The present invention relates to medical devices used to electrically stimulate a neurological cellular mass, in particular, neural tissue of the brain, and more specifically to an implantable pulse generator therefor.
Electrical neurostimulation techniques are used to treat a variety of conditions, such as coronary disorders, gastric dysfunction and neurological conditions. An example of electrical neruostimulation is Deep Brain Stimulation (DBS) which is a technique that may be used as a part of a treatment for various neurological disorders, such as Parkinson's Disease, Huntington's disease, dystonia, and epilepsy, among others. In DBS, one or more probes is implanted into the neural tissue of the brain to administer electric pulses that have the effect of reducing the symptoms. A particular disorder will be associated with a particular region of the brain, therefore, stimulation needs to be site specific. Although not fully understood, DBS is becoming a more widely accepted treatment, as an alternative to or to complement drug therapy. Surgical techniques for both probe (lead) and pulse generator implantation are becoming standardized. Various implantable devices are currently available, an example of such a device is the Active Therapy System sold by Medtronic, Inc. of Minneapolis, Minn. (www.medtronic.com/physician/activa/implantable.html).
The pulses are generated by an implantable pulse generator (IPG) that is typically implanted subcutaneously in the thoracic region of the subject, and electrical pulses generated by the IPG are conducted via subcutaneous extension wires to leads terminating in electrical contacts which stimulate the neural tissue.
These IPG devices, however, are generally large, owing to the requirement for a battery pack with sufficient power output, depth of discharge and lifespan that avoids the need to replace the battery frequently. Although the average lifespan of an implant's battery is 3- to 5-year, another surgical intervention is required to replace the whole device, which can be costly and inconvenient. A more powerful battery will increase battery lifespan, however, such battery is larger and heavier, and increases the overall size of the IPG. When the IPG exceeds a certain dimension, it becomes technically challenging to implant without forming a protuberance at the site of implantation that can be visible, and, moreover, without subjecting the patient to discomfort due to its size and weight implanted. Thus, it would be advantageous to provide an IPG which reduces the intrusive appearance of the implant, and yet does not compromise on battery life or performance.
One embodiment of the invention relates to an implantable pulse generator (100), IPG, for stimulation of a neurological cellular mass comprising:
2. IPG according to claim 1, wherein the second aerial (10) is coiled around the peripheral edge (60) of the housing (40) of the PGM (4).
Another embodiment of the invention relates an IPG as described above, wherein the coil of the second aerial (10) is situated between one fictive plane (100), extending from an upper (56) surface of the housing (40) exterior and a second fictive plane (102) extending from a lower (58) surface of the housing (40) exterior.
Another embodiment of the invention relates an IPG as described above, wherein the casing (2) is substantially formed from silicone rubber or epoxy resin.
Another embodiment of the invention relates an implantable pulse generator (100), IPG, for stimulation of a neurological cellular mass comprising:
Another embodiment of the invention relates an IPG as described above, wherein the interface circuit board (20) comprises one or more filter components, each connected to a feed through wire (80) for the connector block (6) configured to filter out electrical and/or electromagnetic interference.
Another embodiment of the invention relates an IPG as described above, wherein the interface circuit board (20) comprises one or more tuning components connected to the first and/or second aerial (10, 8) configured to tune the aerial (10, 8) to receive electromagnetic signals in a pre-determined frequency range.
Another embodiment of the invention relates an IPG as described above, wherein the interface circuit board (20) comprises one or more protective components connected to the first and/or second aerial (10, 8) configured to protect the PGM from voltage surges.
Another embodiment of the invention relates an IPG as described above, wherein:
Another embodiment of the invention relates an IPG as described above, wherein:
Another embodiment of the invention relates an IPG as described above, wherein:
Another embodiment of the invention relates an IPG as described above, wherein the housing (40) comprises a two-piece assembly having a lid-part (92) and a body-part (94) with a reciprocating opening for the lid-part (92), which lid (92) is closed and sealed over the opening in the body-part (94) of the housing (40), wherein:
Another embodiment of the invention relates a system comprising:
Another embodiment of the invention relates to a system as described above, further comprising a remote charging device (150) (150) adapted to inductively charge a rechargeable power source (16) of the IPG (100) though the second aerial (10).
