of each electrode 48 to the value of the corresponding treatment parameter of each electrode in the other electrodes 48. For example, as... Figure 8A As depicted in the examples, electrodes 48 corresponding to electrode icons 858B-1 and 858B-3 have a current amplitude value of 0.2 mA, and electrodes 858C-1 and 858C-3 have a current amplitude value of 0.5 mA. Referring to electrode icon 858B-1, the ratio of the current amplitude of the electrode corresponding to electrode icon 858B-1 to the current amplitude of the electrode corresponding to electrode icon 858B-3 (e.g., 0.2:0.2 mA) is 1:1, and the ratio of the current amplitude of the electrode corresponding to electrode icon 858B-1 to the current amplitude of each of the electrodes corresponding to electrode icons 858C-1 and 858C-3 is 1:2.5 (e.g., 0.2:0.5 mA). External programmer 40 can store the ratio of each of the electrodes, such that external programmer 40 can maintain these ratios when performing master adjustments to treatment parameters while user interface 800 is in a "locked" configuration, as further described in detail below with respect to 8B.

[0122] Figure 8B The user interface 800 can be used with Figure 8A The user interface 800 operates in a basically similar manner. However, in response to the user selecting the lock button 801, the user interface 800 has been changed to a "locked" configuration, as described above. Figure 8A As discussed. In some examples, when the lock button 801 is opened, all cathodes in the electrode configuration are visually selected and continue to be selected until the primary amplitude is turned off. The value on the amplitude stimulation slider of the treatment parameter control panel 822 indicates the primary amplitude.

[0123] like Figure 8B As shown in the example, the user requests the programmer 40 to perform a master adjustment via the treatment parameter control panel 822 to adjust the value of each treatment parameter for each selected electrode in the selected electrodes 48 (e.g., electrodes corresponding to electrode icons 858B-1, 858B-3, 858C-1, and 858C-3), while maintaining locked relational values. In the example of Figure 8, the user has already selected electrodes 48 corresponding to 858C-1 and 858C-3. Previously, a value of 0.5 mA has been set for the current amplitude of the electrical stimulation delivered via each electrode in the electrodes 48 corresponding to 858C-1 and 858C-3, and a master adjustment has been performed to adjust the value of the current amplitude of the electrical stimulation delivered via each electrode in the electrodes 48 corresponding to 858C-1 and 858C-3 to 1.0 mA.

[0124] Furthermore, because the user interface 800 is in a "locked" configuration, the external programmer 40 adjusts the value of each treatment parameter of each of the other selected electrodes 48 (e.g., electrodes corresponding to electrode icons 858B-1 and 858B-3) by a specified amount to maintain the ratio of treatment parameters between each of electrodes 858B-1, 858B-3, 858C-1, and 858C-3 during the main adjustment. For example, as described above, referring to the electrode corresponding to electrode icon 858B-1, the external programmer 40 has stored a 1:1 (e.g., 0.2:0.2 mA) ratio of the current amplitude of the electrode corresponding to electrode icon 858B-1 to that of the electrode corresponding to electrode icon 858B-3, and a 1:2.5 (e.g., 0.2:0.5 mA) ratio of the current amplitude of the electrode corresponding to electrode icon 858B-1 to that of each of the electrodes corresponding to electrode icons 858C-1 and 858C-3. Therefore, when the master adjustment is performed to adjust the value of the current amplitude of the electrical stimulation delivered via each of the electrodes corresponding to electrode icons 858C-1 and 858C-3 from 0.5 mA to 1.0 mA, the external programmer 40 will also adjust the value of the current amplitude of the electrical stimulation delivered via each of the electrodes corresponding to electrode icons 858C-1 and 858C-3 from 0.2 mA to 0.4 mA to maintain the ratio of the treatment parameters of each of the electrodes corresponding to electrode icons 858B-1, 858B-3, 858C-1, and 858C-3.

