# US 2018/0021576 A1 · Systems for peripheral nerve stimulation to treat tremor > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2018/0021576 A1 - Document ID: US20180021576A1 - Status: Published application - Kind: A1 - Application number: 15/721,480 - Filed: 2017-09-29 - Published: 2018-01-25 - Earliest claimed: 2014-06-02 - Assignees: Cala Health, Inc. - Applicants: Cala Health, Inc. - Inventors: Serena HanYing Wong; Kathryn H. Rosenbluth; Samuel Hamner; Paula Chidester; Scott L. Delp; Terence D. Sanger; David Klein - Web page: https://patentgrep.com/patent/US20180021576A1 ## CPC - A61N 1/36031: {using physiological parameters for adjustment} - A61B 5/1101: {Detecting tremor} - A61B 5/6824: {Arm or wrist} - A61N 1/0456: {Specially adapted for transcutaneous electrical nerve stimulation [TENS]} - A61N 1/0476: {Array electrodes (including any electrode arrangement with more than one electrode for at least one of the polarities)} - A61N 1/0484: {Garment electrodes worn by the patient} - A61N 1/36: for stimulation - A61N 1/36014: {External stimulators, e.g. with patch electrodes (external pacemakers A61N1/3625)} - A61N 1/36034: {specified by the stimulation parameters} - A61N 1/0496: {characterised by using specific chemical compositions, e.g. hydrogel compositions, adhesives} - A61N 1/36025: {for treating a mental or cerebral condition} - 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 A peripheral nerve stimulator can be used to stimulate a peripheral nerve to treat essential tremor, Parkinsonian tremor, and other forms of tremor. The stimulator can have electrodes that are placed circumferentially around the patient's wrist or arm. Specific nerves in the wrist or arm can be targeted by appropriate spacing of the electrodes. Positioning the electrodes on generally opposing sides of the target nerve can result in improved stimulation of the nerve. The stimulation pattern may alternate between the nerves. Improved stimulation algorithms can incorporate tremor feedback, external data, predictive adaptation, and long-term monitoring data. ## Claims ### Claim at position 1 -30. (canceled) ### Claim 31 A transcutaneous method of treating a patient, the method comprising: placing a circumferential band comprising a first electrode and a second electrode around the patient's arm or wrist in a configuration such that in the transverse cross-sectional plane of the arm or wrist there is a 90 degree to 180 degree angle between a line extending between a first nerve and the first electrode and a line extending between the first nerve and the second electrode, the first nerve selected from the patient's median, radial and ulnar nerves, wherein the first and second electrodes are spaced a predetermined distance apart; and delivering a first electrical stimulus from the electrodes to excite the first nerve. ### Claim 32 (depends on 31) The method of claim 31, wherein the band comprises a third electrode spaced a predetermined distance apart from the first and second electrodes such that there is a 90 degree to 180 degree angle between a line extending between a second nerve and the first electrode and a line extending between the second nerve and the third electrode, the second nerve selected from the patient's median, radial and ulnar nerves. ### Claim 33 (depends on 32) The method of claim 32, further comprising delivering a second electrical stimulus from the first electrode and the third electrode to excite the second nerve. ### Claim 34 (depends on 32) The method of claim 32, wherein the first nerve is the median nerve and the second nerve is the radial nerve. ### Claim 35 (depends on 31) The method of claim 31, wherein the band is operatively connected to a housing enclosing a sensor, and the method further comprises measuring one or more physiologic characteristics of the patient. ### Claim 36 (depends on 35) The method of claim 35, further comprising adjusting the first electrical stimulus based upon the measured physiologic characteristic. ### Claim 37 (depends on 33) The method of claim 33, further comprising temporally offsetting the first electrical stimulus from the second electrical stimulus by a period of time. ### Claim 38 (depends on 33) The method of claim 33, wherein the first electrical stimulus and the second electrical stimulus comprise patterned stimuli. ### Claim 39 (depends on 38) The method of claim 38, wherein the first electrical stimulus and the second electrical stimulus comprise burst stimuli. ### Claim 40 (depends on 33) The method of claim 33, wherein the first electrical stimulus and the second electrical stimulus comprise waveforms with ramped amplitudes. ### Claim 41 (depends on 31) The method of claim 31, wherein the positioning of the band is verified by paresthesia being reported in the patient's hand. ### Claim 42 (depends on 31) The method of claim 31, wherein the first electrical stimulus has a duration between about 20 and 60 minutes. ### Claim 43 (depends on 31) The method of claim 31, wherein