Methods and apparatuses for treating stroke using low-frequency stimulation
Methods and apparatuses for treating a patient having a brain lesion (e.g., a stroke patient) by applying a charge-balanced, low-frequency alternating current stimulation (ACS) to a region of the patient's brain immediately before and/or during a directed movement. The charge-balanced, low-frequency ACS may have a depolarizing phase that is slower than the hyperpolarizing phase (e.g., the depolarizing phase may have a frequency of 15 Hz or less and the hyperpolarizing phase with a frequency greater than 15 Hz). The ACS stimulation field may be greater than 1.5 V/m. The ACS may be applied during a preferred excitation phase.
1. A method of treating a patient, the method comprising:
detecting a directed movement or an intended directed movement from the patient; and
applying a charge-balanced, low-frequency alternating current stimulation (ACS) to a region of the patient's brain immediately before and/or during the directed movement, wherein the charge-balanced, low-frequency ACS has a depolarizing phase with a frequency of 15 Hz or less and a hyperpolarizing phase with a frequency greater than 15 Hz, wherein applying the charge-balanced, low-frequency ACS to the region of the patient's brain comprises applying the charge-balanced, low-frequency ACS to a region of the patient's brain that is adjacent to a lesion of the patient's brain;
wherein the ACS field strength is greater than 1.5 V/m.
2. The method of claim 1 , wherein the charge-balanced, low-frequency ACS is applied in phase with a majority of unit of the region of the patient's brain, within an excitable zone of the majority of units of the region of the patient's brain.
3. The method of claim 2 , further comprising determining the excitable zone by stimulating the region during non-movement periods or under anesthesia to determine a frequency and phase relationship of entrainment of the region.
4. The method of claim 3 , wherein the frequency and phase relationship of entrainment of the region is frequency and/or current amplitude dependent.
5. The method of claim 3 , further comprising determining a preferred open-loop stimulation period or a closed-loop stimulation period using the frequency and phase relationship of entrainment, where the charge-balanced, low-frequency ACS is applied in phase with the preferred open-loop period or closed-loop stimulation period.
6. The method of claim 2 , further comprising determining properties of the ACS using a feedforward or recurrent neural network (RNN).
7. The method of claim 6 , wherein the feedforward or RNN is modified based on actual measurements of the frequency, amplitude and phase dependence of the excitable zone.
8. The method of claim 1 , wherein the directed movement is a reaching or reaching and grasping movement.
9. The method of claim 1 , wherein detecting the directed movement or the intended directed movement comprises sensing brain activity.
10. The method of claim 1 , wherein detecting the directed movement or intended directed movement comprises detecting an electromyographic signal.
11. The method of claim 1 , wherein detecting the directed movement or intended directed movement comprises detecting body motion using a motion sensor.
12. The method of claim 1 , wherein the method is a method of treating a brain lesion.
13. The method of claim 1 , wherein the method is a method of treating stroke, chronic small vessel disease seen with aging, and/or traumatic brain injury.
14. The method of claim 1 , wherein the charge-balanced, low-frequency ACS is applied epidurally.
15. The method of claim 1 , wherein the charge-balanced, low-frequency ACS is applied from within a blood vessel.
16. The method of claim 1 , further comprising suppressing application of the charge-balanced, low-frequency ACS when the patient is sleeping.
17. The method of claim 1 , further comprising identifying stimulation parameters by applying, from a subcortical site, a plurality of bursts of charge-balanced, low-frequency pulses having a burst frequency of between 1-10 Hz, an inter-burse pulse frequency of between 10-200 Hz, and a pulse width of between about 0.01 ms and 2 ms, wherein the bursts of charge-balanced, low-frequency pulses each comprises between about 1 and 20 pulses per burst.
18. The method of claim 17 , wherein applying the charge-balanced, low-frequency alternating current stimulation comprises using the stimulation parameters when applying the charge-balanced, low-frequency alternating current stimulation.
19. A system for treating a patient, the system comprising:
one or more sensors configured to detect a directed movement or an intended directed movement from the patient, wherein the one or more sensors comprise electrodes configured to detect neural or neuromuscular activity;
a plurality of electrodes;
one or more processors; and
memory coupled to the one or more processors, the memory configured to store computer-program instructions, that, when executed by the one or more processors, perform a computer-implemented method comprising:
applying a charge-balanced, low-frequency alternating current stimulation (ACS) to the plurality of electrodes immediately before and/or during a detected directed movement, wherein the charge-balanced, low-frequency ACS has a depolarizing phase with a frequency of 15 Hz or less and a hyperpolarizing phase with a frequency greater than 15 Hz, wherein the ACS field strength is greater than 1.5 V/m.
