DEVICE AND METHODS FOR PAIN RELIEF THROUGH NEUROMODULATION WITH CLOSED LOOP MICRO-MAGNETIC HYBRID WAVEFORMS - Patent application

Abstract

To provide a neural stimulator providing closed-loop hybrid simulation.SOLUTION: A closed loop hybrid modulation method includes the following four methods of neural stimulation: a method 1 of a priming electrical signal followed by a second magnetic signal; a method 2 of a magnetic priming signal followed by a second magnetic signal; a method 3 of a priming magnetic signal followed by a second magnetic signal; and a method 4 of a priming hybrid electric and magnetic signal followed by a second hybrid electric and magnetic signal.SELECTED DRAWING: Figure 1A

Description

[Technical field]

[0001] <CROSS REFERENCE TO RELATED APPLICATIONS> This application claims priority to U.S. Patent Application No. 62 / 975,811, filed February 13, 2020, entitled DEVICE AND METHODS FOR RELIEVING PAIN VIA CLOSED-LOOP HYBRID WAVEFORM STIMULATION.

[0002] The present disclosure relates to systems and methods for providing closed-loop hybrid stimulation of neural structures, and more particularly, for addressing pain with multiple signals or a single signal having modulated characteristics. [Background technology]

[0003] The term "Spinal Cord Stimulation (SCS)" is used to describe an advanced, symptomatic treatment for chronic pain that involves the application of a varying electric field to the dorsal columns (DC) of the spinal cord via an electrode array (or arrays) implanted in the epidural space. Traditional SCS, also called "tonic", consists of an electric field that typically varies between 40 and 250 Hz and is directed to the painful target location by superimposing a perceived tingling sensation, called paresthesia, generated by the stimulating electric field. The therapy has been available clinically for about half a century.

[0004] The main mode of action is based on the gate control theory proposed by Melzack and Wall, and its mechanism of action has not been fully understood. The concept behind tonic SCS is that paresthesia induced by the applied varying electric field "closes the gate" or blocks pain signals from traveling to the brain, but the relationship between the frequency, waveform shape, amplitude, and pulse width for SCS to provide analgesic effects and its mechanism of action is not fully understood.

[0005] Spinal cord stimulation (SCS), which uses electrical pulses, has been shown to address the neuropathic causes of patients' pain and therefore reduce the use of opioid analgesics. However, electrical stimulation has significant drawbacks.

[0006] One of the main obstacles to conventional SCS is the encapsulation of the electrode by glial cells, called "glial encapsulation" or "glial scar", caused by gliosis, which usually occurs at a depth of 50-100 μm below the probe.

[0007] Scarring causes increased impedance, increased signal noise, and increased distance to the target neurons, ultimately resulting in reduced effectiveness of stimulation.

[0008] As a further complication, in an attempt to maintain efficacy, implantable pulse generators (IPGs) compensate by increasing their amplitude, thereby shortening the IPG's lifespan.

[0009] If increasing the amplitude fails to overcome the impedance, the only remaining option is surgical revision or removal of the device, with corresponding increases in morbidity and mortality.

[0010] Due to the problems with electrical stimulation, interest in magnetic stimulation has begun. Several studies have shown that compared with traditional electrical stimulation, magnetic-based neuromodulation has the following advantages: · Magnetic fields are not affected by glial encapsulation. Depolarization of target neurons can occur more consistently and from greater distances. Magnetic stimulation offers high directional specificity. Reduced IPG energy consumption extends battery life (unlike traditional SCS IPGs, which must compensate by increasing amplitude to overcome glial encapsulation). Magnetic stimulation causes depolarization of both the extracellular and intracellular matrices.

[0011] The proposed Closed-Loop Omnidirectional Neuromodulation with Eddy Currents (CLONE) is believed to be able to overcome these anatomical and physiological barriers. DISCLOSURE OF THEINVENTION

[0012] A closed loop hybrid waveform using two stimuli, one consisting of a traditional tonic or burst spinal cord stimulation with an electric field varying from 40-1500 Hz and the other consisting of a continuous or varying electromagnetic field (EMF) or magnetic field (with electromagnets, temporary magnets, or permanent magnets), to relieve chronic pain in the central, peripheral, sympathetic, and parasympathetic nervous systems by modulating neurons, ganglia, and glia and promoting second messengers to downregulate nociceptors.

[0013] Transcranial magnetic stimulation (TMS) is a technique to stimulate the nervous system non-invasively through the intact scalp and skin. TMS machines transmit short pulses of electrical current to a TMS coil, which generates a rapidly changing magnetic field around the coil. TMS stimulates neural circuits with eddy currents induced by the changing magnetic field, based on Faraday's law.

[0014] One of the devices for generating magnetic fields is the microcoil. A microcoil is a tiny electrical conductor such as a helical or spiral wire, which may be a solenoid or a planar structure. In the field of quantum science, microcoils play an increasingly important role in fast spin control in nanoscale devices such as multi-qubit spin registers, quantum memories, or actuation of single nuclear spins, such as around nitrogen vacancy centers.

[0015] Similar to the coils used in TMS, when an electric current is applied to the microcoil a magnetic field is generated. As with TMS, a time-varying magnetic field induces an electric field via eddy currents, thereby inducing an action potential.

[0016] Micromagnetic stimulation (μMS) uses sub-millimeter coils that can induce electrical currents in tissue from a distance (i.e., through an insulating layer).

[0017] In nature, these currents are closed-loop circulating currents with a higher spatial focality. Since there are no magnetic monopoles in nature, the magnetic field lines form continuous closed loops. We always find north and south poles, i.e. magnetic poles, joined together such that the magnetic field lines from one pole end in another to form a closed loop. Thus, magnetic field lines behave in a different manner than electric field lines, which start from a positive charge and end in a negative charge and do not form a closed loop.

[0018] Furthermore, the fact that the μMS coil can deliver stimulation while being insulated from tissue, in the absence of ferromagnetic materials, enhances its biocompatibility and suitability for magnetic resonance imaging.