the first electrical stimulus and the second electrical stimulus comprise patterned stimuli, wherein the band comprises a third electrode spaced a predetermined distance apart from the first and second electrodes such that there is a 90 degree to 180 degree angle between a line extending between a second nerve and the first electrode and a line extending between the second nerve and the third electrode, the second nerve selected from the patient's median, radial and ulnar nerves, wherein the method further comprises: delivering a second electrical stimulus from the first electrode and the third electrode to excite the second nerve; measuring one or more physiologic characteristics of the patient using a sensor; temporally offsetting the first electrical stimulus from the second electrical stimulus by a period of time; and adjusting the first electrical stimulus based upon the measured physiologic characteristic. ### Claim 44 A transcutaneous method of treating a patient, the method comprising: placing a band comprising a first electrode and a second electrode around the patient's arm or wrist in a configuration such that in the transverse cross-sectional plane of the arm or wrist there is a 90 degree to 180 degree angle between a line extending between a first nerve in the patient's arm or wrist and the first electrode and a line extending between the first nerve and the second electrode, wherein the first and second electrodes are spaced a predetermined distance apart; and delivering a first electrical stimulus from the electrodes to excite the first nerve. ### Claim 45 (depends on 44) The method of claim 44, wherein the first electrical stimulus and the second electrical stimulus comprise patterned stimuli, wherein the band comprises a third electrode spaced a predetermined distance apart from the first and second electrodes such that there is a 90 degree to 180 degree angle between a line extending between a second nerve and the first electrode and a line extending between the second nerve and the third electrode, the second nerve selected from the patient's median, radial and ulnar nerves, wherein the method further comprises: delivering a second electrical stimulus from the first electrode and the third electrode to excite the second nerve; measuring one or more physiologic characteristics of the patient using a sensor; temporally offsetting the first electrical stimulus from the second electrical stimulus by a period of time; and adjusting the first electrical stimulus based upon the measured physiologic characteristic. ### Claim 46 (depends on 44) The method of claim 44, wherein the band comprises a third electrode spaced a predetermined distance apart from the first and second electrodes such that there is a 90 degree to 180 degree angle between a line extending between a second nerve and the first electrode and a line extending between the second nerve and the third electrode, the second nerve selected from the patient's median, radial and ulnar nerves ### Claim 47 (depends on 46) The method of claim 46, wherein the first electrical stimulus and the second electrical stimulus comprise burst stimuli. ### Claim 48 (depends on 46) The method of claim 46, wherein the first electrical stimulus and the second electrical stimulus comprise waveforms with ramped amplitudes. ### Claim 49 A transcutaneous method of treating a patient, the method comprising: determining a circumference of a patient's wrist; providing a band and housing having a predetermined circumferential spacing for a first electrode, a second electrode, and a third electrode, wherein the predetermined circumferential spacing is based on the determined circumference of the patient's wrist, wherein the housing encloses a pulse generator configured to be in electrical communication with the first electrode, the second electrode, and the third electrode, wherein the band and housing are configured to be positioned on the wrist such that the first electrode is positioned approximately along the midline of the dorsal side of the arm or wrist, the second electrode is positioned approximately along the midline of the ventral side of the arm or wrist, and the third electrode is positioned in between the first electrode and second electrode, wherein the first electrode and the second electrode form a first electrode pair and the first electrode and third electrode form a second electrode pair; stimulating a first nerve by delivering a first electrical stimulus between the first electrode pair; and stimulating a second nerve by delivering a second electrical stimulus between the second electrode pair. ### Claim 50 (depends on 49) The method of claim 49, further comprising: temporally offsetting the first electrical stimulus from the second electrical stimulus by a period of time; and adjusting the first electrical stimulus based upon a measured physiologic characteristic, wherein the first electrical stimulus and the second electrical stimulus comprise patterned stimuli.