[0125] Therefore, during the main adjustment, the electrodes corresponding to electrode icon 858B-1 and electrode icon 858B-3 have a current amplitude of 0.4 mA, and the electrodes corresponding to electrode icons 858C-1 and 858C-3 have a current amplitude of 1.0 mA. Therefore, after the main adjustment, the ratio of the current amplitude of the electrode corresponding to electrode icon 858B-1 to that of the electrode corresponding to electrode icon 858B-3 is 1:1 (e.g., 0.4:0.4 mA), and the ratio of the current amplitude of the electrode corresponding to electrode icon 858B-1 to that of each of the electrodes corresponding to electrode icons 858C-1 and 858C-3 is 1:2.5 (e.g., 0.4:1.0 mA). Furthermore, as... Figure 8B As depicted in the example, during the main adjustment, the size of the electric field 802 (e.g., the volume of tissue activation) has increased, while the overall shape of the electric field 802 has changed from the shape of the electric field 802 before the main adjustment (e.g., Figure 8AThe electric field 802 is essentially the same. Thereafter, the external programmer 40 can control the electrical stimulator 4 to deliver electrical stimulation to the patient 6 according to the adjusted treatment parameters and via electrodes 48 corresponding to the selected electrode icons 858B-1, 858B-3, 858C-1 and 858C-3.

[0126] After performing the main adjustment, the user can select the lock button 801 again to switch the user interface 800 back to the "unlocked" configuration. In the "unlocked" configuration, any previous relationships between the electrodes 48 are cleared and there are no defining relationships between the electrodes 48. In some examples, the user interface 800 can switch to the "unlocked" configuration by selecting a single electrode icon 848 or 858 or by turning off the lock button 801. The user can then adjust the values ​​of the individual treatment parameters of each electrode in the electrodes 48 again without maintaining the previously defining relationships. In this way, the user interface 800 can be configured to allow the user to quickly increase or decrease the stimulation field while maintaining the field shape. The user can then unlock the relationships and adjust individual electrodes, and make smaller adjustments to the stimulation field as needed. Alternatively or additionally, the user can select the lock button 801 again to switch the user interface 800 back to the "locked" configuration a second time to perform another main adjustment, etc.

[0127] exist Figures 8A-8B In the example, electrodes within a specific ring (e.g., electrodes represented by indicators 858B-1 and 858B-3 within the first ring, or electrode 4 represented by indicators 858C-1 and 858C-3 within the second ring) have the same therapeutic parameter values ​​(e.g., 0.2 mA for indicators 858B-1 and 858B-3, and 0.5 mA for indicators 858C-1 and 858C-3). This relationship is provided as an example only. Where not explicitly depicted in... Figures 8A-8B In other examples, each electrode 48 in each ring may have different values ​​for the same treatment parameter. Furthermore, in the aforementioned examples, the user can “lock” all electrodes 48. In other examples not explicitly depicted herein, the user interface 800 may allow the user to lock individual layers (or rings) of electrodes 48 (e.g., layer 858A locked, layer 858B locked, layer 858C locked, and / or layer 858D locked) alternatively or additionally allow the user to lock all electrodes 48.

[0128] exist Figures 8A-8BIn one example, the external programmer 40 performs a master adjustment to increase each value of the treatment parameter of each electrode in the electrodes corresponding to electrode icons 848B-1, 848B-3, 848C-1, and 848C-3 by an amount specified by a relation, to maintain the ratio between the values ​​of the treatment parameters of each electrode in the electrodes 48 corresponding to electrode icons 848B-1, 848B-3, 848C-1, and 848C-3. However, in other examples, the external programmer 40 may perform a master adjustment to decrease each value of the treatment parameter of each selected electrode in the selected electrodes 48 by an amount specified by a relation, to maintain the ratio between the values ​​of the treatment parameters of each selected electrode in the selected electrodes 48. Furthermore, in Figures 8A-8B In the example, the adjusted treatment parameter is the current amplitude of the selected electrode 48. However, in other examples, treatment parameters other than the current amplitude can be used, such as voltage amplitude or current amplitude, electrical stimulation pulse width, electrical stimulation pulse count, electrical stimulation duty cycle, electrical stimulation pulse rate, or electrical stimulation frequency.

[0129] The software user interface design described in this paper supports new programming capabilities such as Independent Electrode Control (IEC) and directional programming. IEC allows for different stimulation amplitudes within the same program, and directional programming is achieved through segmented electrode configuration via leads.

