The present disclosure is directed to the area of implantable electrical stimulation systems and methods of making and using the systems. The present disclosure is also directed to a connector assembly for an electrical stimulation system, as well the system and methods for making and using the connector.
Implantable electrical stimulation systems have proven therapeutic in a variety of diseases and disorders. For example, spinal cord stimulation systems have been used as a therapeutic modality for the treatment of chronic pain syndromes. Peripheral nerve stimulation has been used to treat chronic pain syndrome and incontinence, with a number of other applications under investigation. Deep brain stimulation can be used to treat a variety of diseases and disorders.
Stimulators have been developed to provide therapy for a variety of treatments. A stimulator can include a control module (with a pulse generator) and one or more stimulator electrodes. The one or more stimulator electrodes can be disposed along one or more leads, or along the control module, or both. The stimulator electrodes are in contact with or near the nerves, muscles, or other tissue to be stimulated. The pulse generator in the control module generates electrical pulses that are delivered by the electrodes to body tissue.
One aspect is a stimulation system that includes a connector defining a connector port and a connector lumen extending from the port, the connector including a plurality of connector contacts disposed along the connector lumen; and an implantable lead including a lead body having a proximal end section and a distal end section, electrodes arranged along the distal end section of the lead body, terminals arranged along the proximal end section of the lead body, wherein at least one of the terminals includes an indented circumferential groove, and conductors extending within the lead body and electrically coupling the electrodes to the terminals. The connector lumen is configured for user insertion of the proximal end section of the lead body of the lead and, when fully inserted, align the connector contacts of the connector with the terminals of the lead. The connector and lead are configured so that alignment of the at least one of the terminals with the indented circumferential groove with a one of the connector contacts produces a tactile sensation for the user inserting the proximal end section of the lead body into the connector lumen.
In at least some aspects, a distalmost terminal of the plurality of terminals includes the indented circumferential groove. In at least some aspects, a plurality of the terminals each includes the indented circumferential groove.
In at least some aspects, the indented circumferential groove extends around an entire circumference of the at least one terminal. In at least some aspects, the indented circumferential groove does not extend around an entire circumference of the at least one terminal, but does extend around at least 20% of the circumference of the at least one terminal.
Another aspect is a stimulation system that includes a connector defining a connector port and a connector lumen extending from the port, the connector including a plurality of connector contacts disposed along the connector lumen; and an implantable lead including a lead body having a proximal end section and a distal end section and including spacers, electrodes arranged along the distal end section of the lead body, terminals arranged along the proximal end section of the lead body, wherein each of the spacers separates adjacent terminals, and conductors extending within the lead body and electrically coupling the electrodes to the terminals. Either i) at least one of the spacers has a larger outer diameter than an outer diameter of the terminals or ii) at least one of the terminals has a larger outer diameter than an outer diameter of the spacers. The connector lumen is configured for user insertion of the proximal end section of the lead body of the lead and, when fully inserted, align the connector contacts of the connector with the terminals of the lead. The connector and lead are configured so that, as the at least one of the spacers or the at least one of the electrodes with the larger outer diameter is inserted past each of the connector contacts, a tactile sensation for the user inserting the proximal end section of the lead body into the connector lumen is produced.
In at least some aspects, the at least one of the spacers has the larger outer diameter. In at least some aspects, a spacer proximal to, and adjacent, a distalmost terminal of the plurality of terminals has the larger outer diameter. In at least some aspects, a plurality of the spacers have the larger outer diameter.
In at least some aspects, the at least one of the terminals has the larger outer diameter. In at least some aspects, a penultimate terminal, with respect to the proximal end of the lead, of the plurality of terminals has the larger outer diameter. In at least some aspects, a plurality of the terminals have the larger outer diameter.
