Differential neurostimulation therapy driven by physiological context

Abstract

An implantable neurostimulator system adapted to provide therapy for various neurological disorders is capable of varying therapy delivery strategies based on the context, physiological or otherwise, into which the therapy is to be delivered. Responsive and scheduled therapies can be varied depending on various sensor measurements, calculations, inferences, and device states (including elapsed times and times of day) to deliver an appropriate course of therapy under the circumstances.

What is claimed is:  
     
         1 . A method for using an implantable device to treat a neurological disorder, the method comprising the steps of: 
 detecting a neurological event;    analyzing a parameter observed by the implantable device, wherein the parameter is representative of a characteristic of the neurological event;    selecting a therapy based at least in part on the parameter; and    delivering the therapy.    
     
     
         2 . The method for using an implantable device to treat a neurological disorder of  claim 1 , wherein the parameter is at least somewhat representative of a physiological condition.  
     
     
         3 . The method for using an implantable device to treat a neurological disorder of  claim 2 , wherein the parameter comprises an EEG characteristic, an EMG characteristic, a blood pressure measurement, a blood flow measurement, a blood oxygenation measurement, a drug concentration measurement, a neurotransmitter concentration measurement, a measurement of electrophysiological excitability, a measurement of electrophysiological refractoriness, an orientation of the patient, or a sleep state of the patient.  
     
     
         4 . The method for using an implantable device to treat a neurological disorder of  claim 2 , wherein the parameter comprises a feature derived from an EEG characteristic, an EMG characteristic, a blood pressure measurement, a blood flow measurement, a blood oxygenation measurement, a drug concentration measurement, a measurement of electrophysiological excitability, a measurement of electrophysiological refractoriness, an orientation of the patient, or a sleep state of the patient.  
     
     
         5 . The method for using an implantable device to treat a neurological disorder of  claim 4 , wherein the feature comprises a recent value compared to a trend value.  
     
     
         6 . The method for using an implantable device to treat a neurological disorder of  claim 4 , wherein the feature comprises a half wave measurement, a line length measurement, or an area measurement of a waveform defined by a plurality of measurements.  
     
     
         7 . The method for using an implantable device to treat a neurological disorder of  claim 1 , wherein the parameter is representative of a system state of the implantable device.  
     
     
         8 . The method for using an implantable device to treat a neurological disorder of  claim 7 , wherein the system state comprises a time of day.  
     
     
         9 . The method for using an implantable device to treat a neurological disorder of  claim 7 , wherein the system state comprises an elapsed time since a system event.  
     
     
         10 . The method for using an implantable device to treat a neurological disorder of  claim 9 , wherein the system event comprises a detection, a therapy delivery, a mode change, or a scheduled event.  
     
     
         11 . The method for using an implantable device to treat a neurological disorder of  claim 1 , wherein the detecting step is performed by a triggering detection channel included in a plurality of detection channels of the implantable device, and wherein the parameter is obtained from an indication of which of the plurality of detection channels is the triggering detection channel.  
     
     
         12 . The method for using an implantable device to treat a neurological disorder of  claim 1 , wherein the parameter comprises an electrographic measurement.  
     
     
         13 . The method for using an implantable device to treat a neurological disorder of  claim 12 , wherein the electrographic measurement comprises a characteristic of the neurological event.  
     
     
         14 . The method for using an implantable device to treat a neurological disorder of  claim 13 , wherein the detecting step is performed by a triggering detection channel of the implantable device, and wherein the electrographic measurement is obtained from a data storage area associated with the triggering detection channel.  
     
     
         15 . The method for using an implantable device to treat a neurological disorder of  claim 13 , wherein the detecting step is performed by a triggering detection channel included in a plurality of detection channels of the implantable device, and wherein the electrographic measurement is obtained from a data storage area associated with a detection channel other than the triggering detection channel.  
     
     
         16 . The method for using an implantable device to treat a neurological disorder of  claim 1 , wherein the parameter is obtained from a physiological sensor in communication with the implantable device.  
     
     
         17 . The method for using an implantable device to treat a neurological disorder of  claim 1 , further comprising the step of transforming the parameter.  
     
     
         18 . The method for using an implantable device to treat a neurological disorder of  claim 17 , wherein the transformed parameter is within a specified range.  
     
     
         19 . The method for using an implantable device to treat a neurological disorder of  claim 17 , wherein the transformed parameter is mapped to a specified distribution.  
     
     
         20 . The method for using an implantable device to treat a neurological disorder of  claim 1 , further comprising the step of modifying the therapy based at least in part of the parameter.  
     
     
         21 . The method for using an implantable device to treat a neurological disorder of  claim 1 , further comprising the step of repeating the analyzing, selecting, and applying steps.  
     
     
         22 . The method for using an implantable device to treat a neurological disorder of  claim 1 , wherein the therapy comprises an application of electrical brain stimulation.  
     
     
         23 . The method for using an implantable device to treat a neurological disorder of  claim 22 , wherein the electrical brain stimulation comprises responsive stimulation.  
     