[0130] In some examples, user interface 800 can operate in the following modes and configurations:

[0131] • Electrode selection mode. Stimulation is locked when the user selects the electrode configuration on the lead.

[0132] • Stimulation mode. When the user has updated their electrode configuration and stimulation control is available.

[0133] • Layer configuration. When no single segment on its layer differs from the other electrodes.

[0134] • Layer mode. When a new UI element is displayed in its layer mode.

[0135] • Segment configuration. Refers to any configuration of any segmented layer that has a combination of active and deactivated electrodes or has more than one amplitude value.

[0136] • Segment mode. When a new UI element is displayed in segment mode.

[0137] The following examples illustrate one or more aspects of this disclosure.

[0138] Example 1. A method comprising: defining a relationship among a plurality of electrodes by a processing circuit, wherein the relationship defines a ratio of values ​​of a therapeutic parameter among the plurality of electrodes; performing a master adjustment by the processing circuit, the master adjustment adjusting each value of a therapeutic parameter of each corresponding electrode of the plurality of electrodes by an amount specified by the relationship to maintain a ratio of values ​​of the therapeutic parameter among the plurality of electrodes; and controlling the delivery of electrical stimulation by the processing circuit according to the master adjustment.

[0139] Example 2. The method of Example 1, wherein the relationship further defines the shape of the electric field generated by the electrical stimulation delivered according to each value of the treatment parameters of the plurality of electrodes, and wherein performing the main adjustment includes: performing a main adjustment to adjust each value of the treatment parameters of each of the plurality of electrodes by an amount specified by the relationship, so as to adjust the volume of the patient's tissue activated by the electrical stimulation while maintaining the shape of the electric field generated by the electrical stimulation.

[0140] Example 3. The method of any one of Examples 1 to 2, wherein performing the main adjustment of adjusting each value of the treatment parameter of each corresponding electrode of the plurality of electrodes by an amount specified by the relationship comprises: increasing each value of the treatment parameter of each corresponding electrode of the plurality of electrodes by an amount specified by the relationship to maintain the ratio of the values ​​of the treatment parameter among the plurality of electrodes.

[0141] Example 4. The method of any one of Examples 1 to 2, wherein performing the main adjustment of adjusting each value of the treatment parameter of each corresponding electrode of the plurality of electrodes by an amount specified by the relationship comprises: reducing each value of the treatment parameter of each corresponding electrode of the plurality of electrodes by an amount specified by the relationship to maintain the ratio of the values ​​of the treatment parameter among the plurality of electrodes.

[0142] Example 5. The method of any one of Examples 1 to 4, wherein performing the main adjustment includes performing the main adjustment in response to receiving an input requesting the main adjustment via a user interface.

[0143] Example 6. A method of any one of Examples 1 to 5, wherein the method further comprises: receiving a first input via the processing circuit and via a user interface, the first input specifying the selection of the plurality of electrodes among the plurality of electrodes; and receiving a second input via the processing circuit and via the user interface, the second input specifying the value of the treatment parameter of the plurality of electrodes, wherein defining the relationship of the plurality of electrodes among the plurality of electrodes comprises: defining the relationship of the plurality of electrodes among the plurality of electrodes in response to receiving a third input via the user interface requesting to lock the relationship, and wherein performing the main adjustment comprises: performing the main adjustment in response to receiving a fourth input via the user interface specifying the main adjustment.

[0144] Example 7. The method of Example 6 further includes: receiving a fifth input via the processing circuit and via the user interface, the fifth input being used to unlock the relationship; receiving a sixth input via the processing circuit and via the user interface, the sixth input specifying a value of a treatment parameter of a first electrode among the plurality of electrodes; and performing an adjustment of the value of the treatment parameter of the first electrode without maintaining a ratio of the values ​​of the treatment parameters among the plurality of electrodes, via the processing circuit and in response to receiving the fifth input and the sixth input.

[0145] Example 8. The method of any one of Examples 1 to 7 further includes outputting the following through the processing circuit and displaying them to a user: a representation of the plurality of electrodes defining the relationship; a representation of the other electrodes not defining the relationship; a representation of the value of the treatment parameter of each of the plurality of electrodes; and a representation of the main adjustment.

