System and method for sustained baroreflex stimulation

Abstract

Various aspects of the present subject matter provide an implantable medical device. In various embodiments, the device comprises a baroreflex stimulator and a controller. The baroreflex stimulator is adapted to generate a stimulation signal to stimulate a baroreflex. The controller is adapted to communicate with the baroreflex stimulator and implement a baroreflex stimulation protocol to vary an intensity of the baroreflex stimulation provided by the stimulation signal to abate baroreflex adaptation. According to various embodiments, the controller is adapted to implement the baroreflex stimulation protocol to periodically modulate the baroreflex stimulation to produce an effect that mimics an effect of pulsatile pressure. Other aspects are provided herein.

1 . A system, comprising:
 a neural stimulator configured to generate stimulation pulses to stimulate a neural target; and   a controller configured to control the neural stimulator to deliver the stimulation pulses to the neural target to cause a desired response, wherein the controller includes a programmed stimulation protocol to maintain the desired physiological response by varying a neural stimulation intensity when the stimulation pulses cause the desired physiological response.   
     
     
         2 . The system of  claim 1 , wherein the neural target includes an autonomic neural target. 
     
     
         3 . The system of  claim 1 , wherein the programmed stimulation protocol is configured to vary an amplitude of the stimulation pulses when the stimulation pulses cause the desired physiological response. 
     
     
         4 . The system of  claim 1 , wherein the programmed stimulation protocol is configured to vary a frequency of the stimulation pulses when the stimulation pulses cause the desired physiological response. 
     
     
         5 . The system of  claim 1 , wherein the programmed stimulation protocol is configured to vary a stimulation duty cycle when the stimulation pulses cause the desired physiological response. 
     
     
         6 . The system of  claim 1 , further comprising a physiological sensor, wherein the controller is configured to use the physiological sensor to provide closed loop control for delivering the neural stimulation pulses to cause the desired response. 
     
     
         7 . The system of  claim 6 , wherein the physiological sensor includes a sensor selected from the group of sensors consisting of: a respiration sensor, a nerve traffic sensor, a pulse rate sensor, and a blood pressure sensor. 
     
     
         8 . A system for delivering hypertension therapy, comprising:
 a carotid sinus stimulator configured to stimulate a neural target in a carotid sinus region to lower blood pressure through a baroreflex response; and   a controller configured to control the carotid sinus stimulator to deliver stimulation pulses to the neural target to cause a desired baroreflex response, wherein the controller includes a programmed stimulation protocol to maintain the desired baroreflex response by varying a neural stimulation intensity when the stimulation pulses cause the desired baroreflex response.   
     
     
         9 . The system of  claim 8 , wherein the carotid sinus stimulator is configured to stimulate carotid sinus baroreceptors. 
     
     
         10 . The system of  claim 8 , wherein the carotid sinus stimulator is configured to stimulate a glossopharyngeal nerve. 
     
     
         11 . The system of  claim 8 , wherein the carotid sinus stimulator is configured to stimulate a carotid sinus nerve. 
     
     
         12 . The system of  claim 8 , further comprising a blood pressure sensor, wherein the controller is configured to use the blood pressure sensor to provide closed loop control for delivering the neural stimulation pulses to cause the desired response. 
     
     
         13 . The system of  claim 8 , further comprising a physiological sensor, wherein the controller is configured to use the physiological sensor to provide closed loop control for delivering the neural stimulation pulses to cause the desired response, wherein the physiological sensor includes a sensor selected from the group of sensors consisting of: a respiration sensor, a nerve traffic sensor, a pulse rate sensor, and a blood pressure sensor. 
     
     
         14 . The system of  claim 8 , wherein an external device includes the carotid sinus stimulator and the controller. 
     
     
         15 . A method for delivering a neural stimulation therapy, comprising:
 causing a desired neural stimulation response by delivering neural stimulation pulses to the neural target; and   maintaining the desired neural stimulation response by varying an intensity of the neural stimulation pulses, according to a programmed stimulation protocol, when the neural stimulation pulses cause the desired neural stimulation response.   
     
     
         16 . The method of  claim 15 , wherein causing the desired neural stimulation response includes using a sensed physiological parameter to provide closed loop feedback control of the delivered neural stimulation pulses to the neural target. 
     
     
         17 . The method of  claim 15 , wherein the neural target includes an autonomic neural target. 
     
     
         18 . The method of  claim 15 , wherein varying the intensity of the neural stimulation, according to the programmed stimulation protocol, includes varying at least one parameter selected from the group of parameters consisting of: an amplitude of the stimulation pulses, a frequency of the stimulation pulses, and a stimulation duty cycle. 
     
     
         19 . A method for delivering a hypertension therapy, comprising:
 stimulating a carotid sinus neural target to lower blood pressure through a baroreflex response, wherein stimulating the carotid sinus neural target includes:
 causing a desired baroreflex response by delivering neural stimulation to the neural target; and 
 maintaining the desired baroreflex response by varying an intensity of the neural stimulation, according to a programmed stimulation protocol, when the neural stimulate on causes the desired baroreflex response to maintain the desired baroreflex response. 
   
     
     
         20 . The method of  claim 19 , wherein the carotid sinus neural target includes carotid sinus baroreceptors. 
     
     
         21 . The method of  claim 19 , wherein the carotid sinus neural target includes a glossopharyngeal nerve. 
     
     
         22 . The method of  claim 19 , wherein the carotid sinus neural target includes a carotid sinus nerve. 
     
     
         23 . The method of  claim 19 , wherein causing the desired neural stimulation response includes using a sensed physiological parameter to provide closed loop feedback control of the delivered neural stimulation pulses to the neural target, wherein the sensed physiological parameter includes a sensed parameter selected from the group of parameters consisting of: respiration, nerve traffic, pulse rate, and blood pressure.