Method and apparatus for electronically switching electrode configuration

Abstract

A method and apparatus for selecting neural stimulation electrode configuration is provided. One aspect of this disclosure relates to an implantable medical device including a neural stimulator adapted to generate neural stimulation signals and an electrode configuration tester for testing a first electrode configuration for stimulating a desired neural target. The device includes a controller to control the neural stimulator to selectively provide a first neural stimulation signal with appropriate signal characteristics to stimulate the desired neural target using the first electrical configuration and a second neural stimulation signal with appropriate signal characteristics to stimulate the desired neural target using a second electrode configuration, and adapted to communicate with the electrode configuration tester and to respond to an indication that an efficacy of the first electrode configuration is lower than a threshold by providing the neural stimulation using the second neural stimulation signal. Other aspects and embodiments are provided herein.

1 . An implantable medical device, comprising: 
 a neural stimulator adapted to generate neural stimulation signals;    an electrode configuration tester for testing a first electrode configuration for stimulating a desired neural target; and    a controller to control the neural stimulator to selectively provide a first neural stimulation signal with appropriate signal characteristics to stimulate the desired neural target using the first electrical configuration and a second neural stimulation signal with appropriate signal characteristics to stimulate the desired neural target using a second electrode configuration, and adapted to communicate with the electrode configuration tester and to respond to an indication that an efficacy of the first electrode configuration is lower than a threshold by providing the neural stimulation using the second neural stimulation signal.    
   
   
       2 . The implantable medical device of  claim 1 , wherein the first and second stimulation signals have same signal characteristics.  
   
   
       3 . The implantable medical device of  claim 1 , wherein the first and second stimulation signals have different signal characteristics.  
   
   
       4 . The implantable medical device of  claim 1 , wherein the first electrode configuration is unipolar.  
   
   
       5 . The implantable medical device of  claim 1 , wherein the first electrode configuration is bipolar.  
   
   
       6 . The implantable medical device of  claim 1 , wherein the first electrode configuration is multipolar.  
   
   
       7 . The implantable medical device of  claim 1 , wherein the first electrode configuration includes an intravascular electrode to transvascularly stimulate the neural target.  
   
   
       8 . The implantable medical device of  claim 1 , wherein the first electrode configuration includes a nerve cuff electrode.  
   
   
       9 . The implantable medical device of  claim 1 , wherein the electrode configuration tester includes an impedance measurement circuit to measure impedance for the first electrode configuration, compare the measured impedance to a desired impedance range for the first electrode configuration, and determine that the efficacy of the first electrode configuration is below a threshold when the measured impedance is not within the desired range.  
   
   
       10 . The implantable medical device of  claim 1 , wherein the electrode configuration tester is adapted to measure physiological response for the first electrode configuration, compare the measured physiological response to a desired range for the physiological response, and determine that the efficacy of the first electrode configuration is below a threshold when the measured physiological response is not within the desired range.  
   
   
       11 . A system, comprising: 
 at least one neural stimulation lead having a proximal portion and a distal portion;    a plurality of electrodes along the distal portion of the at least one lead, with at least one of the plurality of electrodes forming part of a first electrode configuration to deliver neural stimulation therapy and another at least one of the plurality of electrodes forming part of a second electrode configuration to deliver neural stimulation therapy; and    an implantable medical device, coupled to the proximal portion of the at least one lead, the implantable device including: 
 a neural stimulator; and  
 a controller to communicate with the neural stimulator, the controller being adapted to deliver an electrical signal to the first electrode configuration to deliver neural stimulation therapy, to measure impedance for the first electrode configuration, and to select the second electrode configuration if the measured impedance for the first electrode configuration is not within a desired range of impedance.  
   
   
   
       12 . The system of  claim 11 , further comprising: 
 a telemetry circuit to communicate with the controller and an external module.    
   
   
       13 . The system of  claim 11 , further comprising: 
 a memory circuit to communicate with the controller; and    computer-readable instructions embedded in the memory circuit, the computer-readable instructions being operable on by the controller to control delivery of neural stimulation therapy.    
   
   
       14 . The system of  claim 11 , wherein the at least one neural stimulation lead includes a direct stimulation lead for providing stimulation directly to a nerve trunk.  
   
   
       15 . The system of  claim 13 , wherein the at least one neural stimulation lead includes a nerve cuff.  
   