[0146] Example 9. The method of any one of Examples 1 to 8, wherein the treatment parameters include either voltage amplitude or current amplitude.

[0147] Example 10. The method of any one of Examples 1 to 8, wherein the treatment parameters include one or more of electrical stimulation pulse width, electrical stimulation pulse count, or electrical stimulation duty cycle.

[0148] Example 11. The method of any one of Examples 1 to 8, wherein the treatment parameters include one of the electrical stimulation pulse rate or the electrical stimulation frequency.

[0149] Example 12. The method of any one of Examples 1 to 11, wherein the plurality of electrodes are disposed on the lead wire, wherein the plurality of electrodes are grouped into a plurality of electrode subsets, each electrode subset comprising a plurality of electrodes disposed at different positions around the periphery of the lead wire, and wherein the plurality of electrodes comprises a plurality of electrodes within one electrode subset of the plurality of electrode subsets.

[0150] Example 13. The method of any one of Examples 1 to 11, wherein the plurality of electrodes are disposed on a lead wire, wherein the plurality of electrodes are grouped into a plurality of electrode subsets, each electrode subset comprising a plurality of electrodes disposed at different positions around the periphery of the lead wire, and wherein the plurality of electrodes comprises: at least a first electrode at a first position within a first electrode subset of the plurality of electrode subsets, and at least a second electrode at a first position within a second electrode subset of the plurality of electrode subsets.

[0151] Example 14. A system comprising: a memory; and processing circuitry operatively coupled to the memory and configured to: define a relationship among a plurality of electrodes, wherein the relationship defines a ratio of values ​​of a therapeutic parameter among the plurality of electrodes; perform a master adjustment that adjusts each value of the therapeutic parameter of each corresponding electrode among the plurality of electrodes by an amount specified by the relationship to maintain a ratio of values ​​of the therapeutic parameter among the plurality of electrodes; and control the delivery of electrical stimulation according to the master adjustment.

[0152] Example 15. The system of Example 14 also includes a plurality of electrodes disposed on the leads.

[0153] Example 16. The system of any one of Examples 14 to 15 further includes: the plurality of electrodes; and an implantable medical device configured to be coupled to the plurality of electrodes, wherein, in order to control the delivery of electrical stimulation according to the master adjustment, the processing circuit is configured to: control the implantable medical device to deliver the electrical stimulation via selected plurality of electrodes according to the master adjustment.

[0154] Example 17. The system of any one of Examples 14 to 16 further includes: an external programmer including the processing circuitry and the memory; and a medical device including the plurality of electrodes, wherein the external programmer is configured to control the medical device to deliver the electrical stimulation according to the master adjustment.

[0155] Example 18. The system of any one of Examples 14 to 17, wherein the system further includes a display, and the processing circuit is further configured to: control the display to display an icon indicating that the relationship is locked, such that the ratio of the values ​​of the treatment parameters between the plurality of electrodes is maintained; or control the display to display an icon indicating that the relationship is not locked, such that the ratio of the values ​​of the treatment parameters between the plurality of electrodes is not maintained.

[0156] Example 19. An apparatus comprising: a display; a memory; and processing circuitry operatively coupled to the memory and configured to: control the display to output a representation of a plurality of electrodes for display to a user; receive a first input specifying a selection of a plurality of electrodes among the plurality of electrodes; control the display to output a representation of the selected plurality of electrodes for display to the user and in response to receiving the first input; receive a second input specifying a value of a treatment parameter for each of the plurality of electrodes; control the display to output a representation of the value of a treatment parameter for each of the plurality of electrodes for display to the user and in response to receiving the second input; and receive a third input to lock the selected electrodes. The system describes the relationship between a plurality of selected electrodes from a plurality of electrodes, wherein the relationship defines a ratio of the values ​​of treatment parameters between the plurality of electrodes; controls the display to output an indication that the relationship between the selected plurality of electrodes is locked, for display to the user and in response to receiving the third input; receives a fourth input specifying a master adjustment, the master adjustment adjusting each value of the treatment parameter of each corresponding electrode of the selected plurality of electrodes by the amount specified by the relationship to maintain the ratio of the values ​​of the treatment parameters between the plurality of electrodes; and controls the display to output a representation of the master adjustment of the values ​​of the treatment parameters of the plurality of electrodes, for display to the user and in response to receiving the fourth input.