[0019] The mechanism of action of magnetic stimulation is fundamentally different from that of electrical stimulation, which activates neural elements by acting on the electrical potential of the extracellular matrix and by manipulating the transmembrane potential. In contrast, eddy currents act not only on the extracellular matrix but also on the intracellular matrix, since the magnetic stimulation field penetrates intracellular compartments.

[0020] Moreover, unlike electrical stimulation, μMS does not require direct electrical contact with tissue. In contrast, metal electrodes implanted in tissue can trigger an immune response by inducing redox reactions at the electrode-tissue interface that alter the pH of the surrounding tissue. Histopathological analysis shows glial encapsulation as described above. However, when using μMS, there is no need to place metal in direct contact with tissue, since the current is induced from a distance.

[0021] Finally, unlike electrical stimulation, μMS does not require charge-balanced stimulation waveforms. In electrical stimulation, charge balancing is necessary to avoid the accumulation of excess charge at the neural interface and thereby avoid unwanted stimulation and electroporation. Electroporation occurs when the external electric field of the cell's membrane potential exceeds a threshold of 0.2-1 V, which causes a change in the molecular structure of the membrane and subsequent membrane perforation with the formation of holes, increasing the membrane's permeability to ions and molecules. Electroporation with a transmembrane potential of about 1 V can cause necrosis due to membrane rupture and subsequent leakage of cytoplasmic contents. In μMS, there is no net charge transferred from the electrode to the tissue.

[0022] The device is also believed to have an effect on synaptic plasticity. Synaptic plasticity involves several processes by which the central nervous system produces neural changes. Two of the mechanisms of action that generally affect synaptic efficacy are long-term potentiation (LTP) and long-term depression (LTD). The device is also believed to have a metaplastic effect. Metaplasticity refers to neural changes induced by activity at one time that persist and affect subsequent induction of LTP or LTD. Metaplasticity refers to neuronal changes induced at one time, commonly referred to as "priming" activity. Due to their persistence, these neuronal changes can modulate synaptic plasticity processes minutes, hours, or days later. One key feature of metaplasticity is that the changes can outlast the occurrence of the triggering ("priming") activity and persist until a second occurrence of activity to induce LTP or LTD. The effect gradually fades over time. It may also be possible to promote the persistence of otherwise decaying LTP or LTD by converting decaying LTP or LTD into a longer-lasting form via plasticity-related proteins (PRPs).

[0023] The device can induce homosynaptic or heterosynaptic metaplasia effects, which affect primed synaptic activity related to plasticity mechanisms, but are limited to primed synapses. Heterosynaptic metaplasia can affect not only activated synapses, but also adjacent non-activated synapses, resulting in long-range interactions between synapses that extend to dendritic compartments in both extracellular and intercellular signaling pathways.

[0024] The closed loop system responds to evoked compound action potentials (ECAPs) to provide feedback to adjust for optimal waveform and stimulation, including adjustable parameters such as amplitude change, and feedback parameters such as conduction velocity, rheobase, time scale, and occurrence of a delayed response, which is the neural response caused by dorsal root activation.

[0025] The device therefore utilises two types of closed loop properties: the natural magnetic (North to South) type described above, and feedback from ECAP.

[0026] The device may have a gradiometer, magnetometer, or both to detect induced magnetic fields, current sources, and record nerve conduction velocity to allow for more detailed assessment of neuroelectrical activity. ECAP and induced magnetic fields can be combined to form Hybrid Evoked Action Potentials (HEAPs), which may cause more precise charge transfer to target neurons, ganglia, or glial cells. These components may be embedded in a flexible silicon wafer embedded in pseudoelastic memory metal or shape memory polymer (SMP) or a combination of both, and consist of an input unit, a central processing unit (memory unit, control unit, and arithmetic and logic unit), an output unit, and a printed circuit board (PCB), connected to multiplexers and demultiplexers to allow for more precise stimulation and recording.

[0027] The device is a Closed Loop Omnidirectional Neuromodulation with Eddy Current (CLONE).

[0028] Four hybrid methods were evaluated, however, the platform is not limited to these four methods.

[0029] The method includes two signals: a first priming signal that reduces the depolarization threshold, and a second signal that depolarizes the target tissue with a minimal effective charge, thereby improving the energy efficiency of the device and reducing side effects and tissue toxicity.

[0030] To summarize: · Method 1: A priming electrical signal followed by a second magnetic signal. · Method 2: A magnetic priming signal followed by a second magnetic signal. · Method 3: A priming magnetic signal followed by a second magnetic signal. · Method 4: A priming hybrid electric and magnetic signal followed by a second hybrid electric and magnetic signal.

[0031] The details are as follows:

[0032] Method 1: A closed loop hybrid waveform using two stimuli, one a traditional tonic or burst spinal cord stimulator with an electric field varying from 40-1500 Hz, and the other in the form of a continuous or varying magnetic field to modulate neurons, ganglia, and glia, promoting second messengers to down-regulate nociceptors, thereby relieving chronic pain.

[0033] Method 2: A closed loop hybrid waveform using two stimuli, one a continuous or varying magnetic field and the other consisting of a conventional tonic or burst spinal cord stimulator with an electric field varying from 40-1500 Hz, to modulate neurons, ganglia, and glia, relieving chronic pain by promoting second messengers to downregulate nociceptors.

[0034] Method 3: A closed-loop hybrid waveform using two stimuli, one formed by a continuous or changing magnetic field and the other formed by another continuous or changing magnetic field, to modulate neurons, ganglia, and glia, promoting second messengers to down-regulate nociceptors, thereby relieving chronic pain.

[0035] Method 4: A closed-loop hybrid waveform using two stimuli, one formed from a hybrid electrical and magnetic signal and the other formed from another hybrid electrical and magnetic signal, to modulate neurons, ganglia, and glia, promoting second messengers to down-regulate nociceptors, thereby relieving chronic pain.