Yet another aspect is a stimulation system that includes a connector defining a connector port and a connector lumen extending from the port, the connector including connector contacts disposed along the connector lumen and a retention contact disposed along the connector lumen or distal to the connector lumen. The stimulation system also includes an implantable lead including a lead body having a proximal end section and a distal end section, electrodes arranged along the distal end section of the lead body, terminals arranged along the proximal end section of the lead body, a retention sleeve disposed along the proximal end section of the lead body and distal to the terminals, wherein the retention sleeve includes an indented circumferential groove, and conductors extending within the lead body and electrically coupling the electrodes to the terminals. The connector lumen is configured for user insertion of the proximal end section of the lead body of the lead and, when fully inserted, align the connector contacts of the connector with the terminals of the lead. The connector and lead are configured so that alignment of the indented circumferential groove of the retention sleeve with the retention contact produces a tactile sensation for the user inserting the proximal end section of the lead body into the connector lumen.
In at least some aspects, the indented circumferential groove extends around an entire circumference of the retention sleeve. In at least some aspects, the indented circumferential groove does not extend around an entire circumference of the retention sleeve, but does extend around at least 20% of the circumference of the retention sleeve.
In at least some aspects, the connector includes a retention block with a contact housing within which the retention contact is disposed. In at least some aspects, the retention block further defines a retention lumen for receiving a retaining element for pressing against the retention sleeve of the lead for retention of the lead within the connector. In at least some aspects, the retention block does not include a retention lumen and the retention contact is configured for exerting a force to retain the lead within the connector. In at least some aspects, the contact housing and the retention contact are adhesively attached to a remainder of the connector. In at least some aspects, the retention contact is configured to only be released from the circumferential groove by use of a tool inserted into the retention block.
Non-limiting and non-exhaustive embodiments of the present invention are described with reference to the following drawings. In the drawings, like reference numerals refer to like parts throughout the various figures unless otherwise specified.
For a better understanding of the present invention, reference will be made to the following Detailed Description, which is to be read in association with the accompanying drawings, wherein:
The present disclosure is directed to the area of implantable electrical stimulation systems and methods of making and using the systems. The present disclosure is also directed to a connector assembly for an electrical stimulation system, as well the system and methods for making and using the connector.
Suitable implantable electrical stimulation systems include, but are not limited to, a least one lead with one or more electrodes disposed on a distal portion of the lead and one or more terminals disposed on one or more proximal portions of the lead. Leads include, for example, percutaneous leads, paddle leads, cuff leads, or any other arrangement of electrodes on a lead. Examples of electrical stimulation systems with leads are found in, for example, U.S. Pat. Nos. 6,181,969; 6,516,227; 6,609,029; 6,609,032; 6,741,892; 7,244,150; 7,450,997; 7,672,734;7,761,165; 7,783,359; 7,792,590; 7,809,446; 7,949,395; 7,974,706; 8,175,710; 8,224,450; 8,271,094; 8,295,944; 8,364,278; 8,391,985; and 8,688,235; and U.S. Patent Applications Publication Nos. 2007/0150036; 2009/0187222; 2009/0276021; 2010/0076535; 2010/0268298; 2011/0005069; 2011/0004267; 2011/0078900; 2011/0130817; 2011/0130818; 2011/0238129; 2011/0313500; 2012/0016378; 2012/0046710; 2012/0071949; 2012/0165911; 2012/0197375; 2012/0203316; 2012/0203320; 2012/0203321; 2012/0316615; 2013/0105071; and 2013/0197602, all of which are incorporated herein by reference. In the discussion below, a percutaneous lead will be exemplified, but it will be understood that the methods and systems described herein are also applicable to paddle leads and other leads.
A percutaneous lead for electrical stimulation (for example, deep brain, spinal cord, or peripheral nerve stimulation) includes stimulation electrodes that can be ring electrodes, segmented electrodes that extend only partially around the circumference of the lead, or any other type of electrode, or any combination thereof. The segmented electrodes can be provided in sets of electrodes, with each set having electrodes circumferentially distributed about the lead at a particular longitudinal position. A set of segmented electrodes can include any suitable number of electrodes including, for example, two, three, four, or more electrodes. For illustrative purposes, the leads are described herein relative to use for deep brain stimulation, but it will be understood that any of the leads can be used for applications other than deep brain stimulation, including spinal cord stimulation, peripheral nerve stimulation, dorsal root ganglion stimulation, sacral nerve stimulation, or stimulation of other nerves, muscles, and tissues.
