Materials and methods for treating neuropathies and related disorders including those involving a keystone nerve

Abstract

Methods, apparatus, compositions and kits for inhibiting a disorder in a human patient, including non-cerebral neurovascular disorder or muscular headache pain, or loss of motor or sensory function, sympathetic tone or range or fluidity of motion that affect a nerve pathway at more than one locus associated with the disorder to inhibit the disorder. Alternatively or in addition, neuropathy associated with a disorder is treatable by palpating to determine a Keystone nerve essential to the neuropathy, applying pressure to determine a point of maximum discomfort or trigger of increased symptoms to identify a Levin Sign as a locus of initial intervention, and intervening to treat the neuropathy at the location of the Levin Sign by administering a pharmaceutically active agent, internal implanted or external neuro stimulation affecting the nerve pathway to inhibit the neuropathy.

What is claimed is: 
     
         1 . A method of inhibiting a disorder in a human patient, the disorder comprising pain, or loss of motor or sensory function, sympathetic tone or range or fluidity of motion that is not cerebral neurovascular disorder pain or not muscular headache pain, the method comprising affecting a nerve pathway at one or more locus associated with the disorder in a manner to inhibit the disorder to thereby inhibit the disorder, wherein at least one locus is a peripheral nerve structure physiologically or anatomically related to the nerve pathway that directly targets a Levin Sign or a Keystone nerve structure associated with the disorder. 
     
     
         2 . The method of  claim 1 , wherein more than one locus associated with the disorder is affected. 
     
     
         3 . The method of  claim 1 , wherein the disorder is selected from the group consisting of posttraumatic or postsurgical pain; cancer-related pain, peripheral neuropathy, trigeminal neuralgia, or loss of motor or sensory function, sympathetic tone or range or fluidity of motion of any one or more of the patient's face, head, neck, oropharynx, oral cavity, dental structure, temporomandibular joint or musculature, thorax, abdomen, pelvis, genitalia, joint, limb, musculature or connective tissue, and any combination of two or more of the disorders, wherein the disorder is complex regional pain syndrome, type I or type II. 
     
     
         4 . The method of  claim 1 , wherein the disorder involves one or more of the group consisting of a frozen shoulder syndrome, a restriction of shoulder range of motion following trauma, injury or surgery or sympathetic mediated disorder, post-surgical cervical, thoracic or lumbar pathology, pain or other symptoms following spinal fusion or laminectomy, spinal or joint degenerative disease or trauma. 
     
     
         5 . The method of  claim 1 , wherein at least one locus is a peripheral or non-peripheral nerve structure physiologically or anatomically related to the nerve pathway that does not directly target a Levin Sign or a Keystone nerve structure associated with the disorder. 
     
     
         6 . The method of  claim 1 , wherein the nerve pathway includes at least one of a nerve structure involving a suprascapular nerve or small fibers therein; a sympathetic or parasympathetic neural structure that is not directly located in the central nervous system; or stellate, lumbar paravertebral or other ganglia; a paraspinal branch of a neural structure; paraspinal sympathetic or parasympathetic fibers not in ganglion structures; a radicular nerve; a nerve of the lower extremities; a nerve of the head and neck; or a small fiber or sympathetic or parasympathetic neural structure related to a major peripheral nerve, wherein the nerve structure includes at least one of a suprascapular, radial, ulnar, median, musculocutaneous, tibial, peroneal, sural, saphenous or peripheral facial nerve. 
     
     
         7 . The method of  claim 1 , wherein one locus of the nerve pathway comprises a nerve of the head or neck or a dorsonasal nerve structure, wherein the dorsonasal nerve structure is at least one of a sphenopalatine ganglion, trigeminal nerve, trigeminal ganglion, cavernous sinus ganglion, carotic sinus ganglion, maxillary nerve, ethmoidal nerve, ethmoidal ganglion, and vidian nerve, and any branch thereof, and wherein the method comprises applying a Stimulation Technique to at least one locus. 
     
     
         8 . The method of  claim 7 , wherein the method comprises implanting an electronic neural stimulator in patient tissue in sufficient anatomic proximity to at least one locus of the nerve pathway and energizing the implanted electronic neural stimulator, so as to inhibit pain associated with the disorder. 
     
     
         9 . The method of  claim 1 , wherein the method comprises administering to the patient pharmaceutically active agent in a manner to affect at least one locus of the nerve pathway. 
     
