Pulsed Passive Charge Recovery Circuitry for an Implantable Medical Device
20230166103 · 2023-06-01
Inventors
- Emanuel Feldman (Simi Valley, CA)
- Jordi Parramon (Valencia, CA)
- Goran N. Marnfeldt (Valencia, CA)
- Adam T. Featherstone (Meridian, ID, US)
Cpc classification
A61N1/36014
HUMAN NECESSITIES
A61N1/3605
HUMAN NECESSITIES
A61N1/08
HUMAN NECESSITIES
International classification
Abstract
The problem of a potentially high amount of supra-threshold charge passing through the patient's tissue at the end of an Implantable Pulse Generator (IPG) program is addressed by circuitry that periodically dissipates only small amount of the charge stored on capacitances (e.g., DC-blocking capacitors) during a pulsed post-program recovery period. This occurs by periodically activating control signals to turn on passive recovery switches to form a series of discharge pulses each dissipating a sub-threshold amount of charge. Such periodic pulsed dissipation may extend the duration of post-program recovery, but is not likely to be noticeable by the patient when the programming in the IPG changes from a first to a second program. Periodic pulsed dissipation of charge may also be used during a program, such as between stimulation pulses.
Claims
1. A method for operating a pulse generator comprising a plurality of electrode nodes each configured to be coupled to one of a plurality of electrodes in contact with a patient's tissue, comprising: actively issuing a first pulse at two or more of the electrode nodes during a first period; actively issuing a second pulse at two or more of the electrode nodes during a second period; and executing a recovery period between the first pulse and the second pulse, wherein during the recovery period a plurality of discharge pulses are issued to passively recover charge during each of the discharge pulses.
2. The method of claim 1, wherein the second pulse comprises an adjustment to the first pulse.
3. The method of claim 1, wherein the first pulse is different from the second pulse.
4. The method of claim 1, wherein the first pulse is the same as the second pulse.
5. The method of claim 1, wherein the two or mode electrodes at which the first pulse is issued are different from the two or mode electrodes at which the second pulse is issued.
6. The method of claim 1, wherein the two or mode electrodes at which the first pulse is issued are the same as the two or mode electrodes at which the second pulses is issued.
7. The method of claim 1, wherein the pulse generator comprises a plurality of switches each connected to one of the electrode nodes, wherein during each of the plurality of discharge pulses at least some of the plurality of switches are closed.
8. The method of claim 7, wherein each of the plurality of switches is configured when closed to couple a reference voltage to its electrode node.
9. The method of claim 8, wherein during each of the plurality of discharge pulses all of the plurality of switches are closed to couple the reference voltage to all of the electrode nodes.
10. The method of claim 8, wherein during each of the plurality of discharge pulses only the switches connected to the electrode nodes to which the first pulse is issued are closed to couple the reference voltage to those electrode nodes.
11. A method for operating a pulse generator comprising a plurality of electrode nodes each configured to be coupled to one of a plurality of electrodes in contact with a patient's tissue, comprising: executing a first stimulation program to cause a plurality of first stimulation pulses to actively issue at two or more of the electrode nodes during a first period; executing a second stimulation program to cause a plurality of second stimulation pulses to actively issue at two or more of the electrode nodes during a second period; and executing a recovery period between the first period and the second period, wherein during the recovery period a plurality of discharge pulses are issued to passively recover charge during each of the discharge pulses.
12. The method of claim 11, wherein the second stimulation program comprises an adjustment to the first stimulation program.
13. The method of claim 11, wherein the first stimulation pulses are different from the second stimulation pulses.
14. The method of claim 11, wherein the first and second stimulation pulses respectively comprise first and second stimulation parameters, wherein at least one of the first stimulation parameters is different from one of the second situation parameters.
15. The method of claim 11, wherein the two or mode electrodes at which the first stimulation pulses are issued are different from the two or mode electrodes at which the second stimulation pulses are issued.
16. The method of claim 11, wherein the two or mode electrodes at which the first stimulation pulses are issued are the same as the two or mode electrodes at which the second stimulation pulses are issued.
17. The method of claim 11, wherein the pulse generator comprises a plurality of switches each connected to one of the electrode nodes, wherein during each of the plurality of discharge pulses at least some of the plurality of switches are closed.
18. The method of claim 17, wherein each of the plurality of switches is configured when closed to couple a reference voltage to its electrode node.