Turning to
The system 10 can also include one or more of an external remote control (RC) 16, a clinician's programmer (CP) 18, an external trial stimulator (ETS) 20, or an external charger 22. The IPG and ETS are examples of control modules for the electrical stimulation system.
The IPG 14 is physically connected, optionally via one or more lead extensions 24, to the stimulation lead(s) 12. Each lead carries multiple electrodes 26 arranged in an array. The IPG 14 includes pulse generation circuitry that delivers electrical stimulation energy in the form of, for example, a pulsed electrical waveform (i.e., a temporal series of electrical pulses) to the electrode array 26 in accordance with a set of stimulation parameters. The implantable pulse generator can be implanted into a patient's body, for example, below the patient's clavicle area or within the patient's buttocks or abdominal cavity or at any other suitable site. The implantable pulse generator can have multiple stimulation channels which may be independently programmable to control the magnitude of the current stimulus from each channel. In some embodiments, the implantable pulse generator can have any suitable number of stimulation channels including, but not limited to, 4, 6, 8, 12, 16, 32, or more stimulation channels. The implantable pulse generator can have one, two, three, four, or more connector ports, for receiving the terminals of the leads and/or lead extensions.
The ETS 20 may also be physically connected, optionally via the percutaneous lead extensions 28 and external cable 30, to the stimulation leads 12. The ETS 20, which may have similar pulse generation circuitry as the IPG 14, also delivers electrical stimulation energy in the form of, for example, a pulsed electrical waveform to the electrode array 26 in accordance with a set of stimulation parameters. One difference between the ETS 20 and the IPG 14 is that the ETS 20 is often a non-implantable device that is used on a trial basis after the neurostimulation leads 12 have been implanted and prior to implantation of the IPG 14, to test the responsiveness of the stimulation that is to be provided. Any functions described herein with respect to the IPG 14 can likewise be performed with respect to the ETS 20.
The RC 16 may be used to telemetrically communicate with or control the IPG 14 or ETS 20 via a uni- or bi-directional wireless communications link 32. Once the IPG 14 and neurostimulation leads 12 are implanted, the RC 16 may be used to telemetrically communicate with or control the IPG 14 via a uni- or bi-directional communications link 34. Such communication or control allows the IPG 14 to be turned on or off and to be programmed with different stimulation parameter sets. The IPG 14 may also be operated to modify the programmed stimulation parameters to actively control the characteristics of the electrical stimulation energy output by the IPG 14. The CP 18 allows a user, such as a clinician, the ability to program stimulation parameters for the IPG 14 and ETS 20 in the operating room and in follow-up sessions. Alternately, or additionally, stimulation parameters can be programed via wireless communications (e.g., Bluetooth) between the RC 16 (or external device such as a hand-held electronic device) and the IPG 14.
The CP 18 may perform this function by indirectly communicating with the IPG 14 or ETS 20, through the RC 16, via a wireless communications link 36. Alternatively, the CP 18 may directly communicate with the IPG 14 or ETS 20 via a wireless communications link (not shown). The stimulation parameters provided by the CP 18 are also used to program the RC 16, so that the stimulation parameters can be subsequently modified by operation of the RC 16 in a stand-alone mode (i.e., without the assistance of the CP 18).
For purposes of brevity, the details of the RC 16, CP 18, ETS 20, and external charger 22 will not be further described herein. Details of exemplary embodiments of these devices are disclosed in U.S. Pat. No. 6,895,280, which is expressly incorporated herein by reference. Other examples of electrical stimulation systems can be found at U.S. Pat. Nos. 6,181,969; 6,516,227; 6,609,029; 6,609,032; 6,741,892; 7,949,395; 7,244,150; 7,672,734; and 7,761,165; 7,974,706; 8,175,710; 8,224,450; and 8,364,278; and U.S. Patent Application Publication No. 2007/0150036, as well as the other references cited above, all of which are incorporated herein by reference.