   
       16 . The system of  claim 11 , wherein the at least one neural stimulation lead includes an indirect stimulation lead for providing stimulation indirectly to a nerve trunk, through the wall of an adjacent blood vessel.  
   
   
       17 . A system, comprising: 
 means for testing a first electrode configuration to deliver neural stimulation therapy;    means for comparing test results of the first electrode configuration to a desired range of results for the first electrode configuration; and    means for selecting a second electrode configuration to deliver neural stimulation therapy if the test results for the first electrode configuration are not within the desired range.    
   
   
       18 . The system of  claim 17 , further comprising: 
 means for storing electrode characteristics and configurations.    
   
   
       19 . The system of  claim 18 , further comprising: 
 means for trending electrode characteristics and configurations over time.    
   
   
       20 . The system of  claim 17 , wherein the means for testing a first electrode configuration includes a means for measuring impedance of a first electrode configuration.  
   
   
       21 . The system of  claim 17 , wherein the means for testing a first electrode configuration includes an implantable cardiac rhythm management device with neural stimulation capabilities.  
   
   
       22 . The system of  claim 17 , wherein the first electrode configuration to deliver neural stimulation therapy includes electrodes on a multipolar lead.  
   
   
       23 . The system of  claim 17 , wherein the first electrode configuration to deliver neural stimulation therapy includes electrodes on at least two leads.  
   
   
       24 . The system of  claim 17 , wherein the second electrode configuration to deliver neural stimulation therapy includes electrodes on a multipolar lead.  
   
   
       25 . The system of  claim 17 , wherein the second electrode configuration to deliver neural stimulation therapy includes electrodes on at least two leads.  
   
   
       26 . A method, comprising: 
 testing a first electrode configuration to deliver neural stimulation therapy;    comparing test results of the first electrode configuration to desired ranges of test results for the first electrode configuration; and    selecting a second electrode configuration to deliver neural stimulation therapy if the test results for the first electrode configuration are not within the desired ranges.    
   
   
       27 . The method of  claim 26 , wherein comparing the test results of the first electrode configuration includes comparing a measured impedance of the first electrode configuration to a desired range of impedance for the first electrode configuration.  
   
   
       28 . The method of  claim 26 , wherein comparing the test results of the first electrode configuration includes comparing a measured physiological response of the first electrode configuration to a desired range of physiological response for the first electrode configuration.  
   
   
       29 . The method of  claim 27 , wherein selecting a second electrode configuration to deliver neural stimulation therapy if the measured impedance for the first electrode configuration is not within the desired range includes: 
 measuring an impedance for the second electrode configuration to deliver neural stimulation therapy; and    comparing the measured impedance of the second electrode configuration to a desired impedance range for the second electrode configuration.    
   
   
       30 . The method of  claim 27 , wherein selecting a second electrode configuration to deliver neural stimulation therapy if the measured impedance for the first electrode configuration is not within the desired range includes the first and second electrode configuration on a multipolar lead.  
   
   
       31 . The method of  claim 27 , wherein selecting a second electrode configuration to deliver neural stimulation therapy if the measured impedance for the first electrode configuration is not within the desired range includes the first and second electrode configurations on at least two leads.  
   
   
       32 . The method of  claim 27 , wherein measuring an impedance for a first electrode configuration to deliver neural stimulation therapy includes measuring an impedance for the first electrode configuration periodically.  
   
   
       33 . The method of  claim 27 , wherein measuring an impedance for a first electrode configuration to deliver neural stimulation therapy includes measuring an impedance for the first electrode configuration in between deliveries of neural stimulation therapy.  
   
   
       34 . The method of  claim 27 , wherein selecting a second electrode configuration to deliver neural stimulation therapy if the measured impedance for the first electrode configuration is not within the desired range includes disabling the first electrode configuration and enabling the second electrode configuration.  
   
   
       35 . The method of  claim 27 , further comprising: 
 delivering neural stimulation therapy via the second electrode configuration.    
   
   
       36 . The method of  claim 35 , further comprising: 
 measuring an impedance for the second electrode configuration to deliver neural stimulation therapy;    comparing the measured impedance of the second electrode configuration to a desired impedance range for the second electrode configuration; and    selecting a third electrode configuration to deliver neural stimulation therapy if the measured impedance for the second electrode configuration is not within the desired range for the second electrode configuration.