The present invention is generally directed to neural stimulation and more specifically to an improved electrode array for neural stimulation. The present invention is more specifically directed to an improved electrode array and return electrode for visual neural stimulation.
In 1755 LeRoy passed the discharge of a Leyden jar through the orbit of a man who was blind from cataract and the patient saw “flames passing rapidly downwards.” Ever since, there has been a fascination with electrically elicited visual perception. The general concept of electrical stimulation of retinal cells to produce these flashes of light or phosphenes has been known for quite some time. Based on these general principles, some early attempts at devising prostheses for aiding the visually impaired have included attaching electrodes to the head or eyelids of patients. While some of these early attempts met with some limited success, these early prosthetic devices were large, bulky and could not produce adequate simulated vision to truly aid the visually impaired.
In the early 1930's, Foerster investigated the effect of electrically stimulating the exposed occipital pole of one cerebral hemisphere. He found that, when a point at the extreme occipital pole was stimulated, the patient perceived a small spot of light directly in front and motionless (a phosphene). Subsequently, Brindley and Lewin (1968) thoroughly studied electrical stimulation of the human occipital (visual) cortex. By varying the stimulation parameters, these investigators described in detail the location of the phosphenes produced relative to the specific region of the occipital cortex stimulated. These experiments demonstrated: (1) the consistent shape and position of phosphenes; (2) that increased stimulation pulse duration made phosphenes brighter; and (3) that there was no detectable interaction between neighboring electrodes which were as close as 2.4 mm apart.
As intraocular surgical techniques have advanced, it has become possible to apply stimulation on small groups and even on individual retinal cells to generate focused phosphenes through devices implanted within the eye itself. This has sparked renewed interest in developing methods and apparatus to aid the visually impaired. Specifically, great effort has been expended in the area of intraocular retinal prosthesis devices in an effort to restore vision in cases where blindness is caused by photoreceptor degenerative retinal diseases; such as retinitis pigmentosa and age related macular degeneration which affect millions of people worldwide.
Neural tissue can be artificially stimulated and activated by prosthetic devices that pass pulses of electrical current through electrodes on such a device. The passage of current causes changes in electrical potentials across visual neuronal membranes, which can initiate visual neuron action potentials, which are the means of information transfer in the nervous system.
Based on this mechanism, it is possible to input information into the nervous system by coding the sensory information as a sequence of electrical pulses which are relayed to the nervous system via the prosthetic device. In this way, it is possible to provide artificial sensations including vision.
One typical application of neural tissue stimulation is in the rehabilitation of the blind. Some forms of blindness involve selective loss of the light sensitive transducers of the retina. Other retinal neurons remain viable, however, and may be activated in the manner described above by placement of a prosthetic electrode device on the inner (toward the vitreous) retinal surface (epiretinal). This placement must be mechanically stable, minimize the distance between the device electrodes and the visual neurons, control the electronic field distribution and avoid undue compression of the visual neurons.
In 1986, Bullara (U.S. Pat. No. 4,573,481) patented an electrode assembly for surgical implantation on a nerve. The matrix was silicone with embedded iridium electrodes. The assembly fit around a nerve to stimulate it.
Dawson and Radtke stimulated cat's retina by direct electrical stimulation of the retinal ganglion cell layer. These experimenters placed nine and then fourteen electrodes upon the inner retinal layer (i.e., primarily the ganglion cell layer) of two cats. Their experiments suggested that electrical stimulation of the retina with 30 to 100 μA current resulted in visual cortical responses. These experiments were carried out with needle-shaped electrodes that penetrated the surface of the retina (see also U.S. Pat. No. 4,628,933 to Michelson).
The Michelson '933 apparatus includes an array of photosensitive devices on its surface that are connected to a plurality of electrodes positioned on the opposite surface of the device to stimulate the retina. These electrodes are disposed to form an array similar to a “bed of nails” having conductors which impinge directly on the retina to stimulate the retinal cells. U.S. Pat. No. 4,837,049 to Byers describes spike electrodes for neural stimulation. Each spike electrode pierces neural tissue for better electrical contact. U.S. Pat. No. 5,215,088 to Norman describes an array of spike electrodes for cortical stimulation. Each spike pierces cortical tissue for better electrical contact.