     
         10 . A method for treating a neuropathy associated with a disorder in a human patient, the method comprising: applying pressure in an increasing manner by palpation to an area associated with the neuropathy to determine a Keystone nerve which is triggering and essential to the neuropathy; applying the pressure to determine a point of at least one of maximum discomfort or trigger of increased trophic symptoms or findings to identify a Levin Sign as a locus of initial intervention; and intervening to treat the neuropathy at the location of the Levin Sign by one or more of administration of a pharmaceutically active agent, internal implanted neurostimulation or external neurostimulation affecting a nerve pathway associated with the neuropathy in a manner to inhibit the neuropathy to thereby inhibit the neuropathy, wherein the disorder involves one or more of the group consisting of a frozen shoulder syndrome, a restriction of shoulder range of motion following trauma, injury or surgery or sympathetic mediated disorder, post-surgical cervical, thoracic or lumbar pathology, pain or other symptoms following spinal fusion or laminectomy, spinal or joint degenerative disease or trauma. 
     
     
         11 . The method of  claim 10 , wherein the neuropathy is neuropathy associated with a disorder selected from the group consisting of posttraumatic or postsurgical pain; cancer-related pain, peripheral neuropathy, trigeminal neuralgia, or loss of motor or sensory function, sympathetic tone or range or fluidity of motion of any one or more of the patient's face, head, neck, oropharynx, oral cavity, dental structure, temporomandibular joint or musculature, thorax, abdomen, pelvis, genitalia, joint, limb, musculature or connective tissue, complex regional pain syndrome, type I, complex regional pain syndrome, type II, and any combination of two or more of the disorders, wherein the nerve pathway includes at least one of a nerve structure involving a suprascapular nerve or small fibers therein; a sympathetic or parasympathetic neural structure that is not directly located in the central nervous system; or stellate, lumbar paravertebral or other ganglia; a paraspinal branch of a neural structure; paraspinal sympathetic or parasympathetic fibers not in ganglion structures; a radicular nerve; a nerve of the lower extremities; a nerve of the head and neck; or a small fiber or sympathetic or parasympathetic neural structure related to a major peripheral nerve; and where the nerve structure includes at least one of a suprascapular, radial, ulnar, median, musculocutaneous, tibial, peroneal, sural, saphenous or peripheral facial nerve. 
     
     
         12 . The method of  claim 11 , further comprising externally supplying at least one of power, control or monitoring power to the implanted electronic neural stimulator from an external component for supplying at least one of power, control or monitoring, wherein externally supplying at least one of power, control or monitoring comprises inductively or remotely coupling the external component to the implanted electronic neural stimulator. 
     
     
         13 . The method of  claim 12 , wherein the method comprises surgically intervening at a nerve structure associated with the nerve pathway and thereby inhibit the disorder. 
     
     
         14 . The method of  claim 13 , wherein the method comprises administering to the patient a pharmaceutically active agent in a manner to affect the nerve pathway so as to inhibit the disorder. 
     
     
         15 . A device for stimulating, sensing a condition of or monitoring the function of an organ or tissue or for inhibiting a disorder in a human patient, the disorder comprising pain, or loss of motor or sensory function, sympathetic tone or range or fluidity of motion that is not cerebral neurovascular disorder pain or muscular headache pain, the device comprising an implantable or external stimulus, sensor or monitor component capable of stimulating, sensing a condition of or monitoring the function of the organ or tissue or affecting a nerve pathway associated with the disorder in a manner to enhance or sense the condition or function of the organ or tissue, or to monitor the function or to inhibit the disorder to thereby inhibit the disorder, the device further comprising a power source directly or indirectly coupled with the stimulus, sensor or monitor component to provide power to the stimulus, sensor or monitor component. 
     
     
         16 . The device of  claim 15 , wherein the device comprises a Stimulation Device, wherein the device applies a Stimulation Technique to the organ, tissue or nerve pathway, wherein the stimulator device is an implantable electronic neural stimulator, wherein the implantable electronic neural stimulator is selected from the group consisting of a microelectromechanical system device, a nanoelectromechanical system device, a maxillofacial device, or one or more implantable electrodes, further comprising an internally implantable component for supplying at least one of power, control or monitoring to the stimulus, sensor or monitor component, further comprising an internally implantable component for supplying at least one of power, control or monitoring to the stimulus, sensor or monitor component, wherein the power is generated by the patient's living tissues in close anatomic proximity to the device, the internally implantable component for supplying at least one of power, control or monitoring to the stimulus, sensor or monitor component separately implantable in a location in the patient remote from the stimulus, sensor monitor component, further comprising an external component for supplying at least one of power, control or monitoring to the stimulus, sensor or monitor component that remotely or inductively supplies power, control or monitoring to the stimulus, sensor or monitor component, wherein the stimulator, sensor or monitor component is an external component retained by the device in sufficient anatomic proximity to a portion of the patient's body in the vicinity of the organ, tissue or nerve pathway to be stimulated, sensed or monitored. 
     
