JP2012506262A - 顔面神経刺激のためのシステムおよび方法 - Google Patents
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Abstract
Description
本発明の様々な実施形態は、片側麻痺した顔面を回復または部分的に回復するための神経プロテーゼを提供する。リハビリテーションの対象となる筋肉は、共同運動的な(すなわち、誤って)再神経支配された筋肉であり、除神経筋ではない。実施形態は、被験者の顔面の損傷側で、適切な顔面神経を刺激するように、所定の方法および位置において、電気刺激を引加する。これは、所望の顔面筋を活性化するように、被験者の顔面の損傷側の耳辺領域中に電極を配置し、適切な神経枝を刺激することによって達成される。活性化した表情筋の合計活動電位は、EMGおよび/または加速センサ等の医療機器を用いて記録され得る。次に、このインパルスを使用して、顔面の損傷側の所望の表情筋を活性化するように、どの神経枝を続いて刺激するかを決定し得る。これは、健側と対応する損傷側の両方の顔面筋を同調して動かす可能性がある。例示的な実施形態の詳細を以下に論じる。
ENT医療の別の領域、すなわち、喉頭学において、声帯不全麻痺の場合の電気刺激に関する研究は、顔面神経麻痺の場合における適用に関する研究よりもはるかに進んでいる。その一方で、上で引用される多くの研究グループは、この主題のみを研究している。Zealearを中心とする研究グループは、1996年に、既にヒトの声帯筋を一時的に電気刺激することに成功している。結果として、完全に埋め込み可能なシステム(Medtronic ITREL II System(R)、慢性痛状態における脊椎の刺激に対して承認)は、7人の患者において試験した。半咽頭の機能的に十分な開口は、4人の患者において達成することができた。刺激は、センサによる誘起なしに固定リズムで発生した。部分的に、筋肉のみならず、付近の神経および筋肉も刺激された。これは、望ましくない筋肉の共同運動をもたらした。電極は、陽極において劣化した。これは、2人の患者において機能不全をもたらした。2チャネルシステムのみを使用することができた。これは、電極障害の場合、または機能適合中に制限をもたらした。過剰に高い刺激の増幅(8.5mAより大)が疼痛を引き起こした。
Claims (24)
- 共同運動的な再神経支配された筋肉を伴う被検者において、顔面神経を刺激する方法であって、
前記被検者の顔面の耳辺領域に電極を提供するステップであって、前記電極は、複数の接点を有する、ステップと、
前記複数の接点のそれぞれを別々に刺激するステップと、
1つ以上の神経枝に所望の顔面筋を活性化させる前記複数の接点から、1つ以上の接点を識別するステップと、
前記1つ以上の神経枝を刺激するように、前記識別した接点を選択するステップと、
を含む、方法。 - 前記電極は、アレイ電極である、請求項1に記載の方法。
- 前記電極は、棒電極である、請求項1に記載の方法。
- 前記顔面筋は、眼輪筋、口輪筋、後頭前頭筋、鼻根筋、鼻筋、鼻中隔下制筋、皺眉筋、眉毛下制筋、耳介筋、口角下制筋、笑筋、大頬骨筋、小頬骨筋、上唇挙筋、上唇鼻翼挙筋、下唇下制筋、口角挙筋、頬筋、および頤筋のうちの少なくとも1つを含む、請求項1に記載の方法。
- 前記電極を提供するステップは、前記1つ以上の神経枝の動作可能距離内に前記電極を埋め込むステップを含む、請求項1に記載の方法。
- 他の顔面筋の活性化を阻害するために、神経枝を刺激するように1つ以上の接点を選択するステップをさらに含む、請求項1に記載の方法。
- 前記1つ以上の神経枝の刺激は、感知信号に基づいて誘起される、請求項1に記載の方法。
- 前記感知信号は、前記被検者の顔面の損傷側の前記耳辺領域中の記録電極から記録され、前記記録電極は、複数の接点を有する、請求項7に記載の方法。
- 前記感知信号は、前記被検者の顔面の正常側の前記耳辺領域中の記録電極から記録され、前記記録電極は、複数の接点を有する、請求項7に記載の方法。
- 前記感知信号は、前記被検者の皮膚の上または下に配置されたセンサから記録される、請求項7に記載の方法。
- 1つ以上の接点を識別するステップは、第1の顔面筋の活性化を引き起こす1つ以上の第1の接点と、第2の顔面筋の活性化を引き起こす1つ以上の第2の接点とを含み、
前記識別した接点を選択するステップは、前記識別した第1および第2の接点を選択するステップを含む、
請求項1に記載の方法。 - 被検者において顔面神経を刺激するためのシステムであって、
前記被検者の顔面の耳辺領域に配置するための複数の接点を有する電極と、
前記電極と通信しているプロセッサであって、前記複数の接点のそれぞれを別々に刺激するため、1つ以上の神経枝に所望の顔面筋を活性化させる前記複数の接点から、1つ以上の接点を識別するため、および前記1つ以上の神経枝を刺激するように前記識別した接点を選択するためのプログラムコードを有する、プロセッサと、
を備える、システム。 - 前記電極は、アレイ電極である、請求項12に記載のシステム。
- 前記電極は、棒電極である、請求項12に記載のシステム。
- 前記プロセッサと通信している1つ以上のセンサをさらに備え、前記センサは、1つ以上の接点を識別するための前記プログラムコードとともに使用するための顔面運動情報を前記プロセッサに提供するように構成される、請求項12に記載のシステム。
- 前記センサは、EMGセンサおよび/または加速度センサであってもよい、請求項15に記載のシステム。
- 前記識別した接点を選択するための前記プログラムコードは、片側麻痺した顔面の損傷側を維持または回復させるように、前記1つ以上の神経枝を連続的に刺激する、請求項12に記載のシステム。
- 顔面麻痺がある被検者において、顔面神経を刺激する方法であって、
前記被検者の顔面の耳辺領域に電極を提供するステップであって、前記電極は、複数の接点を有する、ステップと、
前記複数の接点を別々に刺激するステップと、
1つ以上の神経枝に所望の顔面筋を活性化させる前記複数の接点から、1つ以上の接点を識別するステップと、
前記1つ以上の神経枝を連続的に刺激するように、前記識別した接点を選択するステップと、
を含む、方法。 - 前記電極は、アレイ電極である、請求項18に記載の方法。
- 前記電極は、棒電極である、請求項18に記載の方法。
- 前記電極を提供するステップは、前記1つ以上の神経枝の動作可能距離内に前記電極を埋め込むステップを含む、請求項18に記載の方法。
- 前記1つ以上の神経枝の刺激は、感知信号に基づいて誘起される、請求項18に記載の方法。
- 前記感知信号は、前記被検者の皮膚の上または下に配置されたセンサから記録される、請求項22に記載の方法。
- 1つ以上の接点を識別するステップは、第1の顔面筋の活性化を引き起こす1つ以上の第1の接点と、第2の顔面筋の活性化をもたらす1つ以上の第2の接点とを含み、
前記識別した接点を選択するステップは、前記識別した第1および第2の接点を選択するステップを含む、請求項18に記載の方法。
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