The art of implanting an intraocular prosthetic device to electrically stimulate the retina was advanced with the introduction of retinal tacks in retinal surgery. De Juan, et al. at Duke University Eye Center inserted retinal tacks into retinas in an effort to reattach retinas that had detached from the underlying choroid, which is the source of blood supply for the outer retina and thus the photoreceptors. See, e.g., E. de Juan, et al., 99 Am. J. Ophthalmol. 272 (1985). These retinal tacks have proved to be biocompatible and remain embedded in the retina, and choroid/sclera, effectively pinning the retina against the choroid and the posterior aspects of the globe. Retinal tacks are one way to attach a retinal electrode array to the retina. U.S. Pat. No. 5,109,844 to de Juan describes a flat electrode array placed against the retina for visual stimulation. U.S. Pat. No. 5,935,155 to Humayun describes a retinal prosthesis for use with the flat retinal array described in de Juan.
Implanted stimulation devices usually stimulate the nerve or muscle tissue with biphasic electrical current pulses in either mono-polar or bipolar electrode configurations. In a bipolar configuration, the stimulating currents flow between two active electrodes or electrode groups which may be dynamically selected. In a mono-polar configuration, the stimulation currents flow in one phase from the active electrodes through the tissue being stimulated to the common electrode (CE), also called return electrode. The currents flow in the other phase in the reversed direction to balance the charge. In this case, the direction of the current flow is significantly affected by the relative placements or positioning of the active electrodes and the common electrode.
If an electrode array is placed on the surface of the tissue being stimulated without a ready method of confinement the array may not be in good contact with the retina tissue, or it drifts away from the retina. This applies especially for epi-retinal prosthesis where the stimulating electrode array is placed on the surface of the retina in the vitreous. If the return electrode is placed far away from the active electrode array, the current paths from the active stimulating electrodes will change because of the significant difference between the impedances of the retina tissue and of the vitreous and body fluids. As a result, there may not be enough current density passing through the neuronal cells in the retina tissue to cause a response, or the response may change when the array is moved.
In order to solve this problem, a large return electrode can be placed outside of the eyeball and directly under the active array. Thus the stimulating currents shall pass from the active electrodes through the tissue being stimulated. However, if the active electrodes are lifted from the tissue surface, the responses elicited by the stimulation of the individual electrodes may not be differentiable or distinctive because of the diffusive current paths from the lifted electrodes, resulting great reduction of effective resolution for percepts. Another possible method is to place the active electrode array underneath the retina while placing the return electrode in the vitreous. This sub-retina approach presents significant surgical difficultness when the device and array are implanted.
In a visual prosthesis electrodes stimulate retinal tissue to induce the perception of light to a user implanted with the prosthesis. The prosthesis must have a return, or common, electrode to make a complete circuit with the retinal tissue. To avoid stimulating tissue with the return electrode, it is advantageous that the electrode is large and in tissue less sensitive to electrical stimulation.
The novel features of the invention are set forth with particularity in the appended claims. The invention will be best understood from the following description when read in conjunction with the accompanying drawings.
This invention involves the use of a multi-electrode array as multi-return electrodes placed outside the eyeball and directly under the active epi-retina array. It will greatly reduce the sensitivity of the electrode-tissue distance to stimulation results. The requirement of firm contact of electrodes to the retina is relieves. Therefore the risk of damaging the delicate retina by placing the electrode array on its surface is reduced. The return electrode can be implanted routinely during the surgery.
Performance of electrical stimulation of neurons may depend on the electric field distribution from each electrode. It is believed that a more focused electric field with improved performance reduces threshold charge. In this sense a focal and return electrode or electrode array may be highly advantageous.
For retinal neuron stimulators of the epiretinal configuration, a focal return electrode or array would be placed posterior of the sclera aligned with the epiretinal stimulation array. Alignment could be achieved using concentric fixation structures, such as a tack, or the return electrode could be contained within a somewhat rigid housing connected to the other extra ocular implant components, like band or coil.
This invention involves an electrode array used as multi-return electrodes. The method involves controlling the stimulating current flow between the active electrodes and the return electrodes, and alternative ways to implement the multi-return electrode array. The muti-return electrode comprises an array of electrode discs with larger sizes than the discs of the active electrodes. The electrode discs can be made of safe electrode materials similar to or same as that of the active electrodes. The number of return electrode discs in the array can be a fraction of the active electrodes and may vary depending on the manufacturing flexibility.