20. The system of claim 19 , wherein the computer-implemented method further comprises: applying the charge-balanced, low-frequency ACS in phase with a majority of units of the region of the patient's brain within an excitable zone of the region of the patient's brain.
21. The system of claim 20 , wherein the computer-implemented method further comprises: determining the excitable zone by stimulating the region during non-movement periods or under anesthesia to determine a frequency and phase relationship of entrainment of the region.
22. The system of claim 20 , wherein the computer-implemented method further comprises determining a preferred open-loop stimulation period or a closed-loop stimulation period using the frequency and phase relationship of entrainment, where the charge-balanced, low-frequency ACS is applied in phase with the preferred open-loop period or closed-loop stimulation period.
23. The system of claim 19 , wherein the computer-implemented method further comprises: applying the charge-balanced, low-frequency ACS to a region of the patient's brain is adjacent to a lesion of the patient's brain.
24. The system of claim 19 , wherein the one or more sensors comprise movement sensors.
25. The system of claim 19 , wherein the computer-implemented method further comprises detecting the directed movement or the intended directed movement by sensing brain activity.
26. The system of claim 19 , wherein the computer-implemented method further comprises applying the charge-balanced, low-frequency ACS epidurally.
27. The system of claim 19 , wherein the computer-implemented method further comprises applying the charge-balanced, low-frequency ACS from within a blood vessel.
28. The system of claim 19 , wherein the computer-implemented method further comprises applying the charge-balanced, low-frequency ACS, further comprising suppressing application of the charge-balanced, low-frequency ACS when the patient is sleeping.
29. A non-transitory computer-readable medium including contents that are configured to cause one or more processors to perform a method comprising:
detecting a directed movement or an intended directed movement from the patient; and
applying a charge-balanced, low-frequency alternating current stimulation (ACS) to a subcortical region of the patient's brain immediately before and/or during the directed movement, wherein the charge-balanced, low-frequency ACS has a depolarizing phase with a frequency of 15 Hz or less and a hyperpolarizing phase with a frequency greater than 15 Hz, wherein the ACS field strength is greater than 1.5 V/m.
30. A method of treating a patient, the method comprising:
detecting a directed movement or an intended directed movement from the patient; and
applying a charge-balanced, low-frequency alternating current stimulation (ACS) to a region of the patient's brain immediately before and/or during the directed movement, wherein the charge-balanced, low-frequency ACS has a depolarizing phase with a frequency of 15 Hz or less and a hyperpolarizing phase with a frequency greater than 15 Hz, further wherein the charge-balanced, low-frequency ACS is applied from within a blood vessel;
wherein the ACS field strength is greater than 1.5 V/m.
31. A method of treating a patient, the method comprising:
detecting a directed movement or an intended directed movement from the patient; and
applying a charge-balanced, low-frequency alternating current stimulation (ACS) to a region of the patient's brain immediately before and/or during the directed movement, wherein the charge-balanced, low-frequency ACS has a depolarizing phase with a frequency of 15 Hz or less and a hyperpolarizing phase with a frequency greater than 15 Hz;
wherein the ACS field strength is greater than 1.5 V/m; and
suppressing application of the charge-balanced, low-frequency ACS when the patient is sleeping.
32. A system for treating a patient, the system comprising:
one or more sensors configured to detect a directed movement or an intended directed movement from the patient, wherein the one or more sensors comprise movement sensors;
a plurality of electrodes;
one or more processors; and
memory coupled to the one or more processors, the memory configured to store computer-program instructions, that, when executed by the one or more processors, perform a computer-implemented method comprising:
applying a charge-balanced, low-frequency alternating current stimulation (ACS) to the plurality of electrodes immediately before and/or during a detected directed movement, wherein the charge-balanced, low-frequency ACS has a depolarizing phase with a frequency of 15 Hz or less and a hyperpolarizing phase with a frequency greater than 15 Hz, wherein the ACS field strength is greater than 1.5 V/m.
33. A system for treating a patient, the system comprising:
one or more sensors configured to detect a directed movement or an intended directed movement from the patient;
a plurality of electrodes;
one or more processors; and
memory coupled to the one or more processors, the memory configured to store computer-program instructions, that, when executed by the one or more processors, perform a computer-implemented method comprising:
applying a charge-balanced, low-frequency alternating current stimulation (ACS) to the plurality of electrodes immediately before and/or during a detected directed movement, wherein the charge-balanced, low-frequency ACS has a depolarizing phase with a frequency of 15 Hz or less and a hyperpolarizing phase with a frequency greater than 15 Hz, wherein the ACS field strength is greater than 1.5 V/m, wherein detecting the directed movement or the intended directed movement is detected by sensing brain activity.