# US 11,027,121 B2 · Systems, methods and media for directional coordinated reset deep brain stimulation

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- Number: US 11,027,121 B2
- Document ID: US11027121B2
- Status: Granted
- Kind: B2
- Application number: 16/258,264
- Filed: 2019-01-25
- Published: 2019-08-01
- Granted: 2021-06-08
- Earliest claimed: 2018-01-26
- Assignees: Regents of the University of Minnesota
- Applicants: Regents of the University of Minnesota
- Inventors: Jing Wang; Gregory F. Molnar; Jerrold L. Vitek
- Web page: https://patentgrep.com/patent/US11027121B2

## CPC

- A61N 1/0534: {Electrodes for deep brain stimulation}
- A61B 5/6868: {Brain}
- A61N 1/36067: {Movement disorders, e.g. tremor or Parkinson disease (stimulating motor muscle A61N1/36003)}
- A61N 1/36082: {Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease}
- A61N 1/08: Arrangements or circuits for monitoring, protecting, controlling or indicating {(for external stimulators A61N1/3603; for implantable neurostimulators A61N1/36128; for heart stimulators A61N1/37; for defibrillators A61N1/3925)}
- A61N 1/36175: {Pulse width or duty cycle}
- A61N 1/36185: {Selection of the electrode configuration}
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

In accordance with some embodiments of the disclosed subject matter, mechanisms (which can, for example, include systems, methods, and media) for directional coordinated reset deep brain stimulation are provided. In some embodiments, a method is provided, comprising: implanting a lead with segmented electrodes into an anatomical structure; selecting a first subset of the electrodes corresponding to the anatomical structure as active electrodes; causing electrical pulses at a first stimulation level to be applied at the active electrodes in a first sequence; causing electrical pulses at a second stimulation level that is lower than the first stimulation level to be applied at the active electrodes in a second sequence during a second time period; and inhibiting electrical pulses from being applied at inactive electrodes during the second time period.

## Claims

### Claim 1

A method, comprising:
implanting a lead with segmented electrodes into at least one anatomical structure of a subject;
selecting a first subset of the segmented electrodes that correspond to the at least one anatomical structure as active electrodes, wherein a second subset of the segmented electrodes not selected for inclusion in the first subset are inactive electrodes;
causing electrical pulses at a first stimulation level to be applied separately to each of the active electrodes in a first coordinated reset deep brain stimulation sequence during a first time period;
inhibiting electrical pulses from being applied at the inactive electrodes during the first time period;
causing electrical pulses at a second stimulation level that is lower than the first stimulation level to be applied separately to each of the active electrodes in a second coordinated reset deep brain stimulation sequence during a second time period; and
inhibiting electrical pulses from being applied at the inactive electrodes during the second time period.

### Claim 2 (depends on 1)

The method of claim 1, wherein the at least one anatomical structure comprises the subject's subthalamic nucleus.

### Claim 3 (depends on 1)

The method of claim 1, wherein the at least one anatomical structure comprises the subject's globus pallidus.

### Claim 4 (depends on 1)

The method of claim 1, further comprising:
monitoring a level of symptoms exhibited by the subject during the first time period;
determining, at a second time subsequent to the first time period and preceding the second time period, that the level of symptoms is stable;
in response to determining that the level of symptoms is stable, causing the electrical pulses at the second stimulation level to be applied.

### Claim 5 (depends on 1)

The method of claim 1, wherein selecting the first subset comprises:
performing a monopolar review to determine a stimulation level for each of the segmented electrodes at which side effects are caused by the stimulation;
generating image data showing a relationship between the lead and the at least one anatomical structure; and
determining, based on results of the monopolar review and the image data, which electrodes correspond to the at least one anatomical structure and which electrodes do not correspond to the at least one anatomical structure.

### Claim 6 (depends on 1)

The method of claim 1, wherein the first stimulation level is between 1 milliamps (mA) and 5 mA.

### Claim 7 (depends on 1)

The method of claim 1, wherein the second stimulation level is between 0.1 mA and 1.5 mA.

### Claim 8 (depends on 1)

The method of claim 1, further comprising determining, for at least a first segmented electrode of the segmented electrodes, a threshold stimulation level at which side-effects attributable to the stimulation are observed.

### Claim 9 (depends on 8)

The method of claim 8, wherein the first stimulation level is between one-third of the threshold stimulation level and the threshold stimulation level.

### Claim 10 (depends on 8)

The method of claim 8, wherein the second stimulation level is between one-tenth of the threshold stimulation level and two-tenths of the threshold stimulation level.

### Claim 11

A system, comprising:
a lead with segmented electrodes implanted in at least one anatomical structure of a subject; and
a pulse generator that is configured to:
emit electrical pulses at a first stimulation level separately to each of a plurality of active electrodes of the segmented electrodes in a first coordinated reset deep brain stimulation sequence during a first time period, wherein the plurality of active electrodes comprise a first subset of the segmented electrodes that correspond to the at least one anatomical structure and a second subset of the segmented electrodes not included in the first subset are inactive electrodes;
inhibit emission of electrical pulses to the inactive electrodes during the first time period;
receive, at a second time subsequent to the first time period, an instruction from a computing device to stop emitting electrical pulses at the first stimulation level, and begin emitting electrical pulses at a second stimulation level that is lower than the first stimulation separately to each of the plurality of active electrodes in a second coordinated reset deep brain stimulation sequence during a second time period; and
inhibit emission of electrical pulses to the inactive electrodes during the second time period.

### Claim 12 (depends on 11)

The system of claim 11, wherein the at least one anatomical structure comprises the subject's subthalamic nucleus.

### Claim 13 (depends on 11)

The system of claim 11, wherein the pulse generator is further configured to emit electrical pulses to each of the segmented electrodes during a monopolar review to determine a stimulation level for each of the segmented electrodes at which side effects are caused by the stimulation.

### Claim 14 (depends on 11)

The system of claim 11, wherein the first stimulation level is between 1 milliamps (mA) and 5 mA.

### Claim 15 (depends on 11)

The system of claim 11, wherein the second stimulation level is between 0.1 mA and 1.5 mA.

### Claim 16 (depends on 11)

The system of claim 11, wherein the pulse generator is implanted in a thoracic region of the subject and is electrically connected to the lead via a cable.

### Claim 17 (depends on 11)

The system of claim 11, wherein the instruction from the computing device is received via a wireless link between the pulse generator and the computing device.

### Claim 18 (depends on 11)

The system of claim 11, wherein the pulse generator is further configured to, for at least a first segmented electrodes of the segmented electrodes, emit pulses of increasing intensity to determine a stimulation level for at least the first segmented electrode at which side effects are caused by the stimulation.

### Claim 19 (depends on 18)

The system of claim 18, wherein the first stimulation level is between one-third of the threshold stimulation level and the threshold stimulation level.

### Claim 20 (depends on 18)

The system of claim 18, wherein the second stimulation level is between one-tenth of the threshold stimulation level and two-tenths of the threshold stimulation level.