Therapeutic window determination

Patent metadata

Field	Value
Publication number	US-10086203-B2
Application number	US-201715842105-A
Country	US
Kind code	B2
Filing date	Dec 14, 2017
Priority date	Mar 3, 2014
Publication date	Oct 2, 2018
Grant date	Oct 2, 2018

Abstract

A therapeutic window for at least one electrode of a medical system may be determined based on a volume of tissue expected to be activated (“VTA”) by electrical stimulation delivered by the at least one electrode. In some examples, a processor determines the therapeutic window for a particular electrode by at least determining an efficacy threshold based on the VTA expected to result from the delivery of electrical stimulation according to a set of electrical stimulation parameter values including the stimulation parameter at the efficacy threshold, and determining an adverse-effects threshold based on the VTA expected to result from the delivery of electrical stimulation according to a set of electrical stimulation parameter values including the stimulation parameter at the adverse-effects threshold.

First claim

What is claimed is:

1. A method comprising:
determining, by a processor, an efficacy threshold value of at least one electrical stimulation parameter, wherein the efficacy threshold value is determined based on a volume of tissue activation expected to result from delivery of electrical stimulation by an electrode to a patient;
determining, by the processor, that an adverse-effects threshold value of the at least one electrical stimulation parameter is unknown; and
selecting, by the processor and in response to determining that the adverse-effects threshold value of the at least one stimulation parameter is unknown, a predetermined adverse-effects threshold value of the at least one stimulation parameter.

2. The method of claim 1 , wherein determining the efficacy threshold value comprises selecting the efficacy threshold value from a memory.

3. The method of claim 1 , further comprising:
determining, by the processor, a therapeutic window of the at least one electrical stimulation parameter for the electrode based on the efficacy threshold value and the predetermined adverse-effects threshold value; and
storing the therapeutic window with an indication of the electrode in a memory.

4. The method of claim 1 , further comprising:
determining, by the processor, a therapeutic window of the at least one electrical stimulation parameter for the electrode based on the efficacy threshold value and the predetermined adverse-effects threshold value; and
controlling, by the processor, a medical device to deliver the electrical stimulation to the patient according to a value of the electrical stimulation parameter that is within the therapeutic window.

5. The method of claim 1 , wherein the volume of tissue activation comprises a first volume of tissue activation, wherein determining the efficacy threshold value comprises determining a first value of the at least one electrical stimulation parameter at which the first volume of tissue activation overlaps with one or more first regions of tissue of the patient, wherein the predetermined adverse-effects threshold value comprises a second value of the at least one electrical stimulation parameter, and wherein delivery of electrical stimulation by the electrode and according to the predetermined adverse-effects threshold value is expected to result in a second volume of tissue activation that does not overlap with one or more second regions of tissue of the patient that are different from the one or more first regions of tissue.

6. The method of claim 5 , wherein determining the first value of the at least one electrical stimulation parameter comprises:
selecting a third value of the at least one electrical stimulation parameter;
determining a third volume of tissue activation expected to result from delivery of electrical stimulation with the third value of the at least one electrical stimulation parameter by the electrode;
determining whether the third volume of tissue activation overlaps with the one or more first regions of tissue, wherein the one or more first regions of tissue are associated with efficacious electrical stimulation;
in response to determining the third volume of tissue activation does not overlap with the one or more first regions of tissue, increasing the third value to a fourth value of the at least one electrical stimulation parameter;
determining a fourth volume of tissue activation expected to result from delivery of electrical stimulation with the fourth value of the at least one electrical stimulation parameter by the electrode;
determining whether the fourth volume of tissue activation overlaps with the one or more first regions of tissue; and
in response to determining the fourth volume of tissue activation overlaps with the one or more first regions of tissue, selecting the fourth value as the first value.

7. The method of claim 5 , wherein determining that the adverse-effects threshold value of the at least one stimulation parameter is unknown comprises:
selecting a third value of the at least one electrical stimulation parameter;
determining a third volume of tissue activation expected to result from delivery of electrical stimulation with the third value of the at least one electrical stimulation parameter by the electrode;
determining whether the third volume of tissue activation overlaps with the one or more second regions of tissue, wherein the one or more second regions of tissue are associated with adverse effects of electrical stimulation;
in response to determining the third volume of tissue activation does not overlap with the one or more second regions of tissue, increasing the third value to a fourth value of the at least one electrical stimulation parameter;
determining a fourth volume of tissue activation expected to result from delivery of electrical stimulation with the fourth value of the at least one electrical stimulation parameter by the electrode;
determining whether the fourth volume of tissue activation overlaps with the one or more second regions of tissue; and
in response to determining the fourth volume of tissue activation does not overlap with the one or more second regions of tissue, determining that the adverse-effects threshold is unknown.

8. The method of claim 7 , wherein the predetermined adverse-effects threshold value comprises a sum of a predetermined incremental value of the at least one electrical stimulation parameter and a predetermined maximum value of the at least one electrical stimulation parameter, the predetermined incremental value comprising a difference between the third value of the at least one electrical stimulation parameter and the fourth value of the at least one electrical stimulation parameter.

9. A system comprising:
a memory; and
a processor configured to:
determine an efficacy threshold value of at least one electrical stimulation parameter, wherein the efficacy threshold value is determined based on a volume of tissue activation expected to result from delivery of electrical stimulation by an electrode to a patient,
determine that an adverse-effects threshold value of the at least one electrical stimulation parameter is unknown, and
select, from the memory and in response to determining that the adverse-effects threshold value of the at least one stimulation parameter is unknown, a predetermined adverse-effects threshold value of the at least one stimulation parameter.

10. The system of claim 9 , wherein the processor is configured to determine the efficacy threshold value by at least selecting the efficacy threshold value from the memory.

11. The system of claim 9 , wherein the processor is further configured to:
determine a therapeutic window of the at least one electrical stimulation parameter for the electrode based on the efficacy threshold value and the predetermined adverse-effects threshold value, and
store the therapeutic window with an indication of the electrode in the memory.

12. The system of claim 9 , further comprising a medical device, wherein the processor is further configured to:
determine a therapeutic window of the at least one electrical stimulation parameter for the electrode based on the efficacy threshold value and the predetermined adverse-effects threshold value, and
control the medical device to deliver the electrical stimulation to the patient according to a value of the electrical stimulation parameter that is within the therapeutic window.

13. The system of claim 9 , wherein the volume of tissue activation comprises a first volume of tissue activation, wherein the processor is configured to determine the efficacy threshold value by at least determining a first v

Assignees

• Medtronic Inc

Inventors

• Kaemmerer William F

Classifications

• A61N1/36139 Primary

  with automatic adjustment · CPC title

• A61N1/37247

  User interfaces, e.g. input or presentation means · CPC title

• A61N1/36142

  for improving safety · CPC title