Monitoring brain neural potentials
Neural activity in the brain arising from a stimulus is monitored. A stimulus is applied to a target structure of the brain and a neural measurement is obtained from at least one electrode implanted in contact with the target structure. The neural measurement is configured to capture a measure of any late response arising in the target structure, typically being a neural response arising after conclusion of an ECAP, such as in the period 1.5-10 ms after stimulus onset. The late response(s) can be a useful biomarker such as of therapeutic ranges of deep brain stimulation, disease progression, medication efficacy, and intra-operative changes.
1. A method of monitoring neural activity in a brain arising from a stimulus, the method comprising:
applying a plurality of stimuli to a target structure of the brain, where stimuli in the plurality of stimuli are delivered at varied amplitudes;
obtaining a plurality of neural measurements from at least one electrode implanted in contact with the target structure, each neural measurement configured to capture a measure of any late response arising in the target structure resulting from a corresponding stimulus in the plurality of stimuli; and
identifying a first and a second neural measurement in the plurality of neural measurements that describe a respective first and second late response, the respective first and second late responses being neural responses arising after an evoked compound action potential;
identifying a therapeutic transition by identifying a temporal shift between the respective first and second late responses;
defining a therapeutic stimulus amplitude based on a given amplitude of a stimulus corresponding to the second neural measurement, where the given amplitude is greater than an amplitude of a stimulus corresponding to the first neural measurement; and
controlling a subsequent deep brain stimulation (DBS) therapy to mitigate the symptoms of a neurological condition, wherein the DBS therapy comprises applying a subsequent stimulus to the target structure, where the subsequent stimulus is delivered at the therapeutic stimulus amplitude in order to increase life of a battery used to apply the subsequent stimulus.
2. The method of claim 1 wherein the neural measurement encompasses a time period beginning in the range 1.5-4 ms after the stimulus onset.
3. The method of claim 2 wherein the plurality of neural measurements are obtained in a time period beginning 2-3 ms after the stimulus onset.
4. The method of claim 1 wherein the plurality of neural measurements are obtained in a time period ending in the range 5-10 ms after the stimulus onset.
5. The method of claim 4 wherein the plurality of neural measurements are obtained in a time period ending in the range 5.5-8 ms after the stimulus onset.
6. The method of claim 5 wherein the plurality of neural measurements are obtained in a time period ending in the range 6.5-7.5 ms after the stimulus onset.
7. The method of claim 1 wherein the target structure is the subthalamic nucleus.
8. The method of claim 1 wherein the plurality of neural measurements are obtained in a time period configured to also capture a measure of any compound action potential arising directly from the stimulus, prior to the late response.
9. The method of claim 1 further comprising, comparing a characteristic of the respective first late response to a healthy range in order to diagnose a disease state.
10. The method of claim 9 wherein the characteristic of the late response is one or more of the presence, amplitude, morphology, and latency of the late response.
11. The method of claim 1 further comprising, upon determining the presence of the respective first late response, monitoring a characteristic of subsequent late responses for changes over time, in order to diagnose a disease state.
12. The method of claim 1 wherein the DBS is to regulate neural activity to a target level or target profile.
13. The method of claim 1 , further comprising adjusting a stimulation paradigm of the DBS.
14. The method of claim 1 further comprising monitoring the plurality of neural measurements to assess beta-band oscillations influencing the respective first and second neural late responses.
15. The method of claim 1 , wherein the neurological condition is selected from the group consisting of: Parkinson's disease, Huntington's disease, Tourette's syndrome, chronic depression, dependence, tremor, Alzheimer's disease and dystonia.
16. The method of claim 1 , wherein the temporal shift is at least 0.5 ms.
17. The method of claim 1 , wherein the temporal shift is identified by reference to a temporal location of a peak in the respective first and second late response.
18. An implantable device for monitoring neural activity in the brain arising from a stimulus, the device comprising:
a stimulus source powered by a battery for providing a plurality of stimuli to be delivered from one or more stimulus electrodes to a target structure of the brain, where stimuli in the plurality of stimuli are delivered at varied amplitudes;
measurement circuitry for obtaining a plurality of neural measurements from a sense electrode in contact with the target structure, the neural measurement configured to capture a measure of any late response arising in the target structure resulting from a corresponding stimulus in the plurality of stimuli; and
a processor configured to:
identify a first and a second neural measurement in the plurality of neural measurements that describe a respective first and second late response, the respective first and second late responses being neural responses arising after an evoked compound action potential;
identify a therapeutic transition by identifying a temporal shift between the respective first and second late responses;
define a therapeutic stimulus amplitude based on a given amplitude of a stimulus corresponding to the second neural measurement, where the given amplitude is greater than an amplitude of a stimulus corresponding to the first neural measurement; and
control a subsequent deep brain stimulation (DBS) therapy to mitigate the symptoms of a neurological condition, wherein the DBS therapy comprises applying a subsequent stimulus to the target structure, where the subsequent stimulus is delivered at the therapeutic stimulus amplitude in order to increase life of the battery.
19. The system of claim 18 , wherein the temporal shift is at least 0.5 ms.
20. A non-transitory computer readable medium for monitoring neural activity in the brain arising from a stimulus, comprising instructions which, when executed by one or more processors, causes performance of the following:
applying a plurality of stimuli to a target structure of the brain, where stimuli in the plurality of stimuli are delivered at varied amplitudes;
obtaining a plurality of neural measurements from at least one electrode implanted in contact with the target structure, each neural measurement configured to capture a measure of any late response arising in the target structure resulting from a corresponding stimulus in the plurality of stimuli; and
identifying a first and a second neural measurement in the plurality of neural measurements that describe a respective first and second late response, the respective first and second late responses being neural responses arising after an evoked compound action potential;
identifying a therapeutic transition by identifying a temporal shift in between the respective first and second late responses;
defining a therapeutic stimulus amplitude based on a given amplitude of a stimulus corresponding to the second neural measurement, where the given amplitude is greater than an amplitude of a stimulus corresponding to the first neural measurement; and
controlling a subsequent deep brain stimulation (DBS) therapy to mitigate the symptoms of a neurological condition, wherein the DBS therapy comprises applying a subsequent stimulus to the target structure, where the subsequent stimulus is delivered at the therapeutic stimulus amplitude in order to increase life of a battery used to apply the subsequent stimulus.