[0036] Methods 1-4 induce depolarizations whose thresholds are much lower than previously possible.

[0037] The method is more effective than known methods, is not limited to glial encapsulation, and uses less battery power, two attributes that reduce the morbidity and mortality associated with surgical revision and battery replacement, respectively.

[0038] The magnetic field can also overcome glial encapsulation. One of the main barriers of conventional spinal cord stimulation systems is the encapsulation of the electrodes by glial cells and fibroblasts, called the glial scar or glial encapsulation. In contrast to conventional systems, the magnetic field can pass through the scar tissue without degradation. Glial encapsulation occurs within hours of implantation and continues indefinitely thereafter. The natural inflammatory / immune response reduces the efficacy of the treatment in a number of ways: A) increasing impedance, B) increasing distance to the target neuron (isolation), and C) shortening the lifespan of the implantable pulse generator (IPG) by compensatory increasing in amplitude as it attempts to overcome impedance and distance to the target.

[0039] The device used to create the hybrid waveform is preferably an electrode array, paddle or paddle array, also called a contact or lead, which allows for chronic pain relief without the effects of glial encapsulation.

[0040] One advantage of the system is that small amounts of charge (nanocoulombs) are applied to the stimulator leads or arrays, thus extending battery life; A) there is no need to increase amplitude to overcome glial encapsulation; B) priming stimulation induces a lower threshold, so less energy is required to trigger an action potential; C) feedback from ECAP, induced magnetic fields, and HEAP prevents overstimulation, so less energy is used over time; D) unidirectional stimulation requires less energy.

[0041] Disclosed herein are devices and methods for addressing pain in a patient using closed-loop hybrid stimulation of neural structures with multiple signals or a single signal with modulated characteristics. According to the present disclosure, hybrid modulation for addressing pain contemplates using multiple separate varying stimuli applied independently to specific neural structures using different temporal and amplitude characteristics via an electrode array (referred to as contacts or leads) to modulate chronic pain without being affected by glial encapsulation. In particular, disclosed are devices and methods for modulating the expression of second messengers involved in various pathways, including inflammatory / immune mediators, ion channels, and neurotransmitters, in the spinal cord (SC) and dorsal root ganglion (DRG). In one embodiment, such modulation of expression is caused by spinal cord stimulation or peripheral nerve stimulation. In one embodiment, the amplitude and frequency of one or more signals for generating hybrid stimulation of neural structures may be optimized to improve pain relief with minimal IPG power usage, as described herein.

[0042] In one embodiment of a hybrid modulation therapy, the tonic or burst signal may be monophasic or biphasic with cathodic or anodic polarity, hi another embodiment, the hybrid waveform may include one stimulus that is an EMF or a tonic or burst stimulus.

[0043] Considering the physical device, a foldable neurostimulator has two primary states: a long, narrow profile for insertion and a wider, deployed profile for manipulation.

[0044] The result is a large surface area for nerve stimulation while avoiding the need for large incisions.

[0045] The implantation process can be summarized as follows: Insert the needle into the epidural space. A guidewire is then inserted into the target location. A device having a sheath is carried on the guidewire. Once the device head is in the desired position, the device sheath is retracted, allowing the portion of the lead proximal to the tip to be deployed. The device may further include an internal tension cable, allowing the distal end of the paddle lead to be retracted or deployed. If the device needs to be repositioned or removed entirely, the process is reversible. The needle is then removed and the distal part of the array is connected to an IPG.

[0046] When considering stimulators, there are generally two main types: paddle leads (flat) and percutaneous leads (cylindrical).

[0047] Paddle leads are surgically implanted because they are wider than percutaneous arrays and are placed retrogradely due to anatomical constraints, making implanting paddle arrays using needles a technical challenge.

[0048] The flat, wide profile of the paddle lead provides physical stability. Typically, paddle leads contain an electrode on only one side that is placed facing the nerve to be stimulated. This directed stimulation can conserve power, which is important for battery-powered devices.

[0049] Percutaneous or cylindrical leads are implanted by needles, therefore circular geometries are common due to their compatibility with needles. The use of needles simplifies implantation compared to surgical implantation.

[0050] However, the simplicity of implantation is offset by reduced physical stability and the additional power required for circumferential stimulation.

[0051] The foldable neurostimulator can be inserted via a lead and, once in place, can be deployed into a paddle shape.

[0052] The components include an array / lead housed within a sheath, and the foldable neurostimulator is delivered over a guidewire that is later withdrawn.

[0053] When the sheath is withdrawn, the lead is allowed to widen within the body.

[0054] The deploying lead material is preferably a biocompatible material, such as a pseudoelastic memory metal or a shape memory polymer (SMP) or a combination of both, which when heated by the body tends to conform to the neural structures for stimulation or recording.

[0055] Electrodes are placed on the folded portion of the lead, and optionally on the body of the lead, and are expected to include between 4 and 64 points.

[0056] It is anticipated that two identical arrays will be placed at adjacent locations, resulting in a total of 8 to 128 contacts.

[0057] During use, the device must be powered. Various power sources exist: Batteries, optionally placed inside the body, power the device with chemical energy converted into electrical energy.

[0058] As a further alternative, an internal generator recharges the battery and converts the user's motion into electrical energy.

[0059] Such generators, called nanogenerators due to their small size, can operate in different ways: piezoelectric, triboelectric, or pyroelectric. Piezoelectric and triboelectric nanogenerators convert mechanical energy into electrical power. Pyroelectric nanogenerators can convert thermal energy into mechanical energy.

[0060] Due to the availability of mechanical energy surrounding us, transduction mechanisms based on electromagnetic, piezoelectric, electrostatic and triboelectric principles are available to convert mechanical energy into electrical energy.

[0061] Stimulation methodologies are reviewed, particularly closed-loop hybrid modulation methods.