     
         17 . A method of treating pain of facial trauma of a patient, the method comprising neurostimulation of the patient's sphenopalatine ganglion. 
     
     
         18 . A method of improving a human patient's shoulder's range of motion following injury, trauma, post-surgery, or frozen shoulder syndrome, the method comprising applying a local anesthetic or an anti-neuropathic agent in the vicinity of the patient's suprascapular nerve, or applying a Stimulation Technique in the vicinity of the patient's suprascapular nerve, wherein the Stimulation Technique is applied by a Stimulation Device retained on the patient by a dressing or appliance in the vicinity of the patient's suprascapular nerve. 
     
     
         19 . A method comprising combination of stimulation of SPG with branches of Trigeminal nerves, or occipital nerves. 
     
     
         20 . The method of  claim 19  comprising a step of combining a dorsonasal neural structure including one or more of the SPG, the cavernous sinus ganglion, the carotic sinus ganglion, numerous branches of the maxillary nerve, the ethmoidal nerve, the ethmoidal ganglion, and the vidian nerve or other neural structure in close proximity of the SPG or sphenopalatine recess with stimulation of occipital nerve or sub occipital or high cervical segment including any of Cervical level (or proximal) 1-3 stimulation. 
     
     
         21 . The method of  claim 19  comprising a step of combined stimulation of a dorsonasal nerve with any 1 or more peripheral branches of the Trigeminal nerve or facial nerve including but not limited to 1 or more of the superficial branches of the trigeminal nerve located extracranially in the face, namely the supraorbital, supratrochlear, infraorbital, auriculotemporal, zygomaticotemporal, zygomaticoorbital, zygomaticofacial, nasal and mentalis nerve, anywhere in the course of the facial nerve from the intracranial or cisternal segment distally to the temporal, zygomatic, buccal, mandibular and cervical branches including efferent motor, parasympathetic or afferent sensory branches of the facial nerve 
     
     
         22 . The method of  claim 19  comprising combining occipital nerve, suboccipital, or high Cervical segment stimulation with any 1 or more branches of the Trigeminal nerve or facial nerve including but not limited to 1 or more of the superficial branches of the trigeminal nerve located extracranially in the face, namely the supraorbital, supratrochlear, infraorbital, auriculotemporal, zygomaticotemporal, zygomaticoorbital, zygomaticofacial, nasal and mentalis nerve, anywhere in the course of the facial nerve from the intracranial or cisternal segment distally to the temporal, zygomatic, buccal, mandibular and cervical branches including efferent motor, parasympathetic or afferent sensory branches of the facial nerve. 
     
     
         23 . The method of  claim 19  comprising stimulation of one or more loci of the facial nerve or components thereof, with one or more electrodes or stimulator device component which may be implantable or non-implantable. 
     
     
         24 . The method of  claim 19  wherein the electrode or other stimulator device, magnet, heating device or component may be integral or detachable to a cap, hat, band, glass frame, mask, eye mask, sleep mask pillow, cushion or custom fit device apparatus for comfort and proper position. Optimal position may also be maximized by inflatable, temperature malleable or moldable bolsters or cushioning. 
     
     
         25 . The method of  claim 19  comprising 3D or other neural mapping by XRay, MRI, CT, PET scan, ultrasound, or MR neurography will better elucidate neural anatomy, as well as the anatomy and ‘geometry’ surrounding or associated tissue and Boney structures and recesses to allow for improved formation, construction, and configuration of the stimulator or 1 or more components and optimize electrode or component placement 
     
     
         26 . The method of  claim 19  comprising mapping coverage of stimulation area, by noting geographic anatomic localization of stimulation paresthesia in healthy person, or in afflicted patient, will allow the map of stimulated area to be matched more closely with the patients pain map and will optimize placement results. 
     
     
         27 . The method of  claim 19  comprising mapping during placement, or adjusted for patient subgroup populations. 
     
     
         28 . A method of inhibiting symptoms of disorders affecting or afflicting a human patient, the disorders comprising pain, or loss of motor or sensory function, sympathetic tone or range or fluidity of motion wherein one component of said disorders is not a cerebral neurovascular disorder pain and not a muscular headache pain, the method comprising affecting a nerve pathway at one or more locus associated with the disorder in a manner to inhibit the disorder to thereby inhibit the disorder, wherein at least one locus is a peripheral nerve structure physiologically or anatomically related to the nerve pathway that directly targets a Levin Sign or a Keystone nerve structure associated with the disorder.