[0157] Example 20. The device of Example 19, wherein the processing circuitry is further configured to: perform the master adjustment to adjust each corresponding electrode of the selected plurality of electrodes by an amount specified by the relationship to maintain a ratio of the values ​​of the treatment parameters among the plurality of electrodes; and control the medical device to deliver electrical stimulation according to the master adjustment.

[0158] It should be understood that the various aspects disclosed herein can be combined in combinations different from those specifically presented in the specification and figures. It should also be understood that, by way of example, certain actions or events of any of the processes or methods described herein may be performed in a different order, may be added, combined, or may be omitted entirely (e.g., all described actions or events may not be necessary for performing the technique). Furthermore, although some aspects of this disclosure are described for clarity as being performed by a single module or unit, it should be understood that the techniques of this disclosure can be performed by combinations of units or modules associated with, for example, a medical device.

[0159] In one or more examples, the described techniques can be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functionality can be stored as one or more instructions or code on a computer-readable medium and executed by a hardware-based processing unit. A computer-readable medium can include a non-transitory computer-readable medium, which corresponds to a tangible medium, such as a data storage medium (e.g., RAM, ROM, EEPROM, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer).

[0160] Instructions can be executed by one or more processors, such as one or more digital signal processors (DSPs), general-purpose microprocessors, application-specific integrated circuits (ASICs), field-programmable arrays (FPGAs), or other equivalent integrated or discrete logic circuits. Therefore, the term "processor" as used herein can refer to any of the foregoing structures or any other physical structure suitable for implementing the technology. Furthermore, the technology can be implemented entirely within one or more circuit or logic elements.

Claims

1. A medical system comprising: Memory; as well as Processing circuitry, operatively coupled to the memory and configured to: A relationship is defined among a plurality of electrodes, wherein the relationship defines a ratio of the values ​​of therapeutic parameters among the plurality of electrodes; Receive input via a user interface for locking the relationship between the plurality of electrodes among the plurality of electrodes; Perform a master adjustment, which adjusts each value of the treatment parameter of each corresponding electrode among the plurality of electrodes by an amount specified by the relationship, to maintain the ratio of the values ​​of the treatment parameter among the plurality of electrodes; and The delivery of electrical stimulation is controlled according to the master adjustment.

2. The medical system according to claim 1, in, The relationship also defines the shape of the electric field generated by the electrical stimulation delivered according to each value of the treatment parameters of the plurality of electrodes, and In order to perform the main adjustment, the processing circuit is configured to perform a main adjustment that adjusts each value of the treatment parameter of each of the plurality of electrodes by an amount specified by the relationship, so as to adjust the volume of the patient’s tissue activated by the electrical stimulation while maintaining the shape of the electric field generated by the electrical stimulation.

3. The medical system according to any one of claims 1 to 2, wherein, In order to perform the main adjustment, the processing circuit is configured to increase each value of the treatment parameter of each of the plurality of electrodes by an amount specified by the relationship, so as to maintain the ratio of the values ​​of the treatment parameter among the plurality of electrodes.

4. The medical system according to any one of claims 1 to 2, wherein, In order to perform the main adjustment, the processing circuit is configured to reduce each value of the treatment parameter of each of the plurality of electrodes by an amount specified by the relationship, in order to maintain the ratio of the values ​​of the treatment parameter among the plurality of electrodes.

5. The medical system according to any one of claims 1 to 2, in, The processing circuit is further configured to: Receive a first input via the user interface, the first input specifying the selection of the plurality of electrodes among the plurality of electrodes; and The user interface receives a second input, which specifies the value of the treatment parameter of the plurality of electrodes. In order to define the relationship between the plurality of electrodes among the plurality of electrodes, the processing circuit is configured to define the relationship between the plurality of electrodes among the plurality of electrodes in response to receiving a third input requesting to lock the relationship via the user interface. In order to perform the main adjustment, the processing circuit is configured to perform the main adjustment in response to receiving a fourth input specifying the main adjustment via the user interface.

