Non-invasive treatment of neurodegenerative diseases
Methods and devices for the non-invasive treatment of neurodegenerative diseases through delivery of energy to target nervous tissue, particularly the vagus nerve. In certain embodiments, the devices include a magnetic stimulator having coils with toroidal windings, which are in contact with an electrically conducting medium that is adapted to conform to the contour of a target body surface of a patient. The coils induce an electric current and/or an electric field within the patient, thereby stimulating nerve fibers within the patient. The stimulation brings about reduction of neuroinflammation in patients suffering from conditions comprising Alzheimer's Disease, Parkinson's Disease, Multiple Sclerosis, postoperative cognitive dysfunction and postoperative delirium.
1. A method for treating a neurodegenerative disorder in a patient comprising:
applying energy transcutaneously through an outer skin surface of a patient to generate an electrical impulse at or near a selected nerve within the patient; and
modulating the enerqy such that the electrical impulse is sufficient to inhibit inflammation and increase an anti-inflammatory competence of cytokines in the patient and treat the neurodegenerative disorder.
2. The method of claim 1 wherein the applying energy step is carried out by transcutaneously passing an electrical current through an outer skin surface of the patient.
3. The method of claim 1 wherein the applying energy step is carried out by generating a magnetic field exterior to the patient sufficient to induce an electrical impulse at or near the selected nerve within the patient.
4. The method of claim 1 wherein the electrical impulse is sufficient to increase activity of anti-inflammatory cytokines.
5. The method of claim 1 wherein the electrical impulse is sufficient to stimulate nerve fibers that control or mediate activity of a neurotrophic factor.
6. The method of claim 5 wherein the neurotrophic factor is a member of the transforming growth factor (TGF) beta superfamily of neurotrophic factors.
7. The method of claim 5 wherein the neurotrophic factor is a member of the nerve growth factor superfamily, the neurokine superfamily, or the insulin-like family of non-neuronal growth factors.
8. The method of claim 5 wherein the neurotrophic factor is a member of the same family as nerve growth factor (NGF), glial-cell-line-derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF), or mesencephalic astrocyte-derived neurotrophic factor (MANF).
9. The method of claim 1 wherein the neurodegenerative disease is selected from a group comprising Alzheimer's disease, Parkinson's disease, multiple sclerosis, postoperative cognitive dysfunction or postoperative delirium.
10. The method of claim 1 wherein the selected nerve is a vagus nerve.
11. The method of claim 10 wherein the selected nerve is a right branch of the vagus nerve.
12. The method of claim 1 wherein the electrical impulse is sufficient to inhibit release of a pro-inflammatory cytokine.
13. The method of claim 12 wherein the pro-inflammatory cytokine is tumor necrosis factor (TNF)-alpha.
14. The method of claim 1 wherein the applying energy step is carried out by:
generating a time-varying magnetic field that is located entirely outside of the patient;
shaping an electric field that is induced by said magnetic field; and
conducting an electric current that is induced by said magnetic field through an outer skin surface of the patient to modulate the selected nerve.
15. The method of claim 14 further comprising substantially constraining the electric current from modulating one or more nerves in a region between the outer skin surface and the selected nerve.
16. The method of claim 14 wherein the generating step comprises generating the time-varying magnetic field within a first enclosed coil.
17. The method of claim 16 wherein the shaping step comprises generating a second time-varying magnetic field within a second enclosed coil positioned near or adjacent to the first enclosed coil.
18. The method of claim 14 wherein the shaping step comprises positioning a conducting medium around a portion of the enclosed coil such that the direction of the electrical field is constrained within the conducting medium.
19. The method of claim 14 wherein the conducting step is carried out by electrically coupling the induced electric field to the target region allowing current to flow through the outer skin surface of the patient.
20. The method of claim 1 wherein the selected nerve is at least approximately 1-2 cm below an outer skin surface of the patient.
21. An apparatus for applying energy transcutaneously to a target region within a patient with a neurodegenerative disorder, comprising:
an enclosure;
a power source housed within the enclosure and configured to generate an energy field that is located entirely exterior to an outer skin surface of the patient, the energy field being sufficient to transcutaneously pass through the outer skin surface; and
wherein the power source is configured to generate an electrical impulse at or near the target region sufficient to modulate activity of a selected nerve at the target region to inhibit inflammation and enhance an anti-inflammatory competence of a cytokine in the patient and treat the neurodegenerative disorder.
22. The apparatus of claim 21 further comprising a conduction medium, wherein the source of energy is configured to generate an electric field that induces an electrical current sufficient to pass through the outer skin surface of the patient.
23. The apparatus set forth in claim 22 wherein the electrical field has an amplitude of greater than 10 V/m.
24. The apparatus set forth in claim 22 wherein the electrical field has a gradient of greater than 2 V/m/mm.
25. The apparatus set forth in claim 22 wherein the electrical field comprises bursts of pulses with a frequency of 5 Hz to 100 Hz.
26. The apparatus set forth in claim 22 wherein the electrical field comprises bursts of between 1 and 20 pulses with each pulse 50-1000 microseconds in duration.
27. The apparatus set forth in claim 21 wherein the electrical impulse is sufficient to inhibit release of a pro-inflammatory cytokine.
28. The apparatus set forth in claim 27 wherein the pro-inflammatory cytokine is tumor necrosis factor (TNF)-alpha.
29. The apparatus set forth in claim 21 wherein the cytokine is tumor growth factor (TGF)-beta.
30. The apparatus set forth in claim 21 wherein a retinoid or a component of a retinoic acid signaling system biases the competence of the cytokine towards anti-inflammation.