[0062] The priming electrical signal reduces the depolarization threshold of the nerve fibers while simultaneously modulating the neurons, ganglia, and glia. The priming electrical signal also reduces the impedance of the stimulated tissue, which allows better penetration of the electric field into the nerve tissue. The frequent pulsing of the priming electrical signal also contributes to a lower threshold of depolarization of the nerve fibers by membrane incorporation of the electric or EMF stimulation. Furthermore, the priming electrical signal contributes to desynchronization of the nerve cells, which is a mechanism of action that maintains nociceptive input to the brain by contributing to the re-establishment of unnaturally synchronized neural circuits. The multiple electrodes allow for variable stimulation to the target area. That is, one or more electrodes on the array body deliver stimulation pulses to the target tissue with the desired stimulation depending on the measured ECAP, induced magnetic field, or HEAP. The hybrid system can operate with AC, DC, or both.

[0063] In a first embodiment, the device stimulates or modulates interactions between neurons and ganglia of a subject in the following manner: A) exposing neurons, ganglia, and glial cells of the subject to a first stimulus; and B) simultaneously exposing neurons, ganglia, and glial cells of the subject to a second stimulus. The first and second stimuli have at least one non-common parameter. In one embodiment, the first stimulus consists of a constant or changing electrical signal and the second stimulus is a changing or constant EMF. In another embodiment, the stimuli may have different values ​​for frequency, amplitude, phase polarity, relative phase, harmonic content, or width if a square waveform.

[0064] In a second embodiment, the device stimulates or modulates interactions between neurons, ganglia, and glial cells of a subject in the following manner: A) exposing the neurons, ganglia, and glial cells of the subject to a first stimulus or signal; and B) simultaneously exposing the neurons, ganglia, and glial cells of the subject to a second stimulus or signal. The first and second stimuli have at least one non-common parameter. In one embodiment, the first stimulus comprises a varying or constant EMF and the second stimulus is a constant or varying electrical signal. In another embodiment, the stimuli may have different values ​​for frequency, amplitude, phase polarity, relative phase, harmonic content, or width if a square waveform.

[0065] In a third embodiment, the device stimulates or modulates interactions between neurons, ganglia, and glial cells of a subject in the following manner: A) exposing neurons, ganglia, and glial cells of the subject to a first stimulus; and B) exposing neurons, ganglia, and glial cells of the subject to a second stimulus. The first stimulus and the second stimulus have one common parameter. In one embodiment, the first stimulus includes a first varying or constant EMF, and the second stimulus includes a varying or constant EMF. In another embodiment, the first varying or constant EMF and the second varying or constant EMF are provided by a compound electrical stimulus. In another embodiment, the compound electrical stimulus may be of any frequency, amplitude, phase polarity, relative phase, harmonic content, or width if it is a rectangular waveform.

[0066] In a fourth embodiment, the device stimulates or modulates interactions between neural cells, ganglia, and glial cells of a subject in the following manner: A) providing a lead array having a plurality of electrode contacts electrically connected to a source of electrical stimulation, B) electrically coupling a first subgroup of the plurality of electrode contacts to a first source of electrical stimulation or EMF, C) electrically coupling a second subgroup of the plurality of electrode contacts to a second source of electrical stimulation or EMF, D) exposing the neural cells, ganglia, and glial cells of the subject to a first electrical stimulation or EMF from the electrode contacts of the first subgroup, and E) simultaneously exposing the neural cells, ganglia, and glial cells of the subject to an electrical stimulation or EMF from the electrode contacts of the second subgroup.

[0067] In a fifth embodiment, the device modulates pain in a subject comprising activated neurons and ganglia by controlling second messengers, either calcium binding proteins, cytokines, cell adhesion or specific immune response proteins, by A) decreasing the depolarization threshold of the subject's nerve fibers with a first electrical stimulus or EMF during a first time period, and B) simultaneously modulating the neurons and ganglia with a second varying electrical stimulus or EMF during a second time period different from the first time period, causing a downregulation of nociceptors.

[0068] In a sixth embodiment, the method of addressing pain in a subject includes: A) reducing the depolarization threshold of nerve fibers in the subject with a first varying electrical stimulus or EMF during a first time period, and B) simultaneously modulating second messenger activity with a second varying electrical stimulus or EMF during a second time period different from the first time period, causing downregulation of nociceptors.

[0069] In a seventh embodiment, a method of addressing pain in a subject includes: A) reducing the depolarization threshold of nerve fibers of the subject with a first varying electrical stimulus or EMF during a first time period, and B) simultaneously modulating neuronal, ganglion, and glial cell activity with a second varying or constant EMF during a second time period different from the first time period, where the first varying electrical stimulus or EMF is provided by an electrical signal having an amplitude set to a value corresponding to a percentage of the subject's priming threshold, and the second varying or constant EMF is provided by an electrical signal having an amplitude set to a value corresponding to a percentage of the subject's paresthesia threshold (PT).

[0070] In one embodiment of the hybrid modulation therapy, the priming signal may be monophasic or biphasic, and the polarity of the first phase of the biphasic priming signal may be cathodic or anodic. In this embodiment, the tonic or burst signal may have different waveform characteristics than the priming signal. The tonic or burst signal may be monophasic or biphasic, and the polarity of the first phase of the biphasic tonic or burst signal may be cathodic or anodic.

[0071] In a seventh embodiment, a method for stimulating / modulating interactions between neurons and ganglia of a subject includes: A) exposing neurons, ganglia, and glial cells of a subject to a first stimulus; and B) simultaneously exposing neurons, ganglia, and glial cells of a subject to a second stimulus. The first and second stimuli each have a different phase polarity. In one embodiment, the first and second stimuli include an electrical stimulus or an EMF. In another embodiment, the electrical stimulus or EMF has different values ​​of frequency, amplitude, waveform shape, or width when the electrical stimulus or EMF is a square waveform.