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as is commonly understood by one of skill in the art. All publications referenced herein are incorporated by reference thereto. All United States patents and patent applications referenced herein are incorporated by reference herein in their entirety including the drawings.
The recitation of numerical ranges by endpoints includes all integer numbers and, where appropriate, fractions subsumed within that range (e.g. 1 to 5 can include 1, 2, 3, 4 when referring to, for example, a number of elements, and can also include 1.5, 2, 2.75 and 3.80, when referring to, for example, measurements). The recitation of end points also includes the end point values themselves (e.g. from 1.0 to 5.0 includes both 1.0 and 5.0)
Reference is made in the description below to the drawings which exemplify particular embodiments of the invention; they are not at all intended to be limiting. The skilled person may adapt the device and substituent components and features according to the common practices of the person skilled in the art.
With reference to
The aerials 10, 8 located in the RFEF-transparent casing 2 that at least partially encloses the PGM, facilitate the receipt of electrical energy and exchange of wireless signals. Advantageously, they are located outside the housing of the PGM having radio-shielding characteristics. Less energy is needed for the exchange of wireless signals, thereby reducing the battery drain. Moreover, longer communication distances are possible, allowing a deeper implantation of the device. In addition, charging times are reduced, and less wireless energy is passed through the skin.
With reference to
The housing 40 is typically cuboid in shape, though other shapes are envisaged such as cylindrical, triangular or other irregular shape. In a preferred embodiment, the housing exterior has an upper 56 surface and lower 58 surface (
The PGM module 4 comprises a power source 16, that is typically a rechargeable battery which may be any of the art, including but not limited to those based on lead-acid, alkaline, Ni-iron, Ni-cadmium, NIH2, NiMH, Ni-zinc, Li ion, Li polymer, LiFePO4, Li sulfur, Nano Titanate, Thin film Li, ZnBr, V redox, NaS, Molten salt, Super iron or Silver zinc. The electrical energy is preferably supplied to the rechargeable battery inductively, that is to say, using inductive (magnetic) coupling, via the second aerial 10. The second aerial 10 is a coil that is inductively energized by a reciprocating induction coil of a remote charging device 150 (
The second aerial 10 situated outside the chamber 42 of the housing 40 advantageously facilitates efficient transfer of inductive energy, compared with a second aerial 10 inside the housing chamber 42, especially when the housing 40 is formed from titanium. In the latter case, a loss of the magnetic field due to shielding of the housing prevents an efficient transfer. The consequence of the present configuration is reduced charging times, which is more convenient for the subject. Moreover, the implant may be more deeply located in the body without loss of the inductive link.
The PGM comprises a controller circuit 18 (
Each of the elements is described in more detail below.
The power source 16 provides electrical power to a controller 18 that includes a pulse generating unit 32 configured to generate electrical pulses to the leads via the connector block 6. The pulse generating unit 32, is configured to generate a single sequence of pulses, or one or more sequences of pulses sequentially or simultaneously (see later). A sequence of pulses may be defined by the frequency of the electrical pulses, an amplitude of the electrical pulses, and pulse width of the electrical pulses.
The pulse generating unit may provide pulses using a variety of known techniques, for example, using a pulse generating circuit comprising a coupling capacitor that releases charge in response to a trigger signal provided by a digital controller/timer circuit, when an externally transmitted stimulation command is received, or when a response to other stored commands is received. By way of example, an output amplifier of the present invention may correspond generally to an output amplifier disclosed in U.S. Pat. No. 4,476,868 to Thompson, hereby incorporated by reference herein in its entirety.
According to one aspect of the invention, the pulse generating unit 32 may be controlled by a programmable processor 34 to operate so that it varies the rate at which it delivers stimulating pulses. The pulse generating unit 32 may further be controlled by a programmable processor 34 to operate so that it may vary the morphology of the stimulating pulses it delivers. Numerous features and functions not explicitly mentioned herein may be incorporated into the pulse generating unit while remaining within the scope of the present invention. Various embodiments of the present invention may be practiced in conjunction with one, two, three or more leads, or in conjunction with one, two, three, four or more electrodes. The pulse generating unit 32 may be single channel i.e. with one pulse generating circuit, capable of one output of electrical pulses, typically for a single or two contact lead.