Turning to
Percutaneous leads are described herein for clarity of illustration. It will be understood that paddle leads and cuff leads can be used in lieu of, or in addition to, percutaneous leads. Some of the leads described herein include 8 electrodes. It will be understood that the leads could include any suitable number of electrodes. The leads described herein exclusively include ring electrodes. It will be understood that the leads can include a distal-tip electrode, or one or more segmented electrodes in lieu of, or in addition to one or more ring electrodes. Additionally, the term “elongated member” used herein includes leads (e.g., percutaneous, paddle, cuff, or the like), as well as intermediary devices (e.g., lead extensions, adaptors, splitters, or the like).
Conductors can extend along the longitudinal length of the lead within one or more lumens defined in the lead. In other instances, the conductors may extend along the lead within the lead body itself. The lead 212 includes a retention sleeve 208 disposed along the proximal portion of the body to facilitate coupling of the proximal portion of the lead to a connector. The connector may be disposed in a control module. Alternatively, the retention sleeve 208 can be used to facilitate coupling of the proximal portion of the lead to a connector of an intermediary device, such as a lead extension which, in turn, is coupled to a connector of a control module.
The lead-extension connector 390 contains a lead-extension connector stack 365 that defines a connector lumen 367 configured to receive the proximal portion of an elongated member (e.g., lead 212). The lead-extension connector stack 365 includes lead-extension connector contacts, such as lead-extension connector contact 369, arranged along the connector lumen 367 and configured to electrically couple with terminals of the elongated member (e.g., lead 212) when the proximal portion of the elongated member is received by the lead-extension connector 390. The connector contacts can be electrically isolated from one another by electrically-nonconductive spacers, such as spacer 371. The connector stack may also include an end stop 373 to facilitate alignment of the elongated-member terminals with the lead-extension connector contacts.
The lead-extension connector 390 further includes a retention assembly for facilitating retention of the proximal portion of the elongated member (e.g., lead 212) when the proximal portion of the elongated member is received by the lead-extension connector 390. In the illustrated embodiment, the retention assembly includes a lead-extension retention block 392. The lead-extension retention block 392 is positioned to align with the retention sleeve (208 in
Lead-extension conductors, such as lead-extension conductor 331, extend along a longitudinal length of the lead extension and electrically couple the lead-extension connector contacts to the array of lead-extension terminals 327. The lead-extension conductors can extend along the longitudinal length of the lead-extension body within one or more lumens defined in the lead extension. In other instances, the lead-extension conductors may extend along the lead extension within the lead-extension body itself. The lead extension 312 includes a retention sleeve 308 disposed along the proximal portion of the lead-extension body to facilitate coupling of the proximal portion of the lead extension to a connector, such as a control-module connector, another lead-extension connector, or the like.
A connector assembly 590 is disposed in the header 553. The connector assembly 590 is configured to receive an elongated device (e.g., the lead 212, the lead extension 312, or other intermediary device). The connector assembly 590 defines a connector lumen 567 configured to receive the proximal portion of the elongated member. An array of connector contacts, such as connector contact 569, is arranged along the connector lumen 567 and configured to electrically couple with terminals of the elongated member when the proximal portion of the elongated member is received by the connector 590. The connector contacts can be electrically isolated from one another by electrically-nonconductive spacers, such as spacer 571. The connector stack may also include an end stop 573 to promote alignment of the elongated-member terminals with the connector contacts.
Wires or contacts, such as wire 582, are electrically coupled to the electrical subassembly 558 and extend within the sealed housing 554 to a feedthrough interface 586 disposed along an interface between the header 553 and the sealed housing 554. The connector contacts are electrically coupled to interconnect conductors, such as wire 580, that extend along the header 553 and electrically couple the connector contacts to the wires 582 (and possibly feedthrough pins) at the feedthrough interface 586. In some embodiments, the header 553 is positioned over the feedthrough interface 586.
