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 stimulating a brain, the method comprising:
applying, by a control unit, a plurality of stimuli to a target structure of the brain with at least one implantable electrode in contact with the target structure, where stimuli in the plurality of stimuli are delivered at varied amplitudes;
obtaining, by the control unit, a plurality of neural measurements from the at least one implantable electrode 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, by the control unit, a therapeutic transition point associated with the late response by recording and processing the plurality of neural measurements that each capture a respective measure of the late response arising in the target structure from a respective stimulus of the plurality of stimuli,
wherein the therapeutic transition point comprises a therapeutic transition stimulation amplitude of the plurality of stimuli at, or around which,
a peak of the late response is delayed relative to respective late response peaks corresponding to stimuli having stimulation amplitudes that are lower than the therapeutic transition stimulation amplitude;
or
a growth curve of the late response changes, and
applying, by the control unit, subsequent stimuli to the target structure at amplitudes at or greater than the therapeutic transition stimulation amplitude.
2. The method of claim 1 further comprising:
obtaining a plurality of neural measurements of evoked compound action potentials (ECAPs) arising from respective ones of the plurality of stimuli;
setting a target ECAP amplitude for the ECAPs arising from the plurality of stimuli, the target ECAP amplitude comprising an ECAP amplitude arising from application of the stimuli at or around the therapeutic transition stimulation amplitude; and
adjusting at least one stimulus subsequent to the plurality of stimuli giving rise to the obtained plurality of neural measurements of ECAPs, the adjusting being based on the target ECAP amplitude.
3. The method of claim 1 , further comprising:
obtaining a neural measurement of an evoked compound action potential (ECAP) arising from one of the plurality of stimuli;
determining an ECAP parameter comprising at least one of presence, amplitude, morphology, and latency of the ECAP; and
adjusting at least one stimulus subsequent to said one of the plurality of stimuli giving rise to the obtained neural measurement of the ECAP, the adjusting based on the ECAP parameter.
4. The method of claim 1 , wherein identifying the therapeutic transition point is based on a late response growth curve of the respective late responses.
5. The method of claim 1 wherein each of the plurality of neural measurements are obtained in a respective time period beginning 2-3 ms after onset of the respective one of the plurality of stimuli.
6. The method of claim 1 wherein each of the plurality of neural measurements are obtained in a respective time period ending in a range of 5-10 ms after onset of the respective one of the plurality of stimuli.
7. The method of claim 1 wherein each of the plurality of neural measurements are obtained in a respective time period ending in a range of 5.5-8 ms after onset of the respective one of the plurality of stimuli.
8. The method of claim 1 wherein each of the plurality of neural measurements are obtained in a respective time period ending in a range of 6.5-7.5 ms after onset of the respective one of the plurality of stimuli.
9. The method of claim 1 wherein each of the plurality of neural measurements are obtained in a respective time period configured to also capture a measure of any compound action potential arising directly from the respective stimulus, prior to the respective late response.
10. The method of claim 1 further comprising comparing a characteristic of at least one of the measures of the late response to a healthy range in order to diagnose a disease state.
11. The method of claim 1 further comprising, upon determining a presence of a first late response from a first neural measurement of the plurality of neural measurements, monitoring subsequent neural measurements of the plurality of neural measurements for changes in a respective measure of a characteristic of the respective late responses over time, in order to diagnose a disease state.
12. The method of claim 1 wherein the applying of the subsequent stimuli is to regulate neural activity in the brain to a target level or target profile.
13. The method of claim 1 , further comprising adjusting a stimulation paradigm in response to the measure of the late response.
14. The method of claim 1 further comprising monitoring the plurality of neural measurements to assess beta band oscillations influencing the neural measurements.
15. The method of claim 2 , wherein the method further comprises the step of monitoring changes in the therapeutic transition point, and adjusting, by the control unit, application of subsequent stimuli in response to the monitored changes in the therapeutic transition point.
16. An implantable device for stimulating neural activity in a brain, the device comprising:
a control unit;
a stimulus source powered by a battery and controlled by the control unit to provide a plurality of stimuli from one or more 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 the one or more electrodes 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; wherein
the control unit is configured to identify a therapeutic transition point associated with the late response by recording and processing the plurality of neural measurements that each capture a respective measure of the late response arising in the target structure from a respective stimulus of the plurality of stimuli,
wherein the therapeutic transition point comprises a therapeutic transition stimulation amplitude of the plurality of stimuli at, or around which,
a peak of the late response is delayed relative to respective late response peaks corresponding to stimuli having stimulation amplitudes that are lower than the therapeutic transition amplitude;
or
a growth curve of the measured late response changes;
and
the control unit is further configured to apply subsequent stimuli to the target structure at amplitudes at or greater than the therapeutic transition stimulation amplitude.
17. The device of claim 16 , wherein the control unit is further configured to:
obtain a plurality of neural measurements of evoked compound action potentials (ECAPs) arising from respective ones of the plurality of stimuli;
set a target ECAP amplitude for the ECAPs arising from the plurality of stimuli, the target ECAP amplitude comprising an ECAP amplitude arising from application of the stimuli at or around the therapeutic transition stimulation amplitude; and
adjust at least one stimulus subsequent to the plurality of stimuli giving rise to the obtained plurality of neural measurements of ECAPs, the adjustment being based on the target ECAP amplitude.
18. The device of claim 16 , wherein the control unit is further configured to:
obtain a neural measurement of an evoked compound action potential (ECAP) arising from one of the plurality of stimuli;
determine an ECAP parameter comprising at least one of presence, amplitude, morphology, and latency of the ECAP; and
adjust at least one stimulus subsequent to said one of the plurality of stimuli giving rise to the obtained neural measurement of the ECAP, the adjustment based on the ECAP parameter.
19. The device of claim 17 , wherein the control unit is further configured to monitor changes in the therapeutic transition point, and adjust application of subsequent stimuli in response to the monitored changes in the therapeutic transition point.
20. A non-transitory computer readable medium for stimulating neural activity in a brain, comprising instructions which, when executed by one or more processors, causes performance of the following:
applying, by a control unit, a plurality of stimuli to a target structure of the brain with at least one implantable electrode in contact with the target structure, where stimuli in the plurality of stimuli are delivered at varied amplitudes;
obtaining, by the control unit, a plurality of neural measurements from the at least one implantable electrode 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, by the control unit, a therapeutic transition point associated with the late response by recording and processing the plurality of neural measurements that each capture a respective measure of the late response arising in the target structure from a respective stimulus of the plurality of stimuli,
wherein the therapeutic transition point comprises a therapeutic transition stimulation amplitude of the plurality of stimuli at, or around which,
a peak of the late response is delayed relative to respective late response peaks corresponding to stimuli having stimulation amplitudes that are lower than the therapeutic transition amplitude;
or
a growth curve of the measured late response changes, and
applying, by the control unit, subsequent stimuli to the target structure at amplitudes at or greater than the therapeutic transition stimulation amplitude.