The following description is of the best mode presently contemplated for carrying out the invention. This description is not to be taken in a limiting sense, but is made merely for the purpose of describing the general principles of the invention. The scope of the invention should be determined with reference to the claims.
The electronics package 14 is electrically coupled to a secondary inductive coil 16. Preferably the secondary inductive coil 16 is made from wound wire. Alternatively, the secondary inductive coil 16 may be made from a flexible circuit polymer sandwich with wire traces deposited between layers of flexible circuit polymer. The electronics package 14 and secondary inductive coil 16 are held together by a molded body 18. The molded body 18 may also include suture tabs 20. The molded body 18 narrows to form a strap 22 which surrounds the sclera and holds the molded body 18, secondary inductive coil 16, and electronics package 14 in place. The molded body 18, suture tabs 20 and strap 22 are preferably an integrated unit made of silicone elastomer. Silicone elastomer can be formed in a pre-curved shape to match the curvature of a typical sclera. However, silicone remains flexible enough to accommodate implantation and to adapt to variations in the curvature of an individual sclera. The secondary inductive coil 16 and molded body 18 are preferably oval shaped. A strap 22 can better support an oval shaped coil.
It should be noted that the entire implant is attached to and supported by the sclera. An eye moves constantly. The eye moves to scan a scene and also has a jitter motion to improve acuity. Even though such motion is useless in the blind, it often continues long after a person has lost their sight. By placing the device under the rectus muscles with the electronics package in an area of fatty tissue between the rectus muscles, eye motion does not cause any flexing which might fatigue, and eventually damage, the device.
The flexible circuit 1 is a made by the following process. First, a layer of polymer (such as polyimide, fluoro-polymers, silicone or other polymers) is applied to a support substrate (not part of the array) such as glass. Layers may be applied by spinning, meniscus coating, casting, sputtering or other physical or chemical vapor deposition, or similar process. Subsequently, a metal layer is applied to the polymer. The metal is patterned by photolithographic process. Preferably, a photo-resist is applied and patterned by photolithography followed by a wet etch of the unprotected metal. Alternatively, the metal can be patterned by lift-off technique, laser ablation or direct write techniques.
It is advantageous to make this metal thicker at the electrode and bond pad to improve electrical continuity. This can be accomplished through any of the above methods or electroplating. Then, the top layer of polymer is applied over the metal. Openings in the top layer for electrical contact to the electronics package 14 and the electrodes may be accomplished by laser ablation or reactive ion etching (RIE) or photolithography and wet etch. Making the electrode openings in the top layer smaller than the electrodes promotes adhesion by avoiding delamination around the electrode edges.
The pressure applied against the retina by the flexible circuit electrode array is critical. Too little pressure causes increased electrical resistance between the array and retina. It should be noted that while the present invention is described in terms of application to the retina, the techniques described are equally applicable to many forms of neural stimulation. Application to the retina requires a convex spherical curve. Application to the cochlea requires a constant curve in one dimension and a spiral curve in the other. Application to the cerebral cortex requires a concave spherical curve. Cortical stimulation is useful for artificial vision or hearing, touch and motor control for limb prostheses, deep brain stimulation for Parkinson's disease and multiple sclerosis, and many other applications.
Common flexible circuit fabrication techniques such as photolithography generally require that a flexible circuit electrode array be made flat. Since the retina is spherical, a flat array will necessarily apply more pressure near its edges, than at its center. With most polymers, it is possible to curve them when heated in a mold. By applying the right amount of heat to a completed array, a curve can be induced that matches the curve of the retina. To minimize warping, it is often advantageous to repeatedly heat the flexible circuit in multiple molds, each with a decreasing radius.
It should be noted that suitable polymers include thermoplastic materials and thermoset materials. While a thermoplastic material will provide some stretch when heated a thermoset material will not. The successive molds are, therefore, advantageous only with a thermoplastic material. A thermoset material works as well in a single mold as it will with successive smaller molds. It should be noted that, particularly with a thermoset material, excessive curvature in three dimensions will cause the polymer material to wrinkle at the edges. This can cause damage to both the array and the retina. Hence, the amount of curvature is a compromise between the desired curvature, array surface area, and the properties of the material.