[0072] In an eighth embodiment, a method of stimulating and modulating interactions between neural cells, ganglia, and glial cells of a subject includes: A) providing a lead array having a plurality of electrode contacts electrically coupleable to a source of electrical stimulation, B) electrically coupling a first subgroup of the plurality of electrode contacts to a first electrical stimulus or EMF source, C) electrically coupling a second subgroup of the plurality of electrode contacts to a second electrical stimulus or EMF source, D) exposing neural cells, ganglia, and glial cells of the subject to a first electrical stimulus or EMF from the electrode contacts of the first subgroup, and E) simultaneously exposing neural cells and ganglia of the subject to the second electrical stimulus or EMF from the electrode contacts of the second subgroup, wherein the first electrical stimulus or EMF and the second electrical stimulus or EMF each have distinct phase characteristics.

[0073] In a ninth embodiment, a method for addressing pain in a subject includes: A) reducing the depolarization threshold of nerve fibers in a subject with a first varying electrical stimulus or EMF; and B) simultaneously modulating neurons, ganglia, and glial cells with a second varying electrical stimulus or EMF. In one embodiment, the first varying stimulus and the second stimulus have different frequencies, amplitudes, phases, harmonic content, or widths, if square waveforms. In another embodiment, the first and second varying electromagnetic fields may be provided by a single electrical stimulus or EMF or two different electrical stimuli or EMFs.

[0074] In a tenth embodiment, a system is provided that includes a signal generation module and one or more leads configured to simultaneously expose neuronal, ganglion, and glial cells to a first electrical stimulus or EMF and a second electrical stimulus or EMF, the signal generation module configured to have an operational mode of providing first and second electrical signals to the one or more leads, the first and second electrical signals having at least one common parameter or at least one non-common parameter.

[0075] Further disclosed herein is a device including a signal generating module configured to electrically couple to one or more leads that can capture ECAP, induced magnetic fields, or HEAP to improve charge transfer to a spinal target. The system may be provided by coupling the device to one or more leads.

[0076] Optionally, the signal generating module includes at least first and second electrical signal sources or terminals, and the one or more leads include at least first and second sub-groups of electrodes, the first sub-group of electrodes may be electrically coupled to the first electrical signal source and / or terminal, and the second sub-group of electrodes may be electrically coupled to the second electrical signal source and / or terminal.

[0077] Optionally, the signal generation module is configured to have an operational mode to provide at least first and second electrical signals or EMFs corresponding to the first and second electrical stimuli or EMFs described herein. Optionally, the first and second electrical signals or EMFs have different frequencies.

[0078] Optionally, the signal generation module is configured to have an operational mode that provides electrical signals to electrodes corresponding to electrical or EMF stimulation of any of the methods described herein.

[0079] Other parameters such as pulse width and / or amplitude of the first and second electrical signals may be different. The first electrical signal may be emitted synchronously, i.e. at the same time as the second electric field, or asynchronously, e.g. with a predefined time delay with respect to the first electrical signal.

[0080] Optionally, the signal generation module is arranged to generate a composite electrical signal or EMF, which may be a sum of the first and second electrical signals or EMFs. Optionally, the signal generation module is arranged to generate a hybrid signal, such as a frequency modulated signal, an amplitude modulated signal, a harmonic modulated signal, etc. The composite signal and / or the hybrid signal may be provided to one or more leads.

[0081] Optionally, the signal generation module includes two or more electrical signal sources or EMFs, such as signal generators, configured to deliver electrical signals or EMFs that are independently controllable and have parameters that may be set respectively for each of the electrical signal sources.

[0082] Optionally, the device is a non-permanently implantable type for use in conducting clinical trials on patients, and the system includes a signal generation module having at least two signal generators configured to deliver electrical signals or EMFs, e.g., priming / tonic / burst signals, EMF signals, with parameters that may be set for each signal generator.

[0083] Optionally, an implantable hybrid generator adapted to be electrically coupled to one or more leads or optionally coupled to one or more leads is provided, the implantable hybrid generator including a generator circuit and a housing, the housing hermetically sealing the generator circuit and may be made of a durable biocompatible material, the generator having an output interface for establishing an electrical connection with electrodes mounted on one or more leads, for example first and second terminals for electrically coupling to first and second subgroups of electrodes mounted on one or more leads.

[0084] Optionally, the implantable hybrid generator includes two or more signal generators and timer electronics capable of creating a delay between signals generated from the at least two signal generators by slaveing ​​one of the signal generators to another.

[0085] In an eleventh embodiment, an EMF device is provided, comprising an output unit for connection to at least one electrode array or a plurality of electrode arrays, and a signal generator, the stimulation device being arranged to provide a hybrid stimulation signal by the output unit to the at least one electrode array or a plurality of electrode arrays. The hybrid stimulation signal may be an EMF. The at least one electrode array is configured to expose nerve cells and ganglia to the hybrid stimulation signal. The electromagnetic stimulation device may be a pain treatment device.

[0086] Optionally, the EMF device may have an output unit including a first output for connection to a first lead and a second output for connection to a second lead. The first lead may include a first electrode array. The second lead may include a second electrode array.

[0087] Optionally, the signal generator is arranged to provide a first electrical signal or EMF to the first output and a second electrical signal or EMF to the second output. The first electrical signal or EMF and the second electrical signal or EMF may differ in parameters such as amplitude, frequency, phase, phase polarity, waveform shape, and width. The first electrical signal or EMF and the second electrical signal or EMF may correspond in parameters such as amplitude, frequency, phase, phase polarity, waveform shape, and width. The second electrical signal or EMF may be a tonic or burst stimulation signal, and the first electrical signal or EMF may have a frequency higher than the frequency of the tonic or burst stimulation signal.

[0088] Optionally, the signal generator is arranged to generate a hybrid electrical signal, such as a frequency modulated signal, an amplitude modulated signal, a harmonic modulated signal, etc. The hybrid electrical signal may be provided to at least one electrode.

[0089] In a twelfth embodiment, a method for operating a signal generating module is provided. The method includes connecting the signal generating module to one or more leads. The leads may be already implanted in a subject's body. The method includes using the signal generating module to generate a first electrical signal or at least one changing EMF in one or more leads, and using the signal generating module to generate a second electrical signal or at least one changing EMF in one or more leads. The first electrical signal or changing EMF and the second electrical signal or changing EMF may have at least one non-common parameter.