31. The apparatus set forth in claim 21 wherein the electrical impulse is sufficient to enhance anti-inflammatory activity of a neurotrophic factor.
32. The apparatus set forth in claim 31 wherein the neurotrophic factor is a member of the transforming growth factor (TGF)-beta superfamily of neurotrophic factors, the nerve growth factor superfamily of neurotrophic factors, the neurokine superfamily of neurotrophic factors, or the insulin-like family of non-neuronal growth factors.
33. The apparatus set forth in claim 21 wherein the selected nerve is a vagus nerve of the patient.
34. The apparatus set forth in claim 21 wherein the neurodegenerative disease is Alzheimer's disease, Parkinson's disease, multiple sclerosis, postoperative cognitive dysfunction or postoperative delirium.
35. A method for treating a neurodegenerative disorder in a patient comprising:
applying energy transcutaneously through an outer skin surface of a patient to generate an electrical impulse at or near a selected nerve within the patient; and
modulating the enerqy such that the electrical impulse is sufficient to inhibit inflammation and increase an activity of anti-inflammatory cytokines in the patient and treat the neurodegenerative disorder.
36. The method of claim 35 wherein the applying energy step is carried out by transcutaneously passing an electrical current through an outer skin surface of the patient.
37. The method of claim 35 wherein the applying energy step is carried out by generating a magnetic field exterior to the patient sufficient to induce an electrical impulse at or near the selected nerve within the patient.
38. The method of claim 35 wherein the neurodegenerative disease is selected from a group comprising Alzheimer's disease, Parkinson's disease, multiple sclerosis, postoperative cognitive dysfunction or postoperative delirium.
39. The method of claim 35 wherein the selected nerve is a vagus nerve.
40. The method of claim 39 wherein the selected nerve is a right branch of the vagus nerve.
41. The method of claim 35 wherein the electrical impulse is sufficient to inhibit release of a pro-inflammatory cytokine.
42. The method of claim 41 wherein the pro-inflammatory cytokine is tumor necrosis factor (TNF)-alpha.
43. The method of claim 35 wherein the applying energy step is carried out by:
generating a time-varying magnetic field that is located entirely outside of the patient;
shaping an electric field that is induced by said magnetic field; and
conducting an electric current that is induced by said magnetic field through an outer skin surface of the patient to modulate the selected nerve.
44. The method of claim 43 wherein the generating step comprises generating the time-varying magnetic field within a first enclosed coil.
45. The method of claim 44 wherein the shaping step comprises generating a second time-varying magnetic field within a second enclosed coil positioned near or adjacent to the first enclosed coil.
46. The method of claim 35 wherein the selected nerve is at least approximately 1-2 cm below an outer skin surface of the patient.
47. The method of claim 35 further comprising substantially constraining the electric current from modulating one or more nerves in a region between the outer skin surface and the selected nerve.
48. An apparatus for applying energy transcutaneously to a target region within a patient with a neurodegenerative disorder, comprising:
an enclosure;
a power source housed within the enclosure and configured to generate an energy field that is located entirely exterior to an outer skin surface of the patient, the energy field being sufficient to transcutaneously pass through the outer skin surface; and
wherein the power source is configured to generate an electrical impulse at or near the target site sufficient to modulate activity of a selected nerve at the target region to inhibit inflammation and enhance an anti-inflammatory activity of a neurotrophic factor in the patient and treat the neurodegenerative disorder.
49. The apparatus of claim 48 further comprising a conduction medium, wherein the source of energy is configured to generate an electric field that induces an electrical current sufficient to pass through the outer skin surface of the patient.
50. The apparatus set forth in claim 49 wherein the electrical field has an amplitude of greater than 10 V/m.
51. The apparatus set forth in claim 49 wherein the electrical field has a gradient of greater than 2 V/m/mm.
52. The apparatus set forth in claim 49 wherein the electrical field comprises bursts of pulses with a frequency of 5 Hz to 100 Hz.
53. The apparatus set forth in claim 49 wherein the electrical field comprises bursts of between 1 and 20 pulses with each pulse 50 -1000 microseconds in duration.
54. The apparatus set forth in claim 48 wherein the electrical impulse is sufficient to inhibit release of a pro-inflammatory cytokine.
55. The apparatus set forth in claim 54 wherein the pro-inflammatory cytokine is tumor necrosis factor (TNF)-alpha.
56. The apparatus set forth in claim 48 wherein a retinoid or a component of a retinoic acid signaling system biases the competence of the cytokine towards anti-inflammation.
57. The apparatus set forth in claim 48 wherein the electrical impulse is sufficient to enhance anti-inflammatory activity of a neurotrophic factor.
58. The apparatus set forth in claim 57 wherein the neurotrophic factor is a member of the transforming growth factor (TGF)-beta superfamily of neurotrophic factors, the nerve growth factor superfamily of neurotrophic factors, the neurokine superfamily of neurotrophic factors, or the insulin-like family of non-neuronal growth factors.
59. The apparatus set forth in claim 48 wherein the selected nerve is a vagus nerve of the patient.
60. The apparatus set forth in claim 48 wherein the neurodegenerative disease is Alzheimer's disease, Parkinson's disease, multiple sclerosis, postoperative cognitive dysfunction or postoperative delirium.