Implantable electrode positioning
A method of surgically positioning an electrode array at a desired implantation location relative to a nerve. A temporary probe electrode is temporarily positioned adjacent to the nerve and at a location which is caudorostrally separate to the desired implantation location of the electrode array. The implanted position of the probe electrode is temporarily fixed relative to the nerve. During implantation of the electrode array, electrical stimuli are applied from one of the temporarily fixed probe electrode and the electrode array, to evoke compound action potentials on the nerve. Compound action potentials evoked by the stimuli are sensed from at least one electrode of the other of the temporarily fixed probe electrode and the electrode array. From the sensed compound action potentials a position of the electrode array relative to the nerve is determined.
1. A method of estimating a position of an electrode array relative to a nerve, the electrode array being implanted adjacent to the nerve, wherein the electrodes of the electrode array are configured to apply stimulation or sense evoked compound action potentials (ECAPs), the method comprising:
applying stimulation at at least one electrode;
measuring at least one of an amplitude and latency of the ECAPs;
increasing a stimulation intensity, and repeating the applying and the measuring, until an onset of a late response is observed;
measuring at least one of an amplitude and latency of the late response; and
estimating a position of the electrode array relative to the nerve based on the amplitude and latency of at least one of the ECAPs and the late response.
2. The method of claim 1 , further comprising:
monitoring for an occurrence of muscle twitching, and
correlating the onset of the late response with the occurrence of muscle twitching, wherein the correlation is used to estimate the position of the electrode array.
3. The method of claim 1 , wherein estimating the position of the electrode array comprises using the onset of the late response to indicate that the electrode array is proximal to dorsal roots.
4. The method of claim 1 , wherein estimating the position of the electrode array comprises using a lack or decreased amplitude of the ECAPs to indicate that the electrode array is proximal to dorsal roots.
5. The method of claim 1 , further comprising estimating a position of the electrode array based on a collision of the ECAPs with peripherally evoked compound action potentials.
6. The method of claim 5 , further comprising causing a collision of the ECAPs with the peripherally evoked compound action potentials by introducing a delay between consecutive stimuli.
7. The method of claim 1 , wherein the electrode array is a paddle lead.
8. The method of claim 1 , wherein the electrode array is a percutaneous lead.
9. A system for estimating a position of an electrode array relative to a nerve, the system comprising:
an electrode array configured to be implanted adjacent to the nerve, and comprising at least one electrode configured to apply stimulation or sense compound action potentials (ECAPs); and
a controller configured to:
apply stimulation at at least one electrode;
measure at least one of an amplitude and latency of ECAPs;
increase a stimulation intensity and repeat the applying and the measuring until an onset of a late response is observed;
measure at least one of an amplitude and latency of the late response; and
estimate a position of the electrode array relative to the nerve based on the amplitude and latency of at least one of the ECAPs and the late response.
10. The system of claim 9 , wherein the controller is further configured to monitor for an occurrence of muscle twitching, to correlate the onset of the late response with the occurrence of muscle twitching, and to use the correlation to estimate the position of the electrode array.
11. The system of claim 9 , wherein the controller is configured to use the onset of the late response to indicate that the electrode array is proximal to dorsal roots.
12. The system of claim 9 , wherein the controller is configured to indicate that the electrode array is proximal to dorsal roots based on a lack or decreased amplitude of the ECAPs.
13. The system of claim 9 , wherein the controller is configured to estimate a position for implanting the electrode array based on a collision of the ECAPs with peripherally evoked compound action potentials.
14. The system of claim 13 , wherein the controller is configured to cause a collision of the ECAPs with the peripherally evoked compound action potentials by introducing a delay between consecutive stimuli.
15. The system of claim 9 , wherein the electrode array is a paddle lead.
16. The system of claim 9 , wherein the electrode array is a percutaneous lead.