19. The method of claim 18, wherein during each of the plurality of discharge pulses all of the plurality of switches are closed to couple the reference voltage to all of the electrode nodes.
20. The method of claim 18, wherein during each of the plurality of discharge pulses only the switches connected to the electrode nodes to which the first stimulation pulses are issued are closed to couple the reference voltage to those electrode nodes.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0024]
[0025]
[0026]
[0027]
[0028]
[0029]
[0030]
[0031]
[0032]
[0033]
DETAILED DESCRIPTION
[0034] As noted earlier, an IPG 10 may include circuitry and techniques designed to remove the charge from DC-blocking capacitors 55 in the electrode output paths that provide stimulation to a patient's tissue, Rt. An IPG 10 may issue biphasic pulses, with the second pulse phase 94b (FIG. 3A) designed to actively recover charge stored on the DC-blocking capacitors 55. Beyond this, a passive charge recovery phase 98 may be implemented to recover any remaining charge that was not recovered during active charge recovery (at the end of second pulse phase 94b).
[0035] Using both active (94b) and passive (98) charge recovery techniques, the charge Q across DC-blocking capacitors 55 in any electrode output path involved in providing stimulation is ideally zero before those electrode output paths need to issue a next pulse. In other words, the voltage across such capacitors (V=Q/C) is ideally zero at the end of each passive charge recovery phase 98.
[0036] However, the inventors realize this ideal goal is not always achievable, particularly when the DAC circuit 172 of the IPG 10 is instructed to form pulses of a high frequency, f, such as, but not limited to, ≥5 kHz. Such high frequency pulses as issued pursuant to a stimulation program (SP1) are shown in
[0037] This is shown at the bottom of
[0038] As a result, a next pulse (with first and second phases 94a′ and 94b′) will not start with capacitors C1 and C2 that are completely discharged, i.e., VC1 and VC2 don't equal zero. This increases the voltage across the capacitors: X′ after the first pulse phase 94a′ is higher than after first pulse phase 94a X; Y′ after the second pulse phase 94b′ is higher than after second pulse phase 94b Y; and Z′ at the end of the passive charge recovery phase 98′ is higher than at the end of passive charge recovery phase 98 Z. As subsequent pulses are issued, these voltages begin to climb over time period t1, as shown by the dotted line in
[0039] Eventually, the voltages across the capacitors will increase to a steady-state condition as shown during time period t2 in
[0040] While is it desirable that the voltages across the capacitors VC1 and VC2 be zero at the end of each second pulse phase 94b, or at least at the end of each passive charge recovery phase 98, it is not necessarily a problem that this doesn't occur, particularly if the compliance voltage VH is adjustable as it is in IPG 10. As described earlier, IPG 10 includes on ASIC 160 compliance voltage generation circuitry 76 (
[0041] This is shown in
[0042]
[0043] Similarly to
[0044] The fact that the DC-blocking capacitors 55 cannot be completely discharged raises concern noticed by the inventors, which are illustrated in
[0045] Closing all passive recovery switches 96(x) during post-program recovery period 99 at the end of a program such as SP1 is desirable in the inventors' view. First, this will recover any charge that had built up on the DC-blocking capacitors 55 (e.g., C1 and C2) associated with the electrodes (e.g., E1 and E2) selected to provide stimulation during program SP1, which as just explained may be significant. Other DC-blocking capacitors 55 not associated with electrodes involved in providing stimulation during program SP1 (e.g., C3-C17) would normally have no charge stored on them, and thus no voltage across them. But this may not always be the case, and thus the inventors' preference for closing all passive recovery switches 96(x) during the post-program recovery period 99. For example, such other electrodes may have charge stored on them by virtue of being active in another timing channel different from that running stimulation program SP1. Further, an electrode may have experienced a fault, such as an open circuit, and its DC-blocking capacitor 55 may have stored charge prior to the fault.
