Methods for Evaluating and Selecting Electrode Sites of a Brain Network to Treat Brain Disorders
The present invention involves methods and systems for treatment of brain disorders using neuromodulation of brain networks. Implantation occurs by selecting sites which modulate the network in selected manners, or are modulated by a stimulus in a particular manner that is relevant to treatment of the network. The candidate locations within a brain region are evaluated in relation to how these are indirectly modulated by stimulation at a different brain region. Treatment of one or more brain networks associated with a brain disorder is realized with a consideration of network dynamics and coupling effects such as indirect stimulation of non-target regions. A brain modulation system (BMS) increases, decreases, or otherwise modulates network regional activity in a differential manner. Therapy and electrode locations are adjusted using sensed data and target implantation criteria related to the brain network model. Linking rules be derived during the implantation procedure and used in the subsequent adjusting of the therapy of regions of a brain network.
1 . A method of providing treatment for a brain disorder comprising the steps of:
implanting a first electrode in a location of a first brain region of a brain network
implanting a second electrode in a location of a second brain region of the brain network
selecting two locations in the two brain regions comprising the steps of
providing to the patient at least one stimulus which alters neuronal activity in at least a first brain region of the network,
sensing and measuring neuronal activity related to the stimulus;
analyzing the neuronal activity and determining if the neuronal activity related to the stimulus is at least a target amount or type of activity and in the case where this is true then selecting approximately the location as permanent, and, in the case where the activity related to the stimulus is not at least a target amount or type of activity, then selecting a different location for implanting the electrode and repeating this step until the target amount or type of activity occurs, whereby the true result identifies a location of the first brain region as one for which the provision of neuromodulation treatment should be efficacious indicating that the location of the electrode would be useful during subsequent treatment;
identifying a location in the second brain region at least in part by electrically stimulating the location in the first brain region with at least one stimulation protocol and determining whether or not a change in the second brain region occurs in response to this electrical stimulation, and if the change does not occur then selecting a different location for implanting the second electrode and repeating this entire step, whereby said change reflects either beneficial interactions between the first brain region and the second brain region or unwanted interactions which could be compensated for by stimulation of the second region;
implanting a brain neuromodulation device configured for operating upon the two electrodes; and
providing therapy to the brain network by stimulating with the brain neuromodulation device.
2 . The method of providing treatment for a brain disorder of claim 1 in which the stimulus is a drug.
3 . The method of providing treatment for a brain disorder of claim 1 in which the stimulus is a cognitive task.
4 . The method of providing treatment for a brain disorder of claim 1 in which the stimulus is an emotional task.
5 . The method of providing treatment for a brain disorder of claim 1 in which the changes produced in the second region by stimulation of the first region are used to define linking rules which are used during the step of providing therapy to the brain network.
6 . The method of providing treatment for a brain disorder of claim 1 in which the patient passively views the stimulus.
7 . The method of providing treatment for a brain disorder of claim 1 in which the change includes increased activation of the first brain region relative to the second brain region in relation to the respective activity of the first and second brain regions during a baseline period.
8 . The method of providing treatment for a brain disorder of claim 1 in which the change includes increased correlation of at least one feature of the first and second brain region relative to the correlation of the first and second brain regions during a baseline period.
9 . The method of providing treatment for a brain disorder of claim 1 in which the at least a first target brain region is selected from the group consisting of the subgenual area, anterior cingulate, and ventral tegmental area.
10 . A method of providing treatment for a brain disorder comprising the steps of:
implanting a first electrode in a location of a first brain region of a brain network
implanting a second electrode in a location of a second brain region of a brain network
providing to the patient at least one stimulus which is designed alter neuronal activity in at least the first brain region of the network,
sensing and measuring neuronal activity in response to the stimulus;
analyzing the neuronal activity and if a change of the neuronal activity in response to the stimulus is at least a target amount or type of activity, then making approximately the location of the first electrode permanent, otherwise selecting a different location and repeating this process, whereby the change identifies the brain region within the target area of the first brain region as one for which the provision of neuromodulation treatment should be efficacious and indicates that the candidate location of the electrode should be selected to be permanent;
identifying a location of a second region at least in part by providing a stimulus that stimulates the first region and determining that a change in the second region, related to modulation of the first region, occurs; whereby the change reflects either a beneficial interaction between the first brain region and the second brain region, or reflects an unwanted interaction which could be compensated for by stimulation of the second region;
implanting a brain neuromodulation device configured for operating upon the two electrodes; and
providing therapy to the brain network by stimulating with the brain neuromodulation device.
11 . The method of providing treatment for a brain disorder of claim 10 in which the target amount or type of activity which identifies the brain region within the target area of the first brain region is both a large change in the activity of the first target brain region of a target network and relatively less change in the second target brain region, whereby changing the activity of the second target brain region is an undesired side-effect that is beneficial to avoid.
12 . The method of providing treatment for a brain disorder of claim 10 in which the target amount or type of activity includes producing both a large change in the activity of the first target brain region of a target network and a large change in the second target brain region, whereby changing the activity of the second target brain region is a desired effect indicating that modulation of the first region can modulate the second brain region well relative to other candidate first brain regions and thereby more greatly indirectly produce desired changes in other target areas of the network.
13 . The method of providing treatment for a brain disorder of claim 10 in which the stimulus is a drug.
14 . The method of treating a brain network of claim 10 in which the sensing and measuring neuronal activity is accomplished using a sensor which is selected from the group of: at least one implanted electrode; neuroimaging sensors such as PET, MEG, EEG, MRS or fMRI; and sensors which can measure changes in concentration of neurotransmitters, blood flow, temperature, or metabolism.
15 . The method of providing treatment for a brain disorder of claim 10 in which the stimulus is an emotional task.
16 . The method of providing treatment for a brain disorder of claim 10 in which the stimulus is electrical stimulation provided by an electrode.
17 . The method of providing treatment for a brain disorder of claim 10 in which the changes include activation of the first brain region relative to the second brain region, which is assessed in relation to the activation of these regions during a baseline period.
18 . The method of providing treatment for a brain disorder of claim 10 in which the changes include the correlation of at least one feature calculated in the sensed activity of the first and second brain regions, which is assessed in relation to the correlation that existed during a baseline period.
19 . The method of providing treatment for a brain disorder of claim 10 in which the at least a first target brain region is selected from the group consisting of subgenual area, anterior cingulate, ventral tegmental area.
20 . The method of providing treatment for a brain disorder of claim 10 in which the network is related to a mood and/or anxiety disorder.