Referring to
It is also advantageous to create a reverse curve or service loop in the flexible circuit cable 12 of the flexible circuit electrode array to gently lift the flexible circuit cable 12 off the retina and curve it away from the retina, before it passes through the sclera at a sclerotomy. It is not necessary to heat curve the service loop as described above, the flexible circuit electrode array can simply be bent or creased upon implantation. This service loop reduces the likelihood of any stress exerted extraocularly from being transmitted to the electrode region and retina. It also provides for accommodation of a range of eye sizes.
With existing technology, it is necessary to place the implanted control electronics outside of the sclera, while a retinal flexible circuit electrode array must pass through the sclera to in order be inside the eye and contact the retina. The sclera is cut through at the pars plana, forming a sclerotomy, and the flexible circuit passed through the sclerotomy. A flexible circuit is thin but wide. The more electrode conductors, the wider the flexible circuit must be. It may be difficult to seal a sclerotomy over a flexible circuit wide enough to support enough conductors for a high resolution array unless multiple conductor layers are employed. A narrow sclerotomy is preferable.
While the tube is rounder, it reduces the flexibility of the flexible circuit. A simple fold 48 reduces the width of the flexible circuit with only minimal impact on flexibility.
Further, silicone or other pliable substance may be used to fill the center of the tube or fold 48 formed by the twisted flexible circuit cable 12. Further it is advantageous to provide a sleeve or coating 50 that promotes sealing of the sclerotomy. Polymers such as polyimide, which may be used to form the flexible circuit cable 12 and flexible circuit electrode array 10, are generally very smooth and do not promote a good bond between the flexible circuit cable 12 and scleral tissue. A sleeve or coating of polyester, collagen, silicone, Gore-tex or similar material would bond with scleral tissue and promote healing. In particular, a porous material will allow scleral tissue to grow into the pores promoting a good bond.
Alternatively, the flexible circuit electrode array 10 may be inserted through the sclera, behind the retina and placed between the retina and choroid to stimulate the retina subretinally. In this case, it is advantageous to provide a widened portion, or stop, of the flexible circuit cable 12 to limit how far the flexible circuit electrode array is inserted and to limit the transmission of stress through the sclera. The stop may be widening of the flexible circuit 1 or it may be added material such as a bumper or sleeve.
Human vision provides a field of view that is wider than it is high. This is partially due to fact that we have two eyes, but even a single eye provides a field of view that is approximately 90° high and 140° to 160° degrees wide. It is therefore, advantageous to provide a flexible circuit electrode array 10 that is wider than it is tall. This is equally applicable to a cortical visual array. In which case, the wider dimension is not horizontal on the visual cortex, but corresponds to horizontal in the visual scene.
Also, since the narrowed portion of the flexible circuit cable 12 pierces the sclera, shoulders formed by opposite ends of the narrowed portion help prevent the flexible circuit cable 12 from moving through the sclera. It may be further advantageous to add ribs or bumps of silicone or similar material to the shoulders to further prevent the flexible circuit cable 12 from moving through the sclera.
Further it is advantageous to provide a suture tab 56 in the flexible circuit body near the electronics package to prevent any movement in the electronics package from being transmitted to the flexible circuit electrode array 10. Alternatively, a segment of the flexible circuit cable 12 can be reinforced to permit it to be secured directly with a suture.
An alternative to the bumpers described in
Alternatively, a flexible circuit electrode array 10 may be layered using different polymers for each layer. Using too soft of a polymer may allow too much stretch and break the metal traces. Too hard of a polymer may cause damage to delicate neural tissue. Hence a relatively hard polymer, such a polyimide may be used for the bottom layer and a relatively softer polymer such a silicone may be used for the top layer including an integral skirt to protect delicate neural tissue. The said top layer is the layer closest to the retina.
The simplest solution is to bond the skirt 60 to the back side (away from the retina) of the flexible circuit electrode array 10 as shown in
Referring to
The stress relief 82 may be made of a softer polymer than the flexible circuit, or it may include cutouts or thinning of the polymer to reduce the stress transmitted from the retina tack to the flexible circuit electrode array 10.