The controller circuit 18 preferably includes a programmable processor 34. The programmable processor controls the triggering of the electrical pulses in the pulse generating unit 32. The processor is programmable, allowing the sequence of pulses and the destination electrical contacts to be adapted according to patient requirement. For example, the programmability may allow the surgeon to apply a generic sequence of pulses immediately after implantation surgery, which can later be fine-tuned to suit the patient's needs. The sequence of pulses may be based upon pulse parameters. The pulse parameters may specify the pulse morphology i.e. one or more of a frequency of the electrical pulses in a sequence, an amplitude of the electrical pulses in a sequence, a pulse width of the electrical pulses in a sequence, an on/off state of the electrical pulses, and an application location (i.e. to which electrodes) of the electrical pulses. The pulse parameters may further specify switching of a sequence of pulses in any distribution circuit, or, where there are a plurality of pulse-generating circuits, the sequence of pulses generated by each circuit.
The programmable processor 34 is connected to a wireless communications unit 36 (see below). The connection enables the programmable processor 34 to receive instructions and programs from the wireless communications unit 36 that have been transmitted from an external remote programming device 130. The connection also enables the programmable processor 34 to send information for transmission by the wireless communications unit 36, which information might concern status information, for instance, battery life, memory use, power consumption, electrical load, temperature etc.
The programmable processor 34 may optionally be connected to a power regulator 38 (see below). The connection may enable the programmable processor 34 to regulate power drawn from the power source 16 in the most efficient manner. The connection may also allow the programmable processor 34 to receive status information concerning the power source, which information can be transmitted externally by the wireless communications unit 36, upon demand. The processor 34 may also be used to control aspects of charging the power source by sending appropriate instructions to the power regulator 38.
In one embodiment of the invention, the controller 18 further includes a wireless communications unit 36, adapted to wirelessly exchange data (i.e. to transmit and/or receive data) with an external remote programming device. The data may concern the aforementioned pulse parameters which are received by the wireless communications unit 36. It may include information as to the status of the IPG 100, for example, battery status, temperature, internal diagnostics which data is transmitted from the IPG 100 and outside the body by the wireless communications unit 36.
The wireless communications unit 36, may utilise any wireless communication means including an RF (radio-frequency) link. It can adopt a technical standard for data transfer such as MICS (Medical implant Communications Service), Wi-fi, ZigBee or Bluetooth. The wireless communications unit 36, is connected to the first aerial 8 through which the data is wirelessly exchanged.
In another embodiment of the invention, the controller 18 further includes a power regulator 38 adapted to convert inductive energy received through the second aerial 10 into electrical energy; the electrical energy may be used to directly power the IPG, but more preferably, it is used to charge the rechargeable battery. The power regulator 38 converts energy received by inductively coupling the second aerial 10 with an external inductive loop applied over the skin in the region of the IPG 100. The use of induction to transfer electrical power is well known in the art as already described elsewhere herein.
The power regulator 38 may operate independently of the programmable processor 34. Alternatively, it may be connected to the programmable processor 34. The connection may enable the programmable processor 34 to regulate power drawn from the power source 16 in the most efficient manner. The connection may also allow the programmable processor 34 to receive status information concerning the power source, which information can be transmitted externally by the wireless communications unit 36. For example, when charging is complete, a signal may be sent by the power regulator 38 to the programmable processor 34 which in turn sends a stop signal for transmission by the a wireless communications unit 36. The processor 34 may also be used to control aspects of charging the power source, by sending appropriate instructions to the power regulator 38, for example, charging protocols.