6. The medical system according to claim 5, wherein, The processing circuit system is also configured to: A fifth input is received via the user interface, the fifth input being used to unlock the relationship; A sixth input is received via the user interface, the sixth input specifying the value of the treatment parameter of the first electrode among the plurality of electrodes; as well as In response to receiving the fifth and sixth inputs, without maintaining the ratio of the values ​​of the treatment parameters among the plurality of electrodes, an adjustment is performed to adjust the value of the treatment parameters of the first electrode.

7. The medical system according to any one of claims 1 to 2, wherein, The processing circuit is also configured to output the following items to display to the user: The representation of the plurality of electrodes defining the relationship among the numerous electrodes; Representation of other electrodes among the numerous electrodes that do not define the relationship; Representation of the values ​​of the treatment parameters for each of the plurality of electrodes; as well as The representation of the main adjustment.

8. The medical system according to any one of claims 1 to 2, wherein, The treatment parameters include at least one of the following: One of the voltage amplitude or current amplitude; Electrical stimulation pulse width, electrical stimulation pulse count, or electrical stimulation duty cycle; or Electrical stimulation pulse rate or electrical stimulation frequency.

9. The medical system according to any one of claims 1 to 2, in, The numerous electrodes are arranged on the leads. The numerous electrodes are grouped into numerous electrode subsets, each electrode subset comprising several electrodes disposed at different locations around the periphery of the lead, and The plurality of electrodes includes a plurality of electrodes within one of the plurality of electrode subsets.

10. The medical system according to any one of claims 1 to 2, in, The numerous electrodes are arranged on the leads. The numerous electrodes are grouped into numerous electrode subsets, each electrode subset comprising several electrodes disposed at different locations around the periphery of the lead, and The plurality of electrodes include: At least the first electrode at the first position within the first subset of the plurality of electrode subsets, and At least a second electrode at a first position within a second subset of the plurality of electrode subsets.

11. The medical system according to any one of claims 1 to 2, further comprising: The numerous electrodes; as well as An implantable medical device configured to be coupled to the plurality of electrodes, wherein, in order to control the delivery of electrical stimulation according to the master adjustment, the processing circuit is configured to control the implantable medical device to deliver the electrical stimulation via selected plurality of electrodes according to the master adjustment.

12. The medical system according to any one of claims 1 to 2, further comprising: An external programmer, the external programmer including the processing circuitry and the memory; as well as Medical device, the medical device including the plurality of electrodes, The external programmer is configured to control the medical device to deliver the electrical stimulation according to the master adjustment.

13. The medical system according to any one of claims 1 to 2, in, The system also includes a display, and The processing circuit is further configured to: control the display to show an icon indicating that the relationship is locked, so that the ratio of the values ​​of the treatment parameters among the plurality of electrodes is maintained; or control the display to show an icon indicating that the relationship is not locked, so that the ratio of the values ​​of the treatment parameters among the plurality of electrodes is not maintained.

14. A medical system comprising: A device for defining a relationship among a plurality of electrodes, wherein the relationship defines a ratio of values ​​of therapeutic parameters among the plurality of electrodes; A means for receiving input via a user interface for locking the relationship between the plurality of electrodes among the plurality of electrodes; A means for performing a master adjustment, the master adjustment adjusting each value of a treatment parameter of each of the plurality of electrodes by an amount specified by the relationship, to maintain a ratio of the values ​​of the treatment parameters among the plurality of electrodes; and A device for controlling the delivery of electrical stimulation according to the master adjustment.

15. A computer-readable storage medium including instructions stored thereon, the instructions, when executed by a system, causing the system to perform a method, the method comprising: The relationship between multiple electrodes among a plurality of electrodes is defined by a processing circuit, wherein the relationship defines a ratio of the values ​​of therapeutic parameters among the plurality of electrodes; The processing circuit receives input via a user interface for locking the relationship between the plurality of electrodes among the plurality of electrodes; The processing circuit performs a master adjustment, which adjusts each value of the treatment parameter of each corresponding electrode of the plurality of electrodes by an amount specified by the relationship, to maintain the ratio of the values ​​of the treatment parameters among the plurality of electrodes; and The processing circuit controls the delivery of electrical stimulation according to the master adjustment.

