Selective stimulation systems and signal parameters for medical conditions
Devices, systems and methods are provided for targeted treatment of a variety of conditions, particularly conditions that are associated with or influenced by the nervous system, such as pain. Targeted treatment of such conditions is provided with minimal deleterious side effects, such as undesired motor responses or undesired stimulation of unaffected body regions. This is achieved by directly neuromodulating a target anatomy associated with the condition while minimizing or excluding undesired neuromodulation of other anatomies.
1. A method of treating chronic pain in a patient by electrically stimulating a dorsal root ganglion of the patient, the method comprising:
accessing an epidural space of patient with an implant tool comprising a sheath having a pre-curved distal end with a stimulation lead disposed within the implant tool, wherein (1) the stimulation lead comprises a stylet lumen and (2) a stylet with a pre-curved distal end is disposed within the stylet lumen of the stimulation lead;
advancing the implant tool within the epidural space toward a nerve root wherein the pre-curved distal end of the sheath bends the lead and the stylet therein along a first curvature so as to approach the nerve root;
positioning a distal portion of the lead and a distal portion of the stylet therein beyond the sheath, wherein the distal portion of the stylet bends the distal portion of the lead along a second curvature to position the at least one electrode of the stimulation lead in proximity with the dorsal root ganglion; and
operating a programmer device to control provision of a plurality of stimulating signals by a pulse generator to the at least one electrode to stimulate the dorsal root ganglion to determine optimal therapy parameters to treat the chronic pain of the patient, wherein (1) the operating the programmer device comprises performing mapping operations to identify sets of parameters that activate distinct sub-dermatome regions associated with the dorsal root ganglion, (2) the programmer device provides a current step size that is selectable from a plurality of values, and (3) the plurality of values includes at least one current step size that is sufficiently small to permit identification of sub-dermatomal stimulation.
2. The method of claim 1 further comprising:
performing mapping operations for a second dorsal root ganglion.
3. The method of claim 1 wherein the second dorsal root ganglion includes neural tissue for sub-dermatome regions that overlap with sub-dermatome regions of the dorsal root ganglion.
4. The method of claim 1 wherein the sub-dermatome regions include at least a lower back sub-dermatome region and a leg sub-dermatome region.
5. The method of claim 1 , wherein the optimal stimulation parameters alleviate the chronic pain of the patient without causing a perceptible motor response.
6. The method of claim 1 , wherein the operating a programmer device comprises determining a threshold for ventral root stimulation for one or more electrode settings.
7. The method of claim 1 , wherein the operating a programmer device comprises setting a maximum pulse current value for one or more electrode settings.
8. The method of claim 6 wherein the operating a programmer device automatically switches between plurality of values for the current step size as a clinician steps through pulse current values while using the programmer device.