According to one aspect of the invention, the controller 18 is provided as a single circuit board 24, containing electrical circuitry for processing, power regulation, wireless data exchange, pulse generation etc, as embodied, for instance, in
According to another embodiment of the invention, the controller 18 is provided as two or more circuit boards 20, 22, co-operatively connected, one such circuit board being an interface circuit board 20, wherein at least one component of the controller 18 is located on the interface circuit board 20, and feed through wires for the aerials 10, 8 and connector block 6 are connected thereto 20. Preferably, electrical components associated with the exchange of electrical energy or radio signals (RF components) are located on the interface circuit board 20. Preferably some, all or most of such components are provided on said interface circuit board 20. Examples of such components include a tuning component (78, 76) or a filter component (82), or electrical protection component; these are preferably only provided on the interface circuit board 20. This embodiment of the invention is shown, for example, in
In order to minimize the length of feed-through wires, the interface circuit board 20 is positioned such that the apertures 48, 50, 52 in the housing 40 are aligned with reciprocating holes in the interface circuit board 20 for receiving and connecting the feed-through wires. In other words, a central axis at least one housing 40 aperture 48, 50, 52 is co-axial with a central axis of a reciprocating hole in the interface circuit board 20 for receiving the feed through wires. Preferably all the housing apertures and interface circuit board 20 holes are so-aligned. It will be understood that the central axes are tangential to the planar surfaces of the housing 40 or the interface circuit board 20. The arrangement avoids that the feed-through wires adopt a tortuous route i.e. inside the housing chamber 42, the feed-through wires have a linear and direct path to the interface circuit board 20. Minimising the length of the feed-through wires inside the housing 40 reduces potential electromagnetical interference of the RFEF with other electronic components inside the IPG. In other words, feed-through wires connected to aerials 8, 10 or a connector block 6 can transfer the RFEF through the aperture and have the potential to radiate the same RFEF energy inside the housing. i.e. they act as an extension of the aerials 8, 10 or connector block 6. Minimising the effective length of this extension avoids the aerial effect and reduces electromagnetical interference. Electronic components on the interface board 20 can filter and process relevant signals picked up by the aerials 8, 10 and/or lead 170 via the connector block 6 almost at the point where they enter the housing through the apertures. This arrangement minimizes the total conductive path of unfiltered and unprocessed RFEF inside the housing.
The other components (e.g. processor 34) of the controller 18 may be placed on a separate main circuit board 22, distal to said apertures 48, 50, 52 in the housing, but connected to the interface circuit board 20 using electrical conductors. The main circuit board 22, in common with typical printed circuit boards, has two opposing surfaces either or both disposed with electrical components, and a peripheral edge; preferably, one surface of the main circuit board 22 is aligned essentially parallel with the upper 56 or lower 58 surface of the housing 40. Typically, it will be perpendicular to the plane formed by the apertures 48, 50, 52.
Preferably the loop formed by a feed-through wire (70, 74, 72—
Preferably, at least some or all the electrical components of the wireless communication device 36 are located on the interface circuit board 20. The components include at least tuning elements. This provides better performance in a cost effective way. Preferably, at least some or all the electrical components of the power regulator 38 are located on the interface circuit board 20. The components include at least filter elements. Preferably, at least some or all the signal feed-through wires for the connector block 6 are connected to the interface circuit board 20; said feed through wires may additionally be connected to filtering components on the circuit board 20 to filter out interference.
According to a specific embodiment of the invention, the apertures 48, 50, 52 are situated in a planar part of a peripheral edge surface 60 of the housing 40, and a surface of the interface circuit board 20 is aligned essentially parallel to said housing edge surface 60. This arrangement is depicted in
According to the embodiment in
The embodiment in
Another possible function of filtering components is the elimination of unwanted signals from the pulse regulating unit towards the connector block and hence the neurological cellular mass. Typically low frequency or DC components of signals are considered harmful. Filtering elements configured as high-pass filters can effectively eliminate unwanted low-frequency content from the signal that is conducted from the pulse regulating unit to the cellular mass.
According to one embodiment of the invention, the interface circuit board 20 comprises one or more electrical protection components (not shown in the figures). These serve to protect the PGM, for instance, from voltage related surges, for example, a defibrillation pulse administered to the patient during heart recovery. The energy of this pulse is partially picked up by the lead 170 and could propagate through the connector block 6 into the PGM. Being located close to the feed through, the electrical protection components prevent damage before the surge reaches other more sensitive components. Such protective components could be for instance voltage limiting zener diodes electrically connected to the feed-through wires. Preferably some or all of the electrical protection components are provided on the interface circuit board 20.
