Methods for peripheral nerve stimulation

Patent metadata

Field	Value
Publication number	US-2020254251-A1
Application number	US-202016780758-A
Country	US
Kind code	A1
Filing date	Feb 3, 2020
Priority date	Jun 2, 2014
Publication date	Aug 13, 2020
Grant date	—

Abstract

A peripheral nerve stimulator can be used to stimulate a peripheral nerve to treat essential tremor, Parkinsonian tremor, and other forms of tremor. The stimulator can have electrodes that are placed circumferentially around the patient's wrist or arm. Specific nerves in the wrist or arm can be targeted by appropriate spacing of the electrodes. Positioning the electrodes on generally opposing sides of the target nerve can result in improved stimulation of the nerve. The stimulation pattern may alternate between the nerves. Improved stimulation algorithms can incorporate tremor feedback, external data, predictive adaptation, and long-term monitoring data.

First claim

1 - 31 . (canceled)

32 . A transcutaneous method of stimulating at least one nerve in an arm or wrist of a patient, the method comprising:
placing a circumferential band comprising a first electrode and a second electrode around the patient's arm or wrist in a configuration such that in a transverse cross-sectional plane of the arm or wrist there is a 90 degree to 180 degree angle between a line extending between a first nerve and the first electrode and a line extending between the first nerve and the second electrode, wherein the first and second electrodes are spaced a predetermined distance apart, wherein the first electrode and the second electrode comprise a carbon material, and delivering a first electrical stimulus between the first and second electrodes to preferentially stimulate the first nerve, the first electrical stimulus generated from a pulse generator, wherein the first electrical stimulus comprises a burst stimulus.

33 . The method of claim 32 ,
wherein the method further comprises: delivering a second electrical stimulus from the first electrode and the third electrode to excite the second nerve, the second electrical stimulus generated from the pulse generator; measuring one or more physiologic characteristics of the patient using a sensor; temporally offsetting the first electrical stimulus from the second electrical stimulus by a period of time; and adjusting the first electrical stimulus based upon the measured one or more physiologic characteristics, wherein the first electrical stimulus and the second electrical stimulus comprise burst stimuli, wherein the band comprises a third electrode spaced a predetermined distance apart from the first and second electrodes such that there is a 90 degree to 180 degree angle between a line extending between a second nerve and the first electrode and a line extending between the second nerve and the third electrode.

34 . The method of claim 32 , wherein the band comprises a third electrode spaced a predetermined distance apart from the first and second electrodes such that there is a 90 degree to 180 degree angle between a line extending between a second nerve and the first electrode and a line extending between the second nerve and the third electrode.

35 . The method of claim 34 , further comprising delivering a second electrical stimulus from the first electrode and the third electrode to stimulate the second nerve, the second electrical stimulus generated from the pulse generator.

36 . The method of claim 32 , further comprising measuring one or more physiologic characteristics of the patient via a sensor operably connected to the band.

37 . The method of claim 36 , further comprising adjusting the first electrical stimulus based upon the one or more measured physiologic characteristics.

38 . The method of claim 35 , further comprising temporally offsetting the first electrical stimulus from the second electrical stimulus by a preset period of time.

39 . The method of claim 35 , wherein the first electrical stimulus and the second electrical stimulus comprise patterned stimuli.

40 . The method of claim 39 , wherein the first electrical stimulus and the second electrical stimulus comprise burst stimuli.

41 . The method of claim 40 , wherein the burst stimuli are non-overlapping.

42 . The method of claim 35 , wherein the first electrical stimulus and the second electrical stimulus comprise waveforms with ramped amplitudes.

43 . The method of claim 32 , wherein the first electrical stimulus has a duration between 20 and 60 minutes.

44 . A transcutaneous method of stimulating at least one nerve in an upper extremity of a patient, the method comprising:
placing a band comprising a first electrode and a second electrode circumferentially around the patient's upper extremity in a configuration such that in a transverse cross-sectional plane of the arm or wrist there is a 90 degree to 180 degree angle between a line extending between a first nerve in the patient's upper extremity and the first electrode and a line extending between the first nerve and the second electrode, wherein the first and second electrodes are spaced a predetermined distance apart; and delivering a first electrical stimulus from the first and second electrodes to excite the first nerve, the first electrical stimulus generated from the pulse generator.

45 . The method of claim 44 ,
wherein the first electrical stimulus and the second electrical stimulus comprise patterned stimuli, wherein the band comprises a third electrode spaced a predetermined distance apart from the first and second electrodes such that there is a 90 degree to 180 degree angle between a line extending between a second nerve and the first electrode and a line extending between the second nerve and the third electrode, wherein the method further comprises: delivering a second electrical stimulus from the first electrode and the third electrode to excite the second nerve, the second electrical stimulus generated from the pulse generator; measuring one or more physiologic characteristics of the patient using a sensor; temporally offsetting the first electrical stimulus from the second electrical stimulus by a period of time; and adjusting the first electrical stimulus based upon the one or more measured physiologic characteristics.

46 . The method of claim 44 , wherein the band comprises a third electrode spaced a predetermined distance apart from the first and second electrodes such that there is a 90 degree to 180 degree angle between a line extending between a second nerve and the first electrode and a line extending between the second nerve and the third electrode, the second nerve selected from the patient's median, radial and ulnar nerves.

47 . The method of claim 46 , wherein the first electrical stimulus and the second electrical stimulus comprise burst stimuli.

48 . The method of claim 46 , wherein the first electrical stimulus and the second electrical stimulus comprise waveforms with ramped amplitudes.

49 . A transcutaneous method of stimulating at least one nerve in the upper extremity of a patient, the method comprising:
providing a band and housing having a predetermined circumferential spacing for a first electrode, a second electrode, and a third electrode, wherein the predetermined circumferential spacing is based on the determined circumference of the patient's wrist, wherein the housing encloses a pulse generator configured to be in electrical communication with the first electrode, the second electrode, and the third electrode, wherein the band and housing are configured to be positioned on the upper extremity such that the first electrode is positioned along the midline of the dorsal side of the upper extremity, the second electrode is positioned approximately along the midline of the ventral side of the upper extremity, and the third electrode is positioned in between the first electrode and second electrode, wherein the first electrode and the second electrode form a first electrode pair and the first electrode and third electrode form a second electrode pair; stimulating a first nerve by delivering a first electrical stimulus between the first electrode pair; and stimulating a second nerve by delivering a second electrical stimulus between the second electrode pair.

50 . The method of claim 49 , further comprising:
temporally offsetting the first electrical stimulus from the second electrical stimulus by a period of time; and adjusting the first electrical

Assignees

• Cala Health Inc

Inventors

• Wong Serena Hanying
• Rosenbluth Kathryn H
• Hamner Samuel Richard
• Chidester Paula
• Delp Scott L
• Sanger Terence D
• Klein David

Classifications

• A61B5/1101

  Detecting tremor · CPC title

• A61N1/0484

  Garment electrodes worn by the patient · CPC title

• A61N1/36014 Primary

  External stimulators, e.g. with patch electrodes (external pacemakers A61N1/3625) · CPC title

• A61B5/6824

  Arm or wrist · CPC title

• A61N1/0496

  characterised by using specific chemical compositions, e.g. hydrogel compositions, adhesives · CPC title