[0090] In a thirteenth embodiment, a conductive material, such as a metal, is provided in the form of an electrode for applying EMF to a subject for the treatment of pain. The EMF may include a first electromagnetic stimulus and a second EMF. The first stimulus and the second stimulus may have at least one non-common parameter. The first stimulus and the second stimulus may be a signal, or a composite signal, or a hybrid signal, as described herein.

[0091] In a fourteenth embodiment, an EMF system is disclosed having a memory for storing a plurality of hybrid signal parameter programs, a selection device for selecting one of the plurality of hybrid signal parameter programs, a hybrid signal generator controllable with a selected one of the plurality of hybrid signal parameter programs, and an output unit for connecting to at least one electrode, and the stimulator is configured to provide a hybrid stimulation signal generated by the hybrid signal generator according to a selection into the hybrid signal parameter program to the at least one electrode by the output unit. The system may further include a housing made of a biocompatible material surrounding the hybrid signal generator and the output unit. In one embodiment, the hybrid signal generator generates a first and a second electrical signal or EMF in its operation mode. In one embodiment, the system may include at least a first and a second subgroup of electrodes, and the electrodes of the first subgroup may be electrically coupled to the first electrical signal and the electrodes of the second subgroup may be coupled to at least one electrode electrically coupled to the second electrical signal or EMF.

[0092] In a fifteenth embodiment, a foldable neurostimulator is disclosed with two primary states: a long and narrow profile for insertion and a wider (paddle lead) deployed profile for manipulation. The two arrays have any number of lead contacts from 8 to 64 or more. Dynamic changes result in paddle leads with any number of contacts from 16 to 128 or more. Multiple electrodes allow for variable stimulation to the target area. That is, one or more electrodes on the lead body deliver stimulation pulses to the human target tissue with the desired stimulation depending on the measured ECAP, induced magnetic field, or HEAP.

[0093] The connection of the percutaneous lead body is achieved by a number of pseudoelastic memory metal or shape memory polymer (SMP) bridges molded into each of the percutaneous arrays by a photolithography process. The bridges provide structural integrity to the array and provide the desired flexibility to the lead body. The array is housed in a sheath and has a guide wire. When the sheath is retracted, the array has a deployable region that allows the electrode array to be formed into a paddle lead. The process is reversible if the device needs to be repositioned or removed completely. Next, a method of positioning and fixing the electrodes is described. The tip of the array may have a circular, elliptical, parabolic or hyperbolic opening for a guide wire. The elongated parts are a number of leads, which are fixed to each other where they cross each other. The elongated parts are a number of pseudoelastic memory metals or polymers that allow the device to conform to the underlying neural structure when exposed to body temperature when introduced into the body. The paddle array may or may not have insulating material that allows for unidirectional stimulation, but not insulating material that allows for circumferential stimulation.

[0094] In another embodiment, it is a planar coil that provides a magnetic flux that produces a modulating effect on the interaction between the neuronal cells, ganglia and neuroglia cells. The planar coil may have between 2 and 1 million turns. The planar coil may be stacked on itself to provide an additive effect, thereby producing a larger magnetic flux. The shape of the planar coil may be circular, elliptical, ovoid, parabolic or hyperbolic. It may also be triangular, square, rectangular, rhombus, parallelogram, trapezoid, pentagonal, hexagonal, heptagonal, octagonal, nonagonal or decagonal. The turns may be in a clockwise, counterclockwise or both format.

[0095] A cylindrical coil that provides a magnetic flux that produces a modulating effect on the interaction between neurons, ganglia, and neuroglia. The cylindrical coil may be a coil with 2 to 1 million turns. The planar coil can be stacked on itself to provide an additive effect, thereby producing a larger magnetic flux. The shape of the planar coil may be circular, elliptical, ovoid, parabolic, hyperbolic, or a combination thereof. It may also be triangular, square, rectangular, rhombus, parallelogram, trapezoid, pentagonal, hexagonal, heptagonal, octagonal, nonagonal, decagonal, or a combination thereof. The turns may be in a clockwise, counterclockwise, or both formats.

[0096] During use, the device must be powered. There are various power sources. Batteries, optionally placed outside or inside the body, power the device with chemical energy converted to electrical energy. Power may also be provided wirelessly. This may be achieved using coupled radio frequency antennas, acoustic transducers, optogenetics, or optoelectronics.

[0097] As a further alternative, an internal generator recharges the battery and converts kinetic energy into electrical energy.

[0098] Such generators, called nanogenerators due to their small size, can operate in different ways: piezoelectric, triboelectric, or pyroelectric. Piezoelectric and triboelectric nanogenerators convert mechanical energy into electrical power. Pyroelectric nanogenerators can convert thermal energy into mechanical energy.

[0099] In another embodiment, the nanogenerator may be integrated into the array, thereby eliminating the need for an IPG.

[0100] In another embodiment, the device can be used in spinal cord injury (SCI) patients by helping mesenchymal stem cells, exosomes and second messengers migrate to the targeted area of ​​injury via 40 Hz EMF frequency.

[0101] In another embodiment, the device may include the use of an ultrasound endoscope, which allows for three-dimensional imaging of target tissue for interventional therapy or surgery, and the map is incorporated into the software programming of the device, which is not the current standard of care.

[0102] ACTIVE System = Adaptive, Computational, Neuromap, Image Overlay (3D), Vector Overlay, Epidural Ultrasound.

[0103] ADAPTIVE = Artificial Intelligence, Definition, Adaptation, Pacing, Neuromap, Images (3D), Vectors, Epidural Ultrasound.

[0104] In another embodiment, the cylindrical coil is housed in a disk on the device that rotates from 0 to 360 degrees, allowing the device to control electrical currents or eddy currents to provide neuromodulatory effects between neurons (including nociceptors), ganglia, neurovasculature and glial cells. The rotating disk may be dependent on a 3D software program that uses the epidural ultrasound and / or post-operative imaging.