The embodiment in
A grounding element 84, 86, 88 may be formed from the material of the housing 40, for instance, as a protruding extension thereof. Alternatively, it may be formed from a mass of adhesive-conductive material such as a conductive putty or adhesive, which secures the housing 40 to the interface circuit board 20.
This arrangement of grounding elements in close proximity to the apertures and hence the feed through wires allows for a minimal conductive path for the RFEF signals through the filter, protective or tuning component to the system ground. The reduced path, and concomitantly reduced parasitic inductance is indicated in
In addition or as an alternative, the interface circuit board (20) may be mechanically attached to the housing (40) by a closed loop (e.g. circumferential loop) of electrically conductive element between the housing (40) and the interface board (20). The electrically conductive element may be spring-loaded, which makes contact after being compressed.
In addition or as an alternative, the interface board (20) is electrically connected to the housing (40) by means of electrically conductive adhesive or solder.
According to one aspect of the invention, the housing 40 takes the form of a two-piece assembly comprising a lid-part and a body-part, wherein the interface circuit board 20 is mounted on the lid-part, which lid-part is closed and sealed over an opening in the body-part of the housing. The interface circuit board 20 is mounted on the surface of the lid-part that is closed over the opening. Using a lid-part as a chassis on which to assemble, mount and secure the interface circuit board 20 and feed through wires, considerably simplifies the production process, allowing access to the components for testing without undue hindrance. The interface circuit board 20 and lid-part combination combines the advantages of two conventional production techniques. The first conventional technique is the overmoulding of a silicone header onto the lid-part. The second conventional technique is the manufacturing of printed circuit boards. The grounding elements where present connect both methods in a unique way. The grounding protrusions elements create a solderable link between the interface circuit board 20 and the lid-part with its overmoulded header. This link creates a mechanical embedding of the lid-part, including antenna, on to the RF circuitry. It allows building the RF circuitry in the most cost-effective way without jeopardizing the performance. Without such a mechanical embedding the overall performance of the data and/or inductive link would be significantly reduced. It also benefits the overall immunity of the system to electromagnetic interference (EMI).
According to a specific embodiment of the invention, the lid-part 92 is formed from a planar peripheral edge surface 60 of the housing 40, and a surface of the interface circuit board 20 is aligned essentially parallel to said housing edge surface 60. Apertures 48, 50, 52 for feed though wires for the aerials 10, 8 and connector block 6 are situated in the lid-part 92 of the housing of the housing 40, and a surface of the interface circuit board 20 is aligned over said apertures 48, 50, 52. In other words, the plane formed by the apertures 48, 50, 52 in the lid is parallel to and overlaps the plane formed by one surface of the interface circuit board 20. This arrangement is depicted in
The lid 92 may be attached to the housing body 94 by any suitable technique including welding, adhesive, soldering or other that provides an hermetically sealed enclosure.
The IPG 100 comprises an electrical connector block 6 for electrically connecting the output from the pulse generating module 100 to one or more leads (also known as electrodes). The electrical connector block 6 is well known in the art, and any design may be employed by the instant IPG. As a general description, an electrical connector block 6 usually employs one or more cylindrical passages 12, 14 (
The connector block 6 typically formed from a material different from the PGM housing and casing 2, for example, polypropylene, polycarbonate or polyurethane. The connector block 6, is contained within, preferably embedded in the casing 2 that is transparent to radio-frequency electromagnetic fields, RFEF, which casing at least partially surrounds the PGM.
The IPG 100 comprises a first aerial 8 for wireless exchange of data with the PGM. The aerial may be of any suitable configuration, depending on the strength of the signal and its frequency. As a guidance, the first aerial 8 is a loop of wire, optimized for the receipt and/or transmission of radio frequencies in the range 1 MHz to 3 GHz. Alternative configurations could be dipole or unipolar antennas. Typical loop sizes could range from 5 to 20 mm in diameter or typical antenna lengths could be between 5 mm and 50 mm.