The connector assembly 590, optionally, includes a retention assembly for facilitating retention of the proximal portion of the elongated member when the proximal portion of the elongated member is received by the control module 552. In the illustrated embodiment, the retention assembly includes a retention block 592. The retention block 592 is positioned to align with a retention sleeve (see e.g., 608 in
Connector receptacles, such as those in a lead extension or the header of a control module, may be constructed out of materials, such as silicone, that can be susceptible to stretching upon insertion of the proximal end of a lead or lead extension. This may present difficulties in aligning the connector contacts in the connector with the terminals or contacts on the proximal end of the lead or lead extension. In at least some instances, conventional connectors rely on the user (e.g., a physician or clinician) to visually ensure the alignment. Over- or under-insertion may result in misalignment or failure of alignment between the connector contacts in the connector with the terminals or contacts on the proximal end of the lead or lead extension. These circumstances may also increase the time needed for the implantation procedure.
To facilitate correct insertion, arrangements are described herein for providing a tactile indication when the connector is properly aligned with the proximal end of the lead or lead extension being inserted. In at least some embodiments, novel lead or lead extension retention arrangements are also presented. In the illustrated embodiments described below, a lead extension connector, such as lead extension connector 390 of
In the illustrated embodiments, the circumferential groove 742 extends around the entire circumference of the terminal 727a. In other embodiments, the circumferential groove 742 extends around less than the entire circumference of the terminal 727a, but does extend at least 20%, 25%, 33%, 50%, 66%, or 75% of the circumference of the terminal 727a.
Any suitable connector contact 769 can be used including, but not limited to, coiled contacts, canted coil contacts, ball contacts, ring contacts, and the like or any combination thereof. Groove depth, groove width, connector contact width, connector contact placement, and materials of the terminal and connector contact can be selected to provide a desired amount of tactile sensation.
When the circumferential groove 742 is in the distalmost terminal 727a, the tactile sensation indicates to the user that the terminal 727a is aligned with the connector contact 769. In other embodiments, where a circumferential groove is provided in one or more of the other terminals, there may be multiple instances of the tactile sensation as the user inserts the proximal end of the lead or lead extension into the connector. For example, in an eight electrode lead with a circumferential groove in the most proximal terminal, there may be up to eight consecutive tactile sensations as the most proximal terminal is pushed past each of the connector contacts. Providing circumferential grooves in multiple terminals may increase the tactile sensation as multiple conductor contacts interact with the multiple circumferential grooves.
In at least some embodiments, only one spacer 940 has the larger outer diameter with the other spacers having the same diameter as the terminals 927. For example, the spacer 940 adjacent to, and proximal to, the distalmost terminal 927 may have the larger outer diameter so that as it is pushed past the distalmost connector contact of the connector a tactile sensation is experienced by the user.
In other embodiments, multiple spacers 940 (or even all of the spacers 940) have the larger outer diameter. For example, if all of the spacers 940 have the larger outer diameter, a tactile sensation may be experienced as the spacers 940 are pushed past each of the connector contacts.
In at least some embodiments, the outer diameter, at its largest extent, of the terminal 927 is at least 5%, 10%, or more larger than the outer diameter, at its largest extent, of the adjacent spacers 942.
In at least some embodiments, only one terminal 940 has the larger outer diameter with the other terminals having the same diameter as the terminals 927. For example, the penultimate terminal, with respect to the proximal end of the lead (i.e., the terminal proximal to the distalmost terminal), may have the larger outer diameter so that as it is pushed past the distalmost connector contact of the connector a tactile sensation is experienced by the user.
In other embodiments, multiple terminals 927 (or even all of the terminals 927) have the larger outer diameter. For example, if all of the terminals 927 have the larger outer diameter, a tactile sensation may be experienced as the terminals 927 are pushed past each of the connector contacts.
In some embodiments, in addition to, or as an alternative to, a tactile sensation, an audible sound (for example, a click) may also be heard as spacer(s) 940 or terminal(s) 927 with the larger outer diameters push past the connector contact(s) 769.
In the illustrated embodiments of
In the illustrated embodiments of
It will be understood that any combination of the elements illustrated in
Some of the components (for example, a power source 1112, an antenna 1118, a receiver 1102, and a processor 1104) of the electrical stimulation system can be positioned on one or more circuit boards or similar carriers within a sealed housing of an implantable pulse generator (see e.g., 14 in
As another alternative, power can be supplied by an external power source through inductive coupling via the optional antenna 1118 or a secondary antenna. In at least some embodiments, the antenna 1118 (or the secondary antenna) is implemented using the auxiliary electrically-conductive conductor. The external power source can be in a device that is mounted on the skin of the user or in a unit that is provided near the user on a permanent or periodic basis.