[0105] In another embodiment, the planar coil is housed in a disk on the device that tilts in one or more axes, allowing the device to control electrical currents or eddy currents to provide a neuromodulatory effect between neurons (including nociceptors), ganglia, neurovasculature and glial cells. The tilting disk may be dependent on a 3D software program using the epidural ultrasound and / or post-operative imaging.

[0106] In another embodiment, ultrasound, for example, focused ultrasound (FUS), may be used to provide neuromodulation by amplitude modulation to generate neuromodulatory effects on the interactions between neurons of the central nervous system, peripheral nervous system, sympathetic nervous system, and parasympathetic nervous system, and between ganglia and glial cells, to reduce pain. FUS is 1-20 megahertz. At low intensities, FUS provides an inhibitory effect (increased firing rate of inhibitory interneurons) and at high intensities provides an excitatory effect (increased firing rate of excitatory neurons).

[0107] In another embodiment, the device may be used in Deep Brain Stimulation (DBS), Tumor Treating Fields (TTF), Vagus Nerve Stimulation (Epilepsy, Cardiac Arrhythmia), Cardiac Conduction Disorders (Ventricular Arrhythmia, Atrial Arrhythmia, Heart Failure, Sick Sinus Syndrome, Syncope / Orthostatic Tachycardia Syndrome (POTS), Heart Transplant), Sleep Apnea, Peripheral Nerve Stimulation, Spinal Cord Injury (Using 40Hz Stimulation to Induce Stem Cell Migration to Target), Bioelectronics for Prosthetic Organs, Diaphragm Pacer.

[0108] In another embodiment, the device may include a fiber endoscope, which allows live video recording of interventional therapy or surgery, which is not the current standard of care.

[0109] It will be understood that any aspect, feature, and option described in terms of the method applies equally to the system, signal generation module, and stimulation device. It will be understood that any one or more of the above aspects, features, and options described herein may be combined. [Brief description of the drawings]

[0110] The invention will be best understood by those skilled in the art from the following detailed description when considered in conjunction with the drawings. [Figure 1A] FIG. 1A shows a diagram of a cylindrical embodiment of a foldable neurostimulation device. [Figure 1B] FIG. 1B shows a diagram of insertion of a foldable neurostimulator device expanding in width. [Diagram 2] FIG. 2 shows a diagram of a cylindrical nerve stimulator. [Diagram 3] FIG. 3 shows an anatomical view of the insertion of a foldable neurostimulator device. [Figure 4] FIG. 4 shows a close-up view of the insertion of the foldable neurostimulator device. [Diagram 5] FIG. 5 shows a schematic diagram of a first means for powering a foldable neurostimulator device. [Figure 6] FIG. 6 shows a schematic diagram of a second means for powering the foldable neurostimulator. [Figure 7] FIG. 7 shows a schematic diagram of a third means for powering the foldable neurostimulator, incorporated in its lead. [Figure 8] FIG. 8 shows a front isometric view of an embodiment of Closed Loop Omnidirectional Neuromodulation with Eddy Currents (CLONE). [Figure 9] FIG. 9 shows a rear isometric view of an embodiment of closed-loop omnidirectional neuromodulation with eddy currents (CLONE). [Figure 10] FIG. 10 shows front and side views of an embodiment of closed-loop omnidirectional neuromodulation with eddy currents (CLONE). [Figure 11] FIG. 11 shows an isometric view of a cylindrical embodiment of Closed-Loop Omnidirectional Neuromodulation with Eddy Currents (CLONE). [Figure 12] FIG. 12 shows a side view of a cylindrical embodiment of closed-loop omnidirectional neuromodulation with eddy currents (CLONE). [Figure 13] FIG. 13 shows an exemplary coil used as an electrode. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0111] The present disclosure will be more fully understood through the following description, which should be read in conjunction with the drawings, in which like numbers refer to like elements in various embodiments of the present disclosure. Those skilled in the art will readily appreciate that the methods, apparatus, and systems described herein are merely exemplary, and that modifications can be made without departing from the spirit and scope of the present disclosure.

[0112] The techniques disclosed herein may be accomplished through minimally invasive procedures that may require surgical implantation in certain circumstances, but are preferable to those requiring significant surgical intervention and medical costs. In one embodiment, the lead includes a cylindrical arrangement of multiple electrodes, e.g., 8 to 64. The diameter of the lead may be small enough to allow percutaneous implantation into the spinal canal using an epidural needle, in standard clinical practice. The electrodes are made of biocompatible materials such as titanium nitride, boron doped diamond (BDD), poly(3,4-ethylenedioxythiophene (PEDOT), thiol-ene acrylate polymer, silicon carbide, platinum-iridium alloy, and the materials are corrosion resistant. For example, a 50 cm long lead implemented with eight electrodes may have a diameter of 1.35 mm, with each cylindrical electrode being 3.0 mm long and with 4.0 mm spacing between electrodes. Wires may extend from the electrodes to the distal portion of the lead and into a metal connector. The wires may be encapsulated in a triple insulated container made of a biocompatible material such as pseudoelastic memory metal, or SMP.

[0113] Reference will now be made in detail to the presently preferred embodiments of the invention, examples of which are illustrated in the accompanying drawings, in which like reference numerals refer to like elements in all figures throughout the following detailed description.

[0114] Please refer to Figures IA and IB, which show diagrams of a cylindrical embodiment of a foldable neurostimulation device.

[0115] The foldable neurostimulator 1 includes a guidewire 10 and a sheath 12 having an electrode 50 positioned along a lead 14 (see FIG. 2).

[0116] The body 30 folds along a first hinge 32 and a second hinge 34 .

[0117] The foldable neurostimulator 1 is formed from a main part 60 having a first arm 62 , a second arm 64 and a folding ramp 66 .