[0046] When the passive recovery switches 96(x) are closed during post-program recovery period 99 (RCVx=‘1’), the equivalent circuit 95 of
[0047] Because the equivalent circuit 95 is an RC circuit, the discharge current I.sub.D will start at a maximum (I.sub.D(max)) and will exponentially decay from this value down to zero at a rate dictated by its time constant, τ, as shown in
[0048] How the discharge current I.sub.D will flow through the patient's tissue Rt during the post-program recovery period 99—i.e., the extent to which the discharge current will flow to or from any particular electrode Ex—will depend on different factors, such as the location of the electrodes Ex relative to one another in the patient's tissue, Rt, which electrodes are charged during time period t2 and to what extent, etc. Nonetheless, the discharge current I.sub.D can occur with a significant magnitude (I.sub.D(max)) and—because τ is relatively large—for a significant amount of time. In total, a significant amount of charge may pass through the patient's tissue during the post-program recovery period 99. This discharge current I.sub.D therefore runs the risk of being supra-threshold—that is, felt by the patient. Moreover, the discharge current may be significant enough to actually cause discomfort to the patient, who may perceive the discharge current as an unwanted “zap” to their tissue.
[0049] Note that the equivalent circuit 95 of
[0050] The inventors address the problem of a potentially high amount of supra-threshold charge passing through the patient's tissue post-program by periodically dissipating only small amount of the charge stored on the DC-blocking capacitors 55 during use of a pulsed post-program recovery period 100. This occurs by periodically activating the control signals RCVx during a post-program recovery period to form a series of discharge pulses after the end of the stimulation program, i.e., during a time period when the stimulation circuitry is not providing stimulation pulses. This will extend the duration of post-program recovery because gaps are included between the discharge pulses during which no charge is recovered from the DC-blocking capacitors 55. Nonetheless, the extended duration of pulsed post-program recovery period 100 should be tolerable, as it is not so long as to likely be noticed by the patient when the programming in the IPG 10 changes from a first to a second program.
[0051] IPG architecture 140 as introduced previously includes passive recovery circuitry used to remove charge on the DC-blocking capacitors 55 during each passive charge recovery phase 98 between pulses issued during a program. Such passive recovery circuitry has been modified to remove charge post-program—i.e., after the program has ended—during a pulsed post-program recovery period 100.
[0052] Within improved stimulation circuitry block 170 is a recovery control block 174. Recovery control block includes a mode/resistance select control module 175 that stores data used to select different passive recovery modes and different resistances Rx for the passive recovery resistors 97 (
[0053] Recovery control block 174 further includes a pulsed discharge block 180 configured to initiate and control operation of a pulsed post-program recovery period following the end of a program. The digital logic of the pulsed discharge block 180 can be made aware when the end of a program occurs in different ways. For example, pulsed discharge block 180 may receive a control signal P(end) at the end of a program. Control signal P(end) may issue from the ASIC 160—such as from the microcontroller 150 via internal bus 192 (
[0054] The recovery control block 174—under control of blocks 175 and 180—issues control signals to recovery logic circuitry 176. These control signals include Rec[17:1], which indicate when passive recovery switches 96(x) (
[0055]
[0056] Periods 100, 100′, and 100″ comprise examples of pulsed post-program recovery periods, which are preferable as they periodically permit small sub-threshold amounts of charge to pass through the patient's tissue. In each of periods 100, 100′ and 100″, the dissipation of charge occurs periodically during discharge pulses 101, during which all passive recovery switch control signals RCVx are preferably asserted to close their associated passive recovery control switches 96. Less preferably, only the individual passive recovery switch control signals RCV associated with the previously-active electrodes during program SP1 (e.g., RCV1 and RCV2 for electrodes E1 and E2) are asserted, but this option isn't further discussed, as it would not assist in dissipating charge stored on other non-active capacitors arising from parasitic coupling from the tissue Rt as explained earlier. Between discharge pulses 101 are gaps 102 during which none of the passive recovery switch control signals RCVx are asserted, and thus all passive recovery switches 96 are opened. In other words, DC-blocking capacitors 55 are not discharged during gaps 102.
[0057] In a first example of a pulsed post-program recovery period 100, the duration of the discharge pulses 101, tx, are fixed, and the duration of the gaps 102, ty, between them are also fixed. In one example, the duration tx of the discharge pulses 101 comprises 20 microseconds or less, and the duration ty of gaps 102 comprise 500 microseconds or less. These values are preferred because it is believed that discharge through the tissue Rt of 20 microseconds or less will be sub-threshold and not felt by the patient, regardless of the magnitude of the discharge current I.sub.D. In other words, the total charge passing through the patient's tissue during a discharge pulse 101 should be insignificant from a patient perception standpoint. Further rendering such stimulation imperceptible is the significant duration ty of the gaps 102 between such discharge pulses 101, which allow the tissue ample time to recover.