The first aerial 8 is contained in an RFEF-transparent casing 2 that at least partially surrounds the PGM. Advantageously, the battery drain is reduced compared with aerials located in the PGM housing as typical housings in a conductive material (e.g. Titanium) act as a shield for RFEFs. Moreover, the IPG can be implanted more deeply into the body which reduces the possibility for visible lumps or discomfort in the subject.
The IPG 100 comprises a second aerial 10 for wireless receipt of inductive electrical energy to the PGM. The second aerial 10 may be of any suitable configuration. Generally, it is a coil, having a plane parallel to the one surfaces of the PGM 4 housing so that when the IPG is implanted, there is a natural and strong coupling to a reciprocating induction coil placed over the skin in essentially parallel alignment. A typical coil diameter would range between 30 mm and 100 mm or the circumferential area of the coil would range between 500 mm2 and 3000 mm2.
Preferably, the second aerial 10 is coiled around the peripheral edge 60 of the housing 40 of the PGM 4. Preferably, and with reference to
The second aerial 10 is contained in an RFEF-transparent casing 2 that at least partially surrounds the PGM. Advantageously, less energy is required to charge the battery. Moreover, the IPG can be implanted more deeply into the body which reduces the possibility for visible lumps and/or discomfort in the subject.
One or more additional aerials may be arranged in the same RFEF-transparent casing tuned at frequencies different from the first or second aerial. A typical example would be an aerial for a separate wake-up transceiver circuit. Such a wake-up transceiver would typically operate with a minimal power consumption but would be limited in transfer rate or power transmission. The first and second aerials may or may not be capacitively coupled. Preferably, the first and second aerials are not capacitively coupled.
The IPG 100 comprises a casing 2 that is transparent to radio-frequency electromagnetic fields (RFEF). The casing 2 at least partially, preferably fully, encloses the PGM 4, the connector block 6 and aerials 10, 8. The contained elements are preferably embedded in the casing 2, though they may equally be contained within one or more void spaces formed within the casing 2. The casing 2 may be made for any suitable material that is biocompatible and having the aforementioned transparency to RFEF. An additional property of the casing material may be a shock absorbing property. Suitable materials include silicone rubber or epoxy resin. The casing preferably surrounds at least part of the PGM housing 40, preferably the entire PGM 4 housing 40. Where the casing 2 at least partially surrounds the PGM 4 housing 40, it may surround the peripheral edge 60; the upper 56 surface and/or lower 58 surface of the housing 40 may be at partially devoid of casing 2.
Cylindrical passages may be present in the RFEF-transparent casing 2 for connection to the leads; said passages are preferably co-axial with the one or more cylindrical passages 12, 14 (
A stimulation lead is well known in the art of stimulating a neurological cellular mass, in particular deep brain stimulation. With reference to
Electrical contacts are preferably arranged in an axial array, although other types of arrays may be employed. A lead 170 preferably range between about 10 cm and about 50 cm in length, and more particularly may be about 15 cm, about 20 cm, about 25 cm, about 30 cm, about 35 cm, about 40 cm or about 45 cm in length, depending on the location of the site to be stimulated and the distance of the IPG from the target. Other lead lengths such as less than about 10 cm and more than about 50 cm are also contemplated in the present invention. Some representative examples of leads 170 include MEDTRONIC nerve stimulation lead model numbers 3387, 3389 and 3391 as described in the MEDTRONIC Instruction for Use Manuals thereof, all hereby incorporated by reference herein, each in its respective entirety. Although
The IPG is provided for stimulation of a neurological cellular mass which can include a nerve cell, nerve bundles such as the acoustic nerve inside the cochlea and neurological tissue such as brain tissue and the spinal cord. The IPG can be used to treat a variety of medical disorders, depending primarily on the site at which the leads are implanted.
When the leads are implanted in the brain, the IPG can be employed to treat neurological conditions such as Parkinson's disease, Huntington's disease, dystonia and epilepsy, and other conditions still being researched.
As mentioned elsewhere herein, a remote programming device 130 (
As mentioned elsewhere herein, a remote charging device 150 (
Number | Date | Country | Kind |
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09179845.4 | Dec 2009 | EP | regional |
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/EP2010/069949 | 12/16/2010 | WO | 00 | 11/20/2013 |
Number | Date | Country | |
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61288051 | Dec 2009 | US |