The material body 11 is made of a soft material that is compatible with the electrode array body 10. In a preferred embodiment the body 11 made of silicone having hardness of about 50 or less on the Shore A scale as measured with a durometer. In an alternate embodiment the hardness is about 25 or less on the Shore A scale as measured with a durometer.
The electrode array 10 embedded in or enveloped by the polymer material, preferably silicone 11 can be preferably produced through the following steps. The soft polymer material which contains silicone is molded into the designed shape and partially hardened. The electrode array 10 which preferably contains polyimide is introduced and positioned in the partially hardened soft polymer containing silicone. Finally, the soft polymer 11 containing silicone is fully hardened in the designed shape enveloping the electrode array 10. The polymer body 11 has a shape with a decreasing radius at the edges so that the edges of the body 11 lift off from the retina R.
The cochlear electrode array 110 is made flat as shown in
It would also be advantageous to provide more than one of the return electrodes described herein and provide a switch mechanism to switch between or utilize more than one. This way a user could select the configuration that is most comfortable for them.
This invention addresses this problem by using a multi-electrode array as multi-return electrodes placed outside the eyeball and directly under the active epi-retina array. It will greatly reduce the sensitivity of the electrode-tissue distance to stimulation results. The requirement of firm contact of electrodes to the retina is relieves. Therefore the risk of damaging the delicate retina by placing the electrode array on its surface is reduced. The return electrode can be implanted routinely during the surgery.
This invention involves an electrode array used as multi-return electrodes. The method involves controlling the stimulating current flow between the active electrodes and the return electrodes, and alternative ways to implement the multi-return electrode array. The muti-return electrode comprises an array of electrode discs with larger sizes than the discs of the active electrodes. The electrode discs can be made of safe electrode materials similar to or same as that of the active electrodes. The number of return electrode discs in the array can be a fraction of the active electrodes and may vary depending on the manufacturing flexibility.
Similarly, the discs are only exposed in the array surface facing the eyeball. The back side of the array is sealed. The current flowing to the return electrodes can only come from one direction. The return array needs to be in firm contact with the outside surface of the eyeball. The firm contact can be achieved by suturing. In order to achieve the best result, the return array needs to be placed directly underneath the active array such that the overlapping area between the two arrays is at its largest.
However, perfect alignment of the arrays is not necessary, because any small misalignment will be corrected automatically by the subject's perception adaptation. Electrically, each return electrode is connected to the common return electrode through a multiplexing switch which is turned off when the electrode is inactive. During each stimulation pulse, a small group of active electrodes defined by the prosthesis controller will pair with the closest return electrode in the return array to conduct stimulation as shown in
The pairing return electrode is connected to the current return path in the implant stimulator, while other return electrodes are turned off from it. Thus the currents from the stimulating electrodes will pass through the retina and reach the paired return electrode through the shortest and also the lowest impedance path. For other stimulation pulses other groups of active electrodes are paired with their corresponding closet return electrodes, and so on.
If an active electrode is slightly lifted from the retina surface, the current will still track the similar path and reach the return electrode as long as the size of the return electrode is comparable to the active. On the other hand, active electrodes can choose any return electrode to pair with, making it possible to create virtual electrode mapping. Alternatively, the return electrodes may also be connected to active stimulation drivers of the implant stimulator to conduct through-retina bipolar stimulation. Physically, the multi-return array can be implemented with thin film technologies, thin wire electrode techniques or directly be plated or sticked to the inner surface of the implant coil overmold if a coil is used this way.
Multi Return Electrode for Visual Prosthesis shows the following advantages.
Return electrodes need to be sealed in the backside and the array needs to be sutured to the outside eye wall to guarantee the desired least impedance current paths from the active electrodes to the return electrode discs. The return and active arrays need not be aligned perfectly. A misalignment can be easily corrected using calibration. Tack or other means for fixing of the active array shall not contain conductive material so that the stimulation current paths are not distracted.
The ability to cause a percept by stimulation is not affected by a “non-contact” electrode or the distance of the active array to the retina surface. The effective pixel resolution depends on the size of the return electrode discs. The smaller the size of the return electrode is the better is the result. The effects of active electrode array movement on percepts identification also depend on the sizes of the return electrode discs. Smaller discs should have lower effects. The sizes of the return electrodes will affect the electrode impedance, but in a less significant way as the sizes of the active electrodes.