16. The computer-readable storage medium according to claim 15, in, The relationship also defines the shape of the electric field generated by the electrical stimulation delivered according to each value of the treatment parameters of the plurality of electrodes, and The main adjustment includes performing a main adjustment that adjusts each value of a plurality of therapeutic parameters of each of the plurality of electrodes by an amount specified by the relationship, so as to adjust the volume of the patient’s tissue activated by the electrical stimulation while maintaining the shape of the electric field generated by the electrical stimulation.

17. The computer-readable storage medium according to any one of claims 15 to 16, wherein, Performing the main adjustment, which adjusts each value of the treatment parameter of each of the plurality of electrodes by an amount specified by the relationship, includes: increasing each value of the treatment parameter of each of the plurality of electrodes by an amount specified by the relationship to maintain the ratio of the values ​​of the treatment parameter among the plurality of electrodes.

18. The computer-readable storage medium according to any one of claims 15 to 16, wherein, Performing the main adjustment, which adjusts each value of the treatment parameter of each of the plurality of electrodes by an amount specified by the relationship, includes: reducing each value of the treatment parameter of each of the plurality of electrodes by an amount specified by the relationship to maintain the ratio of the values ​​of the treatment parameter among the plurality of electrodes.

19. The computer-readable storage medium according to any one of claims 15 to 16, in, The method further includes: The processing circuit receives a first input via a user interface, the first input specifying the selection of the plurality of electrodes among the plurality of electrodes; and The processing circuit receives a second input via the user interface, the second input specifying the value of the treatment parameter of the plurality of electrodes. The definition of the relationship among the plurality of electrodes includes: defining the relationship among the plurality of electrodes in response to receiving a third input requesting to lock the relationship via the user interface, and Executing the main adjustment includes: performing the main adjustment in response to receiving a fourth input specifying the main adjustment via the user interface.

20. The computer-readable storage medium of claim 19, further comprising: The fifth input, used to unlock the relationship, is received by the processing circuit and via the user interface. The processing circuit receives a sixth input via the user interface, the sixth input specifying the value of the treatment parameter of the first electrode among the plurality of electrodes; as well as Through the processing circuit and in response to receiving the fifth and sixth inputs, an adjustment of the value of the treatment parameter of the first electrode is performed without maintaining the ratio of the values ​​of the treatment parameters among the plurality of electrodes.

21. The computer-readable storage medium according to any one of claims 15 to 16, the method further comprising outputting the following through the processing circuitry for display to a user: The representation of the plurality of electrodes defining the relationship among the numerous electrodes; Representation of other electrodes among the numerous electrodes that do not define the relationship; Representation of the values ​​of the treatment parameters for each of the plurality of electrodes; as well as The representation of the main adjustment.

22. The computer-readable storage medium according to any one of claims 15 to 16, wherein, The treatment parameters include one of the following: One of the voltage amplitude or current amplitude; Electrical stimulation pulse width, electrical stimulation pulse count, or electrical stimulation duty cycle; or Electrical stimulation pulse rate or electrical stimulation frequency.

23. The computer-readable storage medium according to any one of claims 15 to 16, in, The numerous electrodes are arranged on the leads. The numerous electrodes are grouped into numerous electrode subsets, each electrode subset comprising several electrodes disposed at different locations around the periphery of the lead, and The plurality of electrodes includes a plurality of electrodes within one of the plurality of electrode subsets.

24. The computer-readable storage medium according to any one of claims 15 to 16, in, The numerous electrodes are arranged on the leads. The numerous electrodes are grouped into numerous electrode subsets, each electrode subset comprising several electrodes disposed at different locations around the periphery of the lead, and The plurality of electrodes include: At least the first electrode at the first position within the first subset of the plurality of electrode subsets, and At least a second electrode at a first position within a second subset of the plurality of electrode subsets.

Images