[0058] Note that periodic dissipation of the stored charge may lengthen the post-program recovery period. For example, if a continuous dissipation of the stored charge occurs over a period of tens of milliseconds (99), then fractionalizing this dissipation (100) will extend the length of this period by a factor of (tx+ty)/tx, which may be several hundred milliseconds for the values of tx and ty provided earlier. In other words, pulsed post-program recovery period 100 might last hundreds of milliseconds before a new program is run by the IPG 10 to ensure that the DC-blocking capacitors 55 have been discharged. While this is significantly longer than a continuous post-program recovery period 99, pulsed post-program recovery period 100 from the patient's standpoint comprises only a short delay during which the IPG 10 will transition from a first program SP1 to a new program SP2, which may not even be noticeable by the patient as a practical matter.
[0059] In second and third examples of pulsed post-program recovery periods in
[0060] It is not strictly necessary that duration ty of the gaps 102 decrease as the duration tx of the discharge pulses 101 increase. Instead, although not shown, the duration of the gaps 102 may be kept constant between the discharge pulses 101 in pulsed post-program recovery period 100′. In effect then, the discharge pulses 101 would not issue with a constant frequency, but with a frequency that decreases over the duration of the period 100′. Still, in any of these variations, because the duration tx of the discharge pulses 101 increase, the duration of the total period 100′ can be smaller than for period 100.
[0061] Pulsed post-program recovery period 100″ at the bottom of
[0062] All of the above examples 100, 100′ and 100″ by which discharge pulses 101 are issued during a pulsed post-program recovery period can be modified or combined. What is important is that a plurality of discharge pulses issue during the pulsed post-program recovery period, using constant or variable discharge pulse durations tx, gap durations ty, and/or pulse frequencies f.sub.D, such that the entirety of the charge stored on the DC-blocking capacitors 55 is not continuously discharged through the patient's tissue, Rt, as occurs in post-program recovery period 99.
[0063] As noted earlier, pulsed discharge block 180 (
[0064] In a first option (Op1) shown in
[0065] In a second option (Op2) shown in
[0066] To this point, pulsed post-program recovery periods 100, 100′, 100″ or like post-program periodic discharge periods, have been illustrated as being executed by pulsed discharge block 180 at the end of a stimulation program (such as SP1), and/or after an adjustment to such stimulation program. However, use of the disclosed pulsed post-program recovery periods are not limited to transitions in such stimulation programs, but may also be used more generally at the end of any generic IPG 10 program. This is shown in
[0067] To this point, it has been assumed that use of recovery control block 174 and its pulsed discharge block 180 will provide pulsed discharging of the DC-blocking capacitors 55 only after the end of a program, or between transitioning from one program to another. However, this technique is not so limited, and instead pulsed discharging may be used in other contexts, and during other time periods when the stimulation circuitry is not providing stimulation pulses.
[0068] For example, pulsed discharge may occur in between stimulation pulses within a program, as shown in
[0069] Using periodic discharge pulses 101 could be beneficial during passive recovery periods 98 between stimulation pulses for a number of different contexts. For one, although not illustrated, the stimulation pulses may not be biphasic, but instead may monophasic comprising just the first pulse phases 94a as illustrated in
[0070] While the improved passive recovery circuitry has been described as useful to recover charge from DC-blocking capacitors 55, this is not strictly necessary. Some IPG architectures may not use DC-blocking capacitors, yet may still have inherent capacitances that will charge as a stimulation current is provided. Such inherent capacitances may for example occur at various boundaries, such as the boundary between the electrodes and the patient's tissue. The improved recovery circuitry can be used to recover charge in such architectures, even though they lack intentionally-placed capacitances like the DC-blocking capacitors 55.
[0071] While disclosed in the context of an implantable pulse generator, it should be noted that the improved passive recovery circuitry could also be implemented in a non-implantable pulse generator, such as an External Trial Stimulator (ETS). See, e.g., U.S. Pat. No. 9,259,574 (describing an ETS).
[0072] Although particular embodiments of the present invention have been shown and described, it should be understood that the above discussion is not intended to limit the present invention to these embodiments. It will be obvious to those skilled in the art that various changes and modifications may be made without departing from the spirit and scope of the present invention. Thus, the present invention is intended to cover alternatives, modifications, and equivalents that may fall within the spirit and scope of the present invention as defined by the claims.