The stimulation shall be rastered between the groups of stimulation against different return electrodes. Synchronous stimulation onto different return electrodes is also possible with special circuits. Virtual electrode realization is possible using the multi-return electrode array method, which is potentially important for resolution enhancement and real word visual recognition.
The return electrode array can also be placed on the inner surface of the implant coil receiving the RF power through the inductive link. The electrical implementation of the multi-return in the implanted stimulator can contain common multiplexed switches. The relaxed requirement of active electrode array contacting the retina surface reduces the risk of retina damage by the electrode array.
In the proposed design, the return electrodes are positioned to create lowest impedance paths to guide current flow through retinal cells. The return electrodes will penetrate the eye wall tissue from the back of the eye and will only penetrate through the sclera tissue but not the retina. The back of the return electrode array is insulated. The penetrating tips will also help to stabilize the return electrode in position. A remote big return electrode may still be necessary for shorting purposes.
Examples of penetrating the return electrodes are shown in
Performance of electrical stimulation of neurons may depend on the electric field distribution from each electrode. It is believed that a more focused electric field with improved performance reduces threshold charge. In this sense a focal and return electrode or electrode array may be highly advantageous.
For retinal neuron stimulators of the epiretinal configuration, a focal return electrode or array would be placed posterior of the sclera aligned with the epiretinal stimulation array. Alignment could be achieved using concentric fixation structures, such as a tack, or the return electrode could be contained within a somewhat rigid housing connected to the other extra ocular implant components, like band or coil.
The invention further involves an implantable electronic system wherein the significant mechanical and insulative functions are achieved with a single family of polymer materials. Those materials are thermoplastic and are available in thin sheets, possess low moisture uptake, are suitable for implantation and for multilayer construction with strong chemical bonding between the layers, for example liquid crystal polymer (LCP). Further examples of promising materials include polybenoxazole, polynorbornene, polyethylene naphthalate, fluorinated polymers and polyimides.
Potential applications for these structures include passive and/or active sensor and/or actuator devices, like implantable neural stimulators, recording devices, drug deliver apparatuses and other prosthetics.
A discrete embodiment results in a package architecture that is freestanding and ready for assembly with additional components. An integrated embodiment results in a package architecture that already incorporates additional device components.
An alternative is an all gold metal conductor scheme. Sufficient insulation by the polymer encapsulation prevents exposure of the gold conductors to any corrosive environment. Electron migration is prevented so long as the polymer interfaces are strongly bonded. The advantage of gold in comparison to platinum or iridium is the simplified processing and increased design flexibility gained by gold. The gold conductors at exposed electrode sites, where charge transfer is desired, are over coated or otherwise protected by superior electrochemical materials.
Accordingly, what has been shown is an improved method making a neural electrode array and improved method of stimulating neural tissue. While the invention has been described by means of specific embodiments and applications thereof, it is understood that numerous modifications and variations could be made thereto by those skilled in the art without departing from the spirit and scope of the invention. It is therefore to be understood that within the scope of the claims, the invention may be practiced otherwise than as specifically described herein.
This application claims the benefit of U.S. Provisional Application No. 60/948,166, “Flexible Circuit Electrode Array”, filed Jul. 5, 2007 (Attorney Docket No. S447-PRO), U.S. Provisional Application No. 60/968,014, “Return Electrode for a Visual Prosthesis”, filed Aug. 24, 2007 (Attorney Docket No. S490-PRO), U.S. Provisional Application No. 60/973,230, “Multi Return Electrode for Visual Prosthesis”, filed Sep. 18, 2007 (Attorney Docket No. S496-PRO), and U.S. Provisional Application No. 60/977,929, “Multi Return Electrode for Visual Prosthesis”, filed Oct. 29, 2007 (Attorney Docket No. S506-PRO), the disclosure of each is incorporated herein by reference.
This invention was made with government support under grant No. R24EY12893-01, awarded by the National Institutes of Health. The government has certain rights in the invention.
Number | Date | Country | |
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60948166 | Jul 2007 | US | |
60968014 | Aug 2007 | US | |
60973230 | Sep 2007 | US | |
60977929 | Oct 2007 | US |