     
         24 . The method for using an implantable device to treat a neurological disorder of  claim 22 , wherein the electrical brain stimulation comprises programmed stimulation.  
     
     
         25 . The method for using an implantable device to treat a neurological disorder of  claim 1 , wherein the therapy comprises an application of a therapeutic agent.  
     
     
         26 . The method for using an implantable device to treat a neurological disorder of  claim 1 , wherein the therapy comprises an application of sensory stimulation.  
     
     
         27 . The method for using an implantable device to treat a neurological disorder of  claim 1 , wherein the therapy comprises a patient warning.  
     
     
         28 . The method for using an implantable device to treat a neurological disorder of  claim 22 , wherein the therapy is applied to a focus of epilepti form activity.  
     
     
         29 . The method for using an implantable device to treat a neurological disorder of  claim 22 , wherein the therapy is applied to a predetermined site in the brain of the patient.  
     
     
         30 . The method for using an implantable device to treat a neurological disorder of  claim 29 , wherein the predetermined site is located in a target structure selected from a group comprising the caudate nucleus, the subthalamic nucleus, the anterior thalamus, the ventralateral thalamus, the globus pallidus internus, the globus pallidus externus, the substantia nigra, and the neostriatum.  
     
     
         31 . The method for using an implantable device to treat a neurological disorder of  claim 29 , wherein the predetermined structure comprises a functional neural pathway.  
     
     
         32 . A method for treating a neurological disorder in a patient, the method comprising the steps of: 
 implanting a device in the body of the patient;    implanting a plurality of electrodes in the body of the patient, wherein each of the plurality of electrodes is coupled to the device;    detecting a neurological event with the device;    analyzing a parameter measured by the implantable device, wherein the parameter is representative of a characteristic of the neurological event;    selecting a therapy based at least in part on the parameter; and    applying the therapy with the device.    
     
     
         33 . The method for treating a neurological disorder of  claim 32 , further comprising the step of implanting a sensor in the body of the patient, and wherein the parameter is obtained from the sensor.  
     
     
         34 . The method for treating a neurological disorder of  claim 33 , wherein the sensor comprises an EEG sensor, an EMG sensor, an accelerometer, a motion sensor, an orientation sensor, a blood pressure sensor, a blood flow sensor, a blood oxygenation sensor, a drug concentration sensor, a neurotransmitter concentration sensor, or a sleep sensor.  
     
     
         35 . A method for using an implantable device to treat a neurological disorder, the method comprising the steps of: 
 detecting a neurological event with a triggering detection channel of the implantable device;    analyzing a parameter observed by the implantable device, wherein the parameter comprises an electrographic measurement representative of a characteristic of the event and obtained from a data storage area associated with the triggering detection channel;    selecting a therapy based at least in part on the parameter; and    delivering the therapy.    
     
     
         36 . A method for using an implantable device to treat a neurological disorder, the method comprising the steps of: 
 detecting a neurological event with a triggering detection channel included in a plurality of detection channels of the implantable device;    analyzing a parameter observed by the implantable device, wherein the parameter is representative of a characteristic of the event and obtained from an indication of which of the plurality of detection channels is the triggering detection channel;    selecting a therapy based at least in part on the parameter; and    delivering the therapy.    
     
     
         37 . An implantable neurostimulator for the treatment of a neurological disorder, comprising: 
 a detection subsystem adapted to detect a neurological event and to observe an event characteristic related to the neurological event; and    a therapy subsystem adapted to deliver a therapy to the patient, wherein the therapy is selected at least in part based on the event characteristic.    
     
     
         38 . The implantable neurostimulator of  claim 37 , wherein the neurological event comprises a seizure.  
     
     
         39 . The implantable neurostimulator of  claim 37 , wherein the neurological event comprises a seizure onset.  
     
     
         40 . The implantable neurostimulator of  claim 37 , wherein the event characteristic comprises an event type.  
     
     
         41 . The implantable neurostimulator of  claim 37 , wherein the event characteristic comprises an event location.  
     
     
         42 . The implantable neurostimulator of  claim 37 , wherein the event characteristic is obtained from a device state of the implantable neuro stimulator.  
     
     
         43 . The implantable neurostimulator of  claim 37 , wherein the detection subsystem includes a plurality of detection channels.  
     
     
         44 . The implantable neurostimulator of  claim 43 , wherein the event characteristic comprises a triggering detection channel identified upon an event detection as one of the plurality of detection channels.  
     
     
         45 . The implantable neurostimulator of  claim 37 , wherein the event characteristic is obtained from a data storage area associated with the detection subsystem.  
     
     
         46 . The implantable neurostimulator of  claim 37 , further comprising a sensor in communication with the detection subsystem, and wherein the event characteristic is obtained from the sensor.  
     
     
         47 . The implantable neurostimulator of  claim 37 , wherein the event characteristic is obtained from a measurement of a physiological condition.