[0118] Please refer to FIG. 2, which shows the insertion of a foldable neurostimulator device.

[0119] The foldable neurostimulator 1 is percutaneously inserted through the epidural space between the vertebrae 206. The guide tube 15 guides the lead 14 between the vertebrae T12 and L1. This insertion point is shown by way of example only.

[0120] Please refer to Figures 3 and 4 which show an anatomical and close-up view of the insertion of a foldable neurostimulator device.

[0121] The foldable neurostimulator 1 is inserted into the patient 200 through the skin 202 into the spine 204 between the vertebrae 206 via a percutaneous epidural approach.

[0122] The lead wire 14 passes over the guidewire 10 and into position within the sheath 12 .

[0123] Please refer to Figures 5, 6 and 7 which show three schematic diagrams of means for powering a foldable neurostimulator device.

[0124] 5, the power and control unit 160 is completely internal. One or more piezoelectric generators 70 each include a cantilever arm 72 and a weight 74, and generate and store power in the IPG 90. The power is delivered to the foldable neurostimulator 1 using a power transmission cable 92.

[0125] 6, power is provided by a triboelectric generator 80. Movement of the first element 82 relative to the second element 84 generates power that is stored in the IPG 90 and is carried by a power transmission cable 92 back to the foldable neurostimulator 1.

[0126] 7, power is provided by a triboelectric generator 80, which is integrated into the body of the foldable neurostimulator 1. As previously described, movement of the first element 82 relative to the second element 84 generates power which is stored in the IPG 90.

[0127] Please refer to Figures 8 to 10, which show a second embodiment of a nerve stimulation device.

[0128] The nerve stimulator 100 includes a body 102 having an optional arm 104 with a suture hole 106 .

[0129] The neurostimulator 100 is connected to the implantable pulse generator via electrical contacts 110. The contacts 110 transmit or deliver electrical signals across the array to the neurostimulator 100 via electrical leads 112.

[0130] The leads are connected to components of the neurostimulator 100 , including one or more recording / reference electrodes 120 , a first magnetic planar coil 122 , a second magnetic planar coil 124 , an anode 126 , and a cathode 128 .

[0131] During operation, the implantable pulse generator causes the first magnetic planar coil 122 and the second magnetic planar coil 124 to emit magnetic signals and the anode 126 and cathode 128 to emit electrical signals. The resulting evoked compound action potentials are sensed by the recording / reference electrode 120 and reported to the implantable pulse generator. The implantable pulse generator processes the resulting data, calculates a response, and emits a set of subsequent magnetic and electrical signals. The process is repeated as the implantable pulse generator continually optimizes signal delivery to provide the most effective pain relief while managing power consumption to conserve power reserves.

[0132] Please refer to Figures 11 and 12, which show a cylindrical embodiment of a foldable neurostimulator device.

[0133] Again shown is a neurostimulator 100 having a body 102 , a recording / reference electrode 120 , a first magnetic cylindrical coil 123 , a second magnetic cylindrical coil 125 , an anode 126 , and a cathode 128 .

[0134] 13, which illustrates an exemplary coil. An embodiment of the electrode 50 includes a planar coil 130 and a cylindrical coil 132.

[0135] Equivalent elements may be substituted for the elements described above, functioning in substantially the same way in substantially the same way to achieve substantially the same results.

[0136] It will be appreciated that the above-described system and method and many of its advantages will be understood from the foregoing description. It will also be apparent that various changes can be made in the form, construction and arrangement of its components without departing from the scope and spirit of the invention or sacrificing all of its significant advantages. The forms described above are merely exemplary and illustrative embodiments.

Claims

1. 1. A neurostimulation device for insertion into a patient's spine, comprising: Including lead wires, The lead has a proximal portion and a distal portion; the distal portion is capable of unfolding and expanding after insertion into the patient; the expanded distal portion is wider than the proximal portion, allowing for insertion of a lead that expands to a size larger than could be directly inserted; being made of a pseudoelastic memory metal or shape memory polymer that deploys when warmed by body heat from the patient, thereby allowing the lead to automatically deploy and reducing the number of steps a surgeon must take to place the lead; A neurostimulator device in which a planar coil is incorporated into the pseudoelastic memory metal or shape memory polymer, the planar coil conforming to structures in the central or peripheral nervous system to provide more effective neuromodulation.

2. 2. The nerve stimulation device according to claim 1, wherein the pseudoelastic memory metal or shape memory polymer is a biocompatible material.

3. 2. The nerve stimulation device of claim 1, wherein a cylindrical coil is also incorporated into the pseudoelastic memory metal or shape memory polymer, the cylindrical coil conforming to the structures in the central or peripheral nervous system to provide more effective neuromodulation.

4. A nerve stimulation device as described in claim 1, wherein the cylindrical coil is housed in a disk that can rotate from 0 to 360 degrees, thereby enabling the nerve stimulation device to manipulate electric currents or eddy currents that produce a neuromodulatory effect.

5. 2. The neurostimulator of claim 1, wherein the planar coil is housed in a disk that is tilted in one axis or in a number of different axes, thereby enabling the neurostimulator to manipulate electrical currents or eddy currents that produce a neuromodulatory effect.

6. 2. The neurostimulator device of claim 1, further comprising two or more magnets that interact to hold a first intermediate portion of the lead to a second intermediate portion of a second lead.

7. 10. The neurostimulator device of claim 1, further comprising an implantable pulse generator connected to said lead.

8. further comprising a nanogenerator that functions as an implantable pulse generator; The nanogenerator converts kinetic energy into electrical energy; 2. The nerve stimulation device of claim 1, wherein the electrical energy is used to charge the leads.

9. An implantable pulse generator is incorporated into the lead, 10. The neurostimulation device of claim 1, wherein the neurostimulation device is a self-powered system that does not require a separate implantable pulse generator.

10. 5. The neurostimulation device of claim 4, wherein the cylindrical coil conforms to structures in the central or peripheral nervous system to provide more effective neuromodulation.

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