If the power source 1112 is a rechargeable battery, the battery may be recharged using the optional antenna 1118, if desired. Power can be provided to the battery for recharging by inductively coupling the battery through the antenna to a recharging unit 1116 external to the user. Examples of such arrangements can be found in the references identified above. The electronic subassembly 1158 and, optionally, the power source 1112 can be disposed within a control module (e.g., the IPG 14 or the ETS 20 of
In one embodiment, electrical stimulation signals are emitted by the electrodes 26 to stimulate nerve fibers, muscle fibers, or other body tissues near the electrical stimulation system. The processor 1104 is generally included to control the timing and electrical characteristics of the electrical stimulation system. For example, the processor 1104 can, if desired, control one or more of the timing, frequency, strength, duration, and waveform of the pulses. In addition, the processor 1104 can select which electrodes can be used to provide stimulation, if desired. In some embodiments, the processor 1104 selects which electrode(s) are cathodes and which electrode(s) are anodes. In some embodiments, the processor 1104 is used to identify which electrodes provide the most useful stimulation of the desired tissue.
Any processor can be used and can be as simple as an electronic device that, for example, produces pulses at a regular interval or the processor can be capable of receiving and interpreting instructions from an external programming unit 1108 that, for example, allows modification of pulse characteristics. In the illustrated embodiment, the processor 1104 is coupled to a receiver 1102 which, in turn, is coupled to the optional antenna 1118. This allows the processor 1104 to receive instructions from an external source to, for example, direct the pulse characteristics and the selection of electrodes, if desired.
In one embodiment, the antenna 1118 is capable of receiving signals (e.g., RF signals) from an external telemetry unit 1106 which is programmed by the programming unit 1108. The programming unit 1108 can be external to, or part of, the telemetry unit 1106. The telemetry unit 1106 can be a device that is worn on the skin of the user or can be carried by the user and can have a form similar to a pager, cellular phone, or remote control, if desired. As another alternative, the telemetry unit 1106 may not be worn or carried by the user but may only be available at a home station or at a clinician's office. The programming unit 1108 can be any unit that can provide information to the telemetry unit 1106 for transmission to the electrical stimulation system 1100. The programming unit 1108 can be part of the telemetry unit 1106 or can provide signals or information to the telemetry unit 1106 via a wireless or wired connection. One example of a suitable programming unit is a computer operated by the user or clinician to send signals to the telemetry unit 1106.
The signals sent to the processor 1104 via the antenna 1118 and the receiver 1302 can be used to modify or otherwise direct the operation of the electrical stimulation system. For example, the signals may be used to modify the pulses of the electrical stimulation system such as modifying one or more of pulse duration, pulse frequency, pulse waveform, and pulse strength. The signals may also direct the electrical stimulation system 1100 to cease operation, to start operation, to start charging the battery, or to stop charging the battery. In other embodiments, the stimulation system does not include the antenna 1118 or receiver 1102 and the processor 1104 operates as programmed.
Optionally, the electrical stimulation system 1100 may include a transmitter (not shown) coupled to the processor 1104 and the antenna 1118 for transmitting signals back to the telemetry unit 1106 or another unit capable of receiving the signals. For example, the electrical stimulation system 1100 may transmit signals indicating whether the electrical stimulation system 1100 is operating properly or not or indicating when the battery needs to be charged or the level of charge remaining in the battery. The processor 1104 may also be capable of transmitting information about the pulse characteristics so that a user or clinician can determine or verify the characteristics.
The above specification and examples provide a description of the manufacture and use of the invention. Since many embodiments of the invention can be made without departing from the spirit and scope of the invention, the invention also resides in the claims hereinafter appended.
This application claims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional Patent Application Ser. No. 62/842,712, filed May 3, 2019